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Home My WebLink About4326-z~ORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. No Z-20937 CERTIFICATE OF OCCUPANCY Date AUGUST 12~ 199~ THIS CERTIFIES that the building Location of Property 120 OLD MAIN ROAD House No. County Tax Map No. 1000 Section 126 Subdivision ADDITION LAUREL~ NEW YORK Street Hamlet Block 2 Lot 2 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 8~ 1969 pursuant to which Building Permit No. 4326-Z dated JUNE 5, 1969 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which ~his certificate is issued is ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to MILDRED LAUBENGEIGF~ & GILBERT KOLLOF (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 FOF,,M NO, Z TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 326 Z Permission is hereby granted to: ........... ~i~dr.~s...L~ut~a~ei~e~ .................... ................ lt~..~?, £t~t: .......................................... to ........... ~,~d...e~.. ~.$~o~ ..o~.. ~n..~St .{a~ ..d~3_ _4~ _~ ........................................... ot premises located ot ............. l[~(~....O~.J~ia,i~.~, ................................................................... ........................................................... ~.~eX ...... IE,Y.~ ...................................................................... pursu~n~ to opplicotion doted ................................ ~ ..........~ ........ , 19.~,~., ond approYed by the Building Inspector. Fee $...~fXO ............ Examined . Approved ~ q ~ c~-~ ~ .................... ,19 .... Permit No ................... Disapproved a/c ................................... ~ .... ~ APPLICATIO~ FOR BUILDING P'F..RMIT ~ Date .................... .~.....~....~.... 19.~..~.~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings o n premises, relatkmship to adjoining premises or public streets ~r areas, and giving a detailed descript/on of layout of property must be drawn on the dfa~_.,~m which is part of this application. c. The work covered by this applicat/on may n~t be commenced before issuance of Building Permit. d. Upon approval, of this application, the Building In spector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole va in part f~r any purpose whatever until a Certificate of Occupancy shall have been granted by the Building InspectOr. APPLICATION IS 1-~l~3~y MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of S~,~thold., Suffolk Oounty, New York, and other applicable Laws, Ordinances or Regulations, for the construction o/buildings, additions or alterations, or for removal or demo- tion, as hewein described. The applicant agrees to com ply with all applicable laws, ordinances, building eode, sing code, and regulations. . , (Signature of a~plican~t, or, n~a/e ff a~corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder .................................. ~ ................................................ Name of owner of premise~ ,~ . .~. · .~~ H applicant is a corporate, signature of duly authorize d officer (Name and title of corporate officer) 1. Localion ~f land ~n which proposed work will be done. Map No ................. Lot.~o .............. /~ Street and Number .~./. / ~ /~ /~// ..~...~-- . .~..~.~,ci~li~j~--~'~ , 2.S~te exist~g use and occup~cy of p~mi~s ~ d in~end~ ~e ~ ~cu~cy of ~ ~ction. a. Existing use and occupancy .................................................................... b. Intended use and occupancy .............. .~.~..~ .......................................... 3. Nature of work (cheek which applicable): New Building ........ Addition ........ Alteration ........ Repair ......... Removal ........ Demolition ........ Other V~ork (Describe) ...................... 4.' Estimated Cost v~ ..... (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... Number of dwelling units on each floor .............. If garage, number of cars .......................................................................... .6~ If business commercial or mixed occupancy, specify nature and ext~nt of each type of use .............. 7. Dimensions of existing structures, ff any: Front .............. Rear ............. Depth ............. Height ................ Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front .............. Rear ............... Depth ................ Height ................ Number of Stories ..................... 8. Dimensions of entire new construction: Front ................. Rear .............. Depth ............ Height ............ Number of Stories ~..~....~. / ~ 9. Size of lot: Front ....... ~..~. ~ ... Rear ... ' ......Depth ......... 10. Date of Pu~'chase ............. /~.~..Z ......... Name of Former Owner ..... .~......~....z~..~ 11. ~one or use district in which premise~are situated ............. ~. .... .~~ .................. 12. Does proposed construction violate arly zoning law, ordinance or ~'egul.atfon? ........................... Name of Architect ............... : ........ A~ldress .......... , ............ Phone No ............ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and. block number or description according to deed, and show street names and STATE OF NEW YORK, )S.S. ~.b NA~N ~D~ ~Y CO~ OF .............. ) ~ ~ ~ ~ D e~ ~ ~ ~ .... being duly swo~, de~s~ a~ ~ys ~at he is ~e appli- .,***,*,,**.*.,*,,.,.*.,., ********************** (Name ~ ~divid~ si~ing appllcat~n) ~t a~ve n~. He is ~e .................... ~ ~ ~ ~ ~ (~n~a~r, a~t, ~r~ate ~i~r, etc.) of ~id owner.~ owne~, and h duly au~h~ to p~orm er have Pe~ ~e ~id ~k ~d W m~e ~d file th~ appli~t~n; ~at ~1 s~e~ ~nt~ ~ ~is applicon ~ ~e to the ~st of ~ ~owl~ge ~d ~Hef; .and ~.at ~e ~k will be p~ ~ ~e ma~ er set fo~ ~ ~e applicat~n filed ~em~. ~wom W befo~ me ~is ~]~ day of 19... N~ ~blic, ~ M ~ L ~ ~nty (Si~ of ap~ BP ~326Z Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT AUG I I 765-1802 · APPLICATION FOR CERTIFICATE OF OCCUPANCY ~'~ me This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements.* For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date .... Au~.~ 3~'. 3~! ..................... New Construction ..... g ..... Old Or Pre-existing Building .............. ,.. Location of Property~ ..... ~q .~ .~ .~ ~t~ ~ ~.r~..~1~? .... ? ................... House No. Street Hamlet Mildred Laubengeiger and Gilbert Kolloff ' Onwer or Owners of Property ................................................................. County Tax Map No I000, Section..%~,qq ...... Block..q~qq ......... LotP~.%'~? ............... Subdivision ' Filed Map Lot ~ 6/5/69 -- li t Mildred Laubengeiger Permit No ........... Date Of Permit ..... ........... app can ............................ . Health Dept. Approval ......................... . Underwriters Approval ......................... Planning Board Approval ........................ Request for: Temporary Certificate ...... Fee Submitted: $.~:PQ .................. Final Certicate x OLP CERTIFIED TO' ~~ RICHARD E. ODDON EILEEN E. ODDON SECURITY TITLE AI~ GUARANTY COMPANY AREA= I1,010 sq. ft. t~lO~ SURVEY FOR RICHARD E ODDON & EILEEN E. ODDON A T MA TTITUCK TOWN OF SOUTHOLD SUFFOLK COUNTY, N Y. 1000- 126- 02- 02 Scale: 1"-- 30' July 6, 1992 ~p.C. MAIN ROAD SOUTHOLD, N. Y. 11971 LIC. NO. 49618 Prepored in eccordence with rite minimum stenderds for lille surveys es esleblis~ed by the L.I.A.L.S. one epproved end edopled for such use i~y The New York Stole Lend Title Associotion. -210