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Home My WebLink About4397-zFORN NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Builafng Inspector Town Hall Southold, N.Y. UPDATED CERT~'ICATE OF OCCUPANCY No Z- 17662 Date JANUARY 9 ~, 1989 THIS CERTIFIES that the building. ADDITION Location of Property 250WILLIAN~BERGDR. House No. Street County Tax Map No. 1000 Section 78 Block 5 Subdivision Filed ~ No. SO~a~OLD~ NENYORK H~mlet Lot 8 Lot No. conforms substantially to the Application for Buil&~n9 Permit heretofore filed in this office dated JULY 28~ 1969 pursuant to which Building Permit No. 4397-Z dated ~LY 28~ 1969 was issued, and confo~,~ to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ADDITION TOR~T~/~GO~EF~HILYD~KI~* The certificate is issued to BDB PROPERTIES (o~ner) ~ of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL H.R. UNDERWRi'£EKS ~/~TIFICATE NO. 9N758713 PLUMBERS CERTIFICATION DA.£w.~ N.A Building Inspector *This updated CO Z-3599dated 10/6/69. Rev. 1/81 FORM NO. :B TOWN OF SOUTHOLD BUILDING DEI)ARTMENT TOWN CLERK'S OFFICE SOUTHOL~, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 4397 / ,4/ Permission is granted to: at premises Iocoted ot ................................................................................................................... ......................................................................... .................................................... p rsuant to apphcahon dc~ed ................................................. ~ ....... , 19.. and approved by the / Building Inspector. / Building In~tor FOR3~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . Map No ....~'= ......Block No ...... ~g..Lot No.. l ...... ~tll~l~ · · .l~,~, .... conforms substantially to the Application for Building Permit heretofore filed in this office dated .........J~.. ~..., 19 ~. pursuant to which Buildin~ Permit No. ~... dated .......~.. ~ ..... , 19 .~., was issued, and conforms to all of the require- ments of the applicable provisions of the ]~w. The occupancy for which this certificate is issued is ...[~*~..~M~. ~.~t~..~1~.... The certificate is issued to ~ .~[~ ...... g~M~'. ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...~.*.~.*. ............................ Building Inspector ilouso P FORM NO. 6 ~u~old, N.Y. 11871 ~PLICATION FOR CERTIFICATE OF Inactions A. This application must be filled in typewriter OR ink, and submitted m m to the Bui!diog Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate Io~_ation of all buildings, property lines, streets, and unusual natural or topographic feature~ 2.Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3.Approval of electrical inst~llation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple ResidenceS-and similar bu'ildings and Installa- tions, a certificate of Code compliance from the Architect or ~ngineer responsible for~he btlildlng. 5.Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to .April 1957), Non-conforming Uses, or buildings and "pra~existing' land uses: 1. Accurate survey of p:operty showing all property lines, streets, buildings and unusual natural or topographic features. 2.Sworn statement of owner or p .rqvious owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. : C. Fees: Additions $25.00 POOLS $25.OOALTERATION $25.00 1. Certificateofoccupancy New Dwelling $25.00, Accessdry ,$10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $100.00 . ,~ 3. Copy of certificate of occup~ncy $ 5 00, over 5 y~ars $10.00 ~/ 4.Vacant L,a, nd C.O. S ~n n0 ' / /.~-~ 56.oo-'", D te. ....... NewConstruc t, ion ...... Old or Pre-exjsting Building ./.: ........ Vacant Land ............. L. ocatlon of Property ~ ,~.q,.,,, ,~, ,~, ,,: ....... ~' ............. Owner or Owners of Property ,,. ,~p/, ;-;. ~, ,v..~', .N ,~~ ..... - ........................ County Tax Map No. 1000 Section .. ;...~..~ ...... Block ............ Lot .... ., ........ Subdivision ................................. Filed Map No ........... Lot No .............. ,ermitNo. 5/~7-~- Date of Permit ..... Applicant .~.~.~. ~ .... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ..................... ... Planning Board Approval ................ . . ' .... Request for Temporary Certificate ..................... Final Certificate .~.. ................... Fee Submitted $ ~-~), (~. Construction on above described building and pgr~mit meets all applicable codes and regulations. .......... Rev, 10-10-78 FOB~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. .. .................. D scl roved Pp a/c ................................................................. ;~ ................ (Bu Id~ng Inspector) APPLICATION FOR BUILDING PERMI1 pete .................... INSTRUCTIONS a. This application must be completely filled in by t~pawriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjo n ng prem sas or public streets or areas, and giving a detailed description of layout at property must be drawn on the diagram which is port of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Perm t 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 or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for remova or demolition, as herein described. The applicant ~grees to comply with all applicable laws, ordi~O~ building code, ~n,g ~c,g,de, and regulafiorls_ (S'g ature of opplicont, or'~, i~'~--c'~'r~'t~'ni~~''' (Address of applicant) State whether applicant is owner, lessee, agent, architect,.engineer, general contractor, electrician, plumber or builder. Name of owner or premises ............................................................................................................................... If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which propaeed work will be done. J~ap No.: ................................ Lot No.: ........................ Street and Ndmber ~7~ I//~' Munici~'lity .................... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existinguseandoccunnncv . // ,~',,~ ,~ / L "~ b. Intended use and occuoancv .. ~'/t,~ E' /4//7-/'/ ~ g~)~) / 'T- I ~A/ 3. Nature of work (check which applicable): New Building .................. Addition // Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ (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 extent of each type of use ............................ 7. Dimensions of existing structures, if 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-.--'~'-7". ............ Height ....... .... Nu. er of Stories ........................ ........... . ...................................................................... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or re~ulationP ...... ,.,~..:.,,.~ ....................................... Name of Architect ...................................................... Address .~i:~....~.~..~).~. ..... Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or pr..oposed, and indicate all set-beak dimensio?s .from property lines. Give street and block number or description according to deed, and show street names end md~cote whether interior or comer lot. ~/ (~(~ ~.~ ~" ~/ I STATE OF NL:W YORK, ~ c c COUNTY OF ................................ ~-'~)/'//'/)IV/ ~/~! O0~{~--.~. ~J~ be ng duly sworn, deposes and says that he is the applicant (Nome of individual signing application) above named. He is the .................................................. .~ .............. ~ .............................................................................. (C~ntmctor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Swam to befo~'e me this k,/~'~. ~' ~ ~ ' // Notary public,~ ............. C PUBLI(~, State of .ow ¥o~l~ignature of applicant) I C~'RTIFI£D TO: $OUTNOI D SAVINGS BANK CHICAGO TITL~= 7NSURANC~= CO. ~. D.B. Pt?Q~"I~TI~CS