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Home My WebLink About4955-zFOP~M NO. 4 TOWN OF SOUTHOL[ BUILDING DEPARTMENT office of the Building Inspector Town Hall i Southold~ N.Y0 No Z-23973 CERTIFICATE OF OCG~JPANCY Date OCTOBER 20, 1995 THIS CERTIFIES that the building Location of Property 15155 MAIN ROAD House No. DWELL~;NG EAST [~It. ION, N.Y. S~reet Hamlet County Tax Map No. 1000 Section 23 Block 1 Lot 4 Subdivision Filed Map No. Lot No. filed in this office dated Building Permit No. 4955-Z conforms substantially to the Application for Building Permit heretofore SEPTEMBER 14, 197~ pursuant to which dated SEPT~ER 14, 1970 was issued, and conforme to all of the requir~mente of the applicable provisions of the law. The occupancy for which this certificate is issued is ONE FAMILY DWELLING WITH GABAGE UNDER & ATTACHED WOOD DECK * The certificate is issued to NAN~Y GAYLE G~LLISPIE (owners)~ of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL iAPRIL 19, 1971 - R. Villa UNDERWRITERS CERTIFICATE NO. ~N/A PLUMBERS CERTIFICATION DATED *TH~S UPDATES CO E-4199 ISSCED ON 4~21~1971. ~ ' / ~ iuildi~g knspector Rev. 1/81 FOItM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No, Zt~199 Date Apr$1 21 19.71 THIS CERTIFIES that the building located at . l.t/.8.. ~a.i~.. Roa. d. ~R. T2~)... Street Map No...x~x.. ........ Block No.. ~ ..... Lot No... ~.. ~ast. ~rio~... conforms subst~tially to the Application for Building Permit heretofore filed in this office dated .......... ~Dt...J.~. , 19.~0. pursuant to which Building Permit No.. dated .......... 5~P$...J.~..., 19..~ was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .~$E¢~9. ?.q?. ?.~[..~e~.~ng ...................................... The certificate is issued to . ~b~F} .~'? ~. ~.~$~..~ .~¢. }~.~e .... (?V~ ........ (owner, lessee or tenant) of the afores~d building. Suffolk County Department of Health Approval Ap~i~...~9...~.9~...b~. ~.t .~.~a... .....V ............ Building Inspee~r FORM NO~ 2 OF SDUTHOLD TOWN BUILDING TOWN GLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON'THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4955 Z Permission is hereby granted to: at premises located at ....i. ............. ........................................................... ~ ............. ?.*.,.[ ............. pursuan¢ to a ~cahon ed ......~,~,, ...................... ,~ , ,.,.., .., and approv e Building Inspector. ~ tO ~ Fee,~: ......... ,,,~ ............ S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date ~ Bldg. Permit NO. TO WHOM IT MAY CONCERN: The sewage disposal faciliti, es for a structure located at north ,~de Route 25~ 1600' Jl east of Dam ~Pond Bridge, East ~iarSon (Give deed location) ~ Town of oouthold have been inspected by this department and fbund to be satisfactory. ~ t~ Of (}~ ~nginee~.ing Services D~strict 'Engineer Form No. 6 TOWN OF SOUTltOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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 o~ ali buildings, property lines, streets, and unusua'l nstural or topographic featu(es. 2. Final Approval from Itealth Dept, of water supp]y ~nd 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 bsildJng, industrial but.]ding, multipl~ residences and similar bul]d[ugs arid instal [ations, s certificate of Code Comp]Jande from aPchltect or engineer respoasible for the building. 6. Submit Planning Board Approva] of completed site plan requirements. For existing buildSngs (prior to April 9, 1957) non-conforming uses, or buildings and "pre-ex'isting" land nses: I. Accnrate survey of property showing all property lines, streets, buildJng and unusual natural, or topographic featnres. 2. A properly completed application and a consent to inspect signed by the applicant. l.f a Certificate of Occupancy is denied, the Build]ing Inspector shall state tile reasons therefor in writing to the applicant. 1. Certificate of Occupancy - New dwelling $25.00, Adldit£ons to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.,00, Accessory building $25.00, AddLtious to accessory buS]ding $25.00. I½usinesses $50.00. 2. Certif~icate of Occupancy on Pre-existln~ Buildin~ - $100.00 3. Copy of Certificate of Occupancy - ~20,00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occnpancy - Residential $115.00, Commercial $15.00 New Constrnction ........... OJ.d Or Pre-exis~ing Buildimz...