The URL can be used to link to this page

Home My WebLink About5809-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building . .A.d.d..J:.~..i.o.n..~..o..c4.a.r..a~.e...' ....................... 15 Peconic Lane Location of Property .... .43.9.6.5...M.a.i.n...R.d... ........................ P. ~.c.o.n..i.c .......... House No. Street Hamlet County Tax Map No. 1000 Section . .0.7. 5. ....... Block ...0.5. .......... Lot .. 010 Subdivision ...... X ...... Filed Map No. X .Lot No. X conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... April 14 19 .72. pursuant to which Building Permit No. 5809Z dated .... .ARr. 5:..Z ..... .1.7 ........... 19.7.2., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Addition to Garage The certificate is issued to .... .~.L.V.I. lXJ...L....I?..~.C.g. '/o~,n'e'r,'t.~~'-'- ................... of the aforesaid building. Suffolk County Department of Health Approval .. N/.A .................................... UNDERWRITERS CERTIFICATE NO .... 3q:~ 063.5.], ..................................... Building Inspector Re~. 1/81 FOI~..~ NO. ~' TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5809 Z Permission is hereby granted to: ........... ~!.~..~.~....... ............................................ ot premises located at ........... II~N~II~II..;i~I~..&..~.~,(~, ....................................................... ........................................................... ~eea.:ke ......... N.,¥., ................................................................. pursuant to application dated ............................ .~p~.t,'l ....... .~.~..., 19..~t~., and approved by the Building Inspector. Fee $..R~.~J~ ......... FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ,~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted-i~dafH~to the Building Inspec- tor with the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 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 "pm-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous 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: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwellingt land 3. Copy of certificate of occupancy $I.00 use--?re-Existing C.O. $15100 Vacant land C.O. $ 5.00 New Building .. ,//-~/~ .'.. Old o,r~Pre-existing Building ..... .~. ....., .Vacan~ Land ............. Location of Property.. ~.Q¥?'!.~~.. ~('. ~. P~ ~ '~ ~ . l.: ..... Hou~ No. ~ S~t Ham/et Owner or Owners of Prope~ ~ ~ [.~ ..... ~.' ....~.~.(~.~ .......................... CounW Tax Map No. 1000 Section ...~ ~ ..... Block ... ~¥~. ....... Lot .... ~. [ D ....... Subdivision .... ~ ........................... Filed Map No... ~ ...... Lot No .... ~. ....... Permit No. ~.~.O~.~Date of Permit .~ ~.[~.(.~plicant .... ~..~ ............ Health Dept. Approval ..... ~ ................. Labor Dept. Approval ........................ Unde~riters Approval .. ~.. ~ ~ .~ ~ ...... Planning Board Approval ...................... R~ue~ for Tempora~ Ce~ificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and permitp~-~ts all ap~plicable codes~ld regul,~s. Applicant ......... ~ · · · ...,o.,o.,. FIELD INSPECT] IN FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY QODE FINAL COMMENTS: :- THE NEW YORK BOARD OF FIRE UNDERWRITERS : : BUREAU OF ELECTRICITY ~ lg '!~' 33 JOHN STREET, NEW YORK, NEW YORK 10038 T.,S C~~AT ~' ~15 N 206351 o~y t~ e~t~ ~u~t ~ ~d~ ~ ~ int~ by t~ ~t ~m~ ~ t~ a~ ~pl~at~ numar in t~ premiss o~ in the following I~atlon; ~ ~ement ~ Ist FI. ~ 2nd Fl. ~t~n Bl~k ~t was examined on ~ tR~ ~ ~ ~ ~ ~ ~ ~ and found to be in core,lance with the requlremente of this B~rd. RXTURE. L I 2 I RXTUR~ I RANGES [~KINO ~KS [ OVENS ]DI~ WA~ERS [ EXHAUST FANS aUTOS ~'~A~S ~'T~' iNCAN~E~ FL~,~ ~v ~T. K.W. ~T. K.W. ~1. K.W. OTHER APPARATUS: Peter BogovicR Main Rd., Southhold, L.I. 11971 Per~ This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. Examined ....... ..~....~ ........ ..~..., Approved t~ , ~ TOWN CLERK'S OFFICE $OUTHOLD, N. Y. 19.?....~/ A ' o.....~...~....0. 19..~..~/Pemit No ..... ...'~.....~...,~,..?.......~... ....... ~ ..... '~' ............... '- Di~pproved o/c ............................................................................................. ............................. ; ............. ~ ......... -~ ~ ~z~ ,~'~'"~ ~ l/ ., ,, .~..',.,...-~£~..A ~" ~ (Building Inspector) / ~,~o ,~ . L _ ...................... ....................... '" ....... a lhis a lication must ' c ~ole I ill' ' ~ ..... r'~ · pp De omp te y ' ~ea 'n ny typewriter or in inK ana suomitted in tripdcate to the Building Inspector, v~h 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot 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 diagram which is part 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 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, SuffoJk County, New York, and other applicable Laws, 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, · 0rdinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ........... At. vtm...1~ee ................................................ (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........ ,~..~,..v..j:..~...~...a..c..e. .................................................................................................................. ~, If applicant is a corporate, signature of duly authorized officer. ~ ..................... i ........ ............ ao 1. Location of land on which proposed work will be done. Map No.: ...~ .......... Lot No .......... N ~ M ~n ~oad & W ~ eeo c ~.~e ..P..~Qr~.~ .............. Street and Number ...... Municipality 2, State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing USe a, nd~ceup~ncy ..... Int~ ;:Se and occupancy ..... ~a~e..~.~..a~..a~d,~,~.i~z~ .......................................................................... 3. Nat~'re of work (check which applicable): New Building ....................... Addition ........ ~... Alteratior~ ........ ~ .... Repair ......................... Removal ......................... Demolition ........................ Other Work ..... *... !Description) 4. Estimated Cost ............................................... Fee ......... 2..~O ............. ., ............................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units z~cme ........ 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,.......~u,s,-J.z~e,s& ........... 7. Dimensions of existing structures, if any: Front .....................Rear ........................... Depth ..;....~ ........................... Height ..., ...................................................... Number of Stories ....~¢. ................................... i .............................. 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 ...........o...n..e. ........................................................................ Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchase ..................................... Name of Former Owner ........... ~,~,3 l~r...R~.tr~le.~,t~ ............................ .11. Zone or use district in which premises are situated .......... ~'..~...~.~.!..". ............................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ......... . .~..o. .............................................. 13. Will lot be regraded ~_;~T~.s. ......................... Will excess fill be removed from premises: [ ] Yes [~ No 14. Name of Owner of premises ....~3,~.iz~..Race ...............................~.e..c..~.T~,i~.c. ............................................................ (Address) (Phone No.) Name of Architect ................................................................................................................................. (Address) (Phone No.) Name of Contractor ....... .s.~.m...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 wheth- er interior or corner lot. See attached Plan STATE OF NEW~OR~ ) ~uffolk ~ COUNTY OF ...................................................... ) .......................................................................................................... being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing contract) He is the ................................. ~1145.~1.8...&~?~1~.~ ............................................................................................................................................ (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. .................... .1..~. ............. day of ........... A19.~..'L3.. ........................ 19 ~'.,2.. ........ ,~'~,/~ ~ notary Public ...................................................................... County ,, ,~, ,,,,,,, , .,ir~,..~/ x/// ' ........... ,/.,..~, ~/ ....................................... (Signature of applicant) t '/,]'~ %17 L_ /qL~