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Home My WebLink About6065-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. ~TIFICATE OF OC~umANCY No Z-23224 Date SEPTEMBER 15, 1994 THIS CERTIFIES that the building Location of Property 155 LAKE House No. County Tax Map No. 1000 Section 59 Subdivision ADDITION ~Ou'£~OLDr N.Y. Street Hamlet Block 5 Lot 8 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated A~UST 15r 1972 pursuant to which Building Permit No. 6065-Z dated A~UST 15, 1972 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 DO~MER ADDITION TO EXISTING ONE FAMILY SEASONAL D~-ING The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 N/A N/A Building I~spect o~/ - l~O~ NO. ~ 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) No. 6065 Z Permission is hereby granted to: ........ ~/..~..t.~..z........~.......//.~.~. .......... .......... ..~....~.......~C~.z~.~..-~./.~.~.£..~.'.... to ...... ~.z~.~ ........... .A, .......... .~.~.~...~..~. ............................................................................... at premises located at .......................................... ~.t~../d ............. ~./,~..t../..1-.~ ................................ ................................................................................... .~.~t ~....-z..~.~?..z...~ ......................................... pursuant to application dated ..................................... /..._~......,,~J.~//~19.7.~ and approved by the Building Inspector. Fee $...../.~..~... ' ~- Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN ]~LL APPLICATION FOR CERTIFICATE OF OCCUPANCY A. 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 lihes, 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. B.. 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~ Alterations to dwelling $25.00, Swimming pool $25.00, Accessorybuildlng~.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buildinm - $100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial ~15.00 New w'/ Date ..... ~.~.~..~ f ~.. ;.. . · Construction ........... Old Or Pre-exi~g~Building ................. House No. Street ................. Hamlet Onwer or Owners of Propert ....~.<~ ~ ~.O ~..~..~..~.~. 0ounty T~ ,ap No 1000, Section...~f. ...... Bloc~...~. ........... ~ot ................... o, . .. . . . Health Dept. Approval ............ o .... Underwriters Approval ......................... Planning Board Approval ...................... Request for: Temporary Certificate .......... Final Certicate .......... Fee S~bmi=ted: $.~?..~ ................... (~N~,~. ~ ~-~ ?~ ...... co ....................... OUNDATION (2nd) ~0UGH FRAME & -PLUMBING iNSULATIO.~! PER N. Y. STATE ENERGY CODE Fi:;AL FORM NO. 6 TOWN OF $OUTHOLD , Building Department Town Clerks Office Southo]d, N. !'. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions ,6,. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of oil buildings, property lines, streets, end 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 installations, 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 "pre-existing" land uses: 1. Accurate survey.of property 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 in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 ...... ................ New Building ................ Addition ................ Old or Pre-existing Building ..... ~ ..... Vacant Land .............. Location Of Prope,y .... ................................................................ Owner Or Owners Of Property ...... .~..,..~..:...:.~..~.~..~..~.l.~..~..~.~ .................................................................. Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No....~..O..~.: .~..;.~... Date Of Permit .'~./?..5.~./..'.7.~.Applicant .... .~.!.~........./t/.././).~!~.A~.. ............................. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fined Certificate .....?.: .................................. F~ Submitted $ ...~...~.; ........................... Construction on above described building and perr~it meets, all applicable codes and regulations. Applicant..~..~, ~...~:....~: .'.~...~,../~..~. ~.~4: .~'.~, ............................................................ Sworn to before me this day of .......... Notary Public .~~ ........... County (stamp or seal) WILLI~/~ ALEXANDER ~ . . -- ~_~.~ ,~./'~,,,.~.... ~//~/~ "UILDIHG DEF'AI~.TMENT'->'~'~/ 'd' .. ~ ,~,2/~ .- ~,TOWN CLERK'S OFFICE ~UTHOLD, N. Y. ....................... , ~ t ~ ................. ........ ........................ . . ........................................................................................................................ ~~~ ~*~ ~h/r~, ~ ~ ~ ~ 2~ ' .............................................. ~ ............ .- ........................... ~2- ~F- ~_ ~~~ (Building Ins~ctor) -t~ Cb. APtLICATIOH FOR ~UILDIHG tfR~lT~s~.*~,_r ,~ ~~ ' ...................... ~ ...................... , ]~ ............ ~. Thi~ a~lication mu~t ~ com~l~t~l~ fillad in b~ W~writ*r or in ink ~nd *ubmitted in triplimte to the 8uildin~ In~ctor, ~ ~ of ~lin~, aceur*t~ ~lot ~l~n to *cal~. ~* a~rdin~ to ~ehedule. b. ~lot ~l~n ~ho~in~ location of lot ~nd of buildings on ~remi~e*, r~lation,hip to adjoinin~ pr~m m~ or public *tr~t~ or ~i~in~ a d~t~ilad d~*eri~tion of I~out of pro~rW mu~t b~ dr~n on diagram ~hich i~ ~art of thi~ a~li~tion. e. The ~ork eo~rad b~ thi* i~lication m~ n~t ~ communed ~for~ i~uanm of 8ui~dinfl ~*rmit. d. O~n a~ro~l of thi~ a~lication, th~ 8uildin~ ~n~ctor will i~u~ a 8uildin~ ~*rmit to the a~li~nt. Su~ ~rmit ~hell ~ k~ffi on~. the ~r~mim~ ~il~bl~ for in~ction throughout the ~ork. · . ~o buildin~ ~h~ll ~ oceupiad or u~d in whol~ or in ~rt for an~ purpo~ white,or until a ~rtifi~t~ o~ O~u~n~ ~he~l he~ ~r~n~ b~ the Buildinfl In~ctor. 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 removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (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 ,-~OA/~--~ [C ~-~'~-- ~-~ 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 done. Map No.: ..................................................... Lot No ............. Street --. -- ano I~lu maer ................................... ,.....,~ .................. ,....~._ ....................... , .............. ,....~.. ................. (x.f~--. $"~' ,~ v,~) Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: · a. Existing use and occupancy ................. ~ .................................................................................................................. ob. Intended use and occupancy 3. ~f ork (check which applicable): New Building ........... .. .......... Addition .................... Alteration ............... " Repair ............. · ............ Removal Demolition ........................ Other Work i Description) 4. Estimated Cost .................... ~....O....O...~.....~.-~.~.. ..... Fee ........... /..~. ............................................................................... (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 usa ..................................... 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 ................................. Height ................................................. Number of Stories ......................................................................................... 9. Sizeof lot: Front ...................................... Rear .......................................... Depth · / 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or usa district in which premises are situated 'r 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................................................ 13. Will lot be regraded .................................... Will excess fill be removed from premises: [ ] Yes _ [~J~No 14. Name of Owner of pre misas . ~/..'......."~,4¢'~?..,=...~- ./..C.../..C~ ..X?=:... .................... ./...?...~'....~'...,~.....X:~......~....x~....../~....'~......C..~.. ............... (Address)'-~/,,~,,./,,,,.,/z,,,..~,~.~.,~,,/_~___,<~_~~ '~v (Phone No.) Name of Architect .............................. ;~ .................................................. ?...~.~...~.7..,..-~.~./.~..~x..;~......~.~-,~.~..~. ...... (Address) -- -- ----(Phone r~o.i Name of Contractor .................................... · ............................................................................................................... (Address) (Phone No.) PLOT DIAGRAM " I:ocate clearly and distinctly all buildings, whether existing or proposed, and indicate all sat-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. STATE OF NEW YORK, ) ~ ~ ,~ COUNTY OF ...................................................... ) , .......................................................................................................... being duly sworn, deposes and says that he is the applicant above named. {Name of individual signing contract} He is the ....................................................... ~...~ ................. .......i ............................................................................................................................. {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 be~to.of h{~r~w~le~aed belief; and that the WOrk will be performed in the manner set forth in the application filed therewith. No. 52-0344963 Suffolk County ...................................... day o~ ................................................. , lu..; .......... ~ Notary Public ............................................................... .County ............................................... .~ ..................... (Sigtutture of applicant] THE NEW YORK BOARD OF FIRE UNDERWRITERS 1~(~121 SUREAU OF ELECTRICITY --- 85 JOHN STREET. NEW YORK, NEW YORK 10038 D. te SEFTE~ER 14,1994 Applicetion~o, on~ile 06364694/94 N 327014 THIS CE~IFIES THAT BRI~ & B~ B~CK, ~ DRIP, SO~O~, . . A~UST ~, 1994 and found to ~ in compl~ce wHh ~e N~n~ Elec~c~ ~e. ORYERS I ,U~AC~ MOTORS I ,uTu. ^m,^.c, m=., ~RV~ m~N~T [ ~. m ~ S E ~2~ CB ME[R~X1 D~'~S ~ ~'rr~ OF 8/8/94-1 ~C. ~ ~'1'~7-7 K.W. ,2-3.5 K.W. ~AN~ES V I C OF CC, COND. 2/0 EXHAUST FANS DIMMERS AN, T. WATTS ,o.o* .,-t~a A.W.O. i A 2/A0 w ,~ PAUL R. BURNS P.0.BOX 1061 SOUT~OLD, NY, 11971-0932 LIC.#3897-E 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. COPY FOR ~UILD[NG DEPARTMENT. TH;S COPY OF CEfiTIFICATE ~,",UST NOT BE ALTERED IN ANY MANNER. ,/'