~ ....... . ....... . ......... ......................... County Tax Map No 1000, ....... .... f. ......... Lot ...... ~ .............. Subdivi sion .................................... Filed Mat) ............ Lot ...................... Permit No ................ Date Of Permit ................ AppL'icant ............................. Ileal~l) Dept. Apprswtl ........................... Underwriters Approva! ......................... Pinnn.Lng Board Approval ........................, 'f' ....... Request for: Temporary (,ert~ _~cate .... Final Certic te ......... Fee Submitted: $.. ..... -~ ~o., TOWN OF ~UTHOLD ~/,/~,/ BUILDIHG DEPARTMENT ~ TOWN CLERK'S OFFICE S~TH~D, N.Y. ~/,~/?/ ~ro~ed ........................... ~.~ ......... , ~..t.~... ~ ~o. ........................... ~ ~ ~ ~i~r~ed~/~ ..... ~._...~ ........ ~ ............................................... / .......................... ......... ..................... ~....v ................................. APPLICATIOH FOR BUlLDIHG ~te INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plat plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of 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 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 or tn 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 Lows, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances,/~ilding code, housing code, and regulations. (Signature of app~efnt, or n~ne, if a corporation) Main Road, East Marion, New York (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Owner Name of Robert W. Gillispie, 111 &: Wife owner of premises .................................................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be don. e. Map No.: ........................................ Lot No.: ........................ Street and Number Main Road, East Marion, Town of Southold, New York r, .......................... ,,,unicipo,ity ....... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .U..noccupied b. Intended use and occupancy Single Family. DweJling 3., Not'bm of work (check which applicable): New Building Z Addition Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost $26,000. ~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ....0.D..e. .................. Number of dwelling units on each floor ............................ If garage, number of cars ?,wa, under house : 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ......... ~]/,~ ............ 7. D mens one of existing structures, if any: Front ....~..o.,$.t~.o.~.~..e. .... Rear ......~.~....x.....2.~. .......... Depth .................... Height ........................ Number of Stories ...0...~..e. ............................... ; ...................................................... Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ........ ~..~. ........................ Rear ........... ~.~,.~. .......... Depth 26' Height Number of Stories One 9. Size of lot: Front 110' Rear 110' , Depth 1210' + West & 1170' + East 12, Does proposed constructioD .vjoJqte opy zor]ioG Iow, o{dinonce or regulation? .......... ~,.o. ............................................. Robert W. uz±±zspls, zzz & Wzfe Main Rd.,E.Marion Phone 13. Name of Owner of premises ........................................ Address ............................................ Name of Architect .....~...o..~...e. ........................................ Address ............................................ 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 indicate whether interior or corner lot. Please see attache~ Dhotocgpy of survey by Van Tuyl, dated 7/24770, wzth approximate location of proposed dwelling indicated. STATE OF NEW YORK, t¢¢ COUNTY OF ................................ ,f '"'~' Robert W. Gillisnie, 111 . . .......................................................... ~ ..................................... oe~ng duly sworn, deposes and says that he is the applicant (Name of individual signing application) ~. above named. He is the Owner (Contractor, 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 before me this .~ ~ · //~,. . .-------- ...... ........ HOTARY PUBLIC, State of New York .o. 52-8125850. Suffe,k ~,~ ~rmJ~ires Much 30, ?~em~se8 o~