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Home My WebLink About9870-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z1215B Date December 23 -, 198..3 THIS CERTIFIES that the building..ad......d i t i. on.......... ............................. Location of Property 350 Aborn Lane ...... C..u.~.c.h. 9~;.u.e .... House No. Street Ham/et County Tax Map No. 1000 Section .. ! .~ .8 ....... Block . .0.5. ........... Lot .... .0.0.6. ..... ;..-~-- Subdivision..~a.s..s.a.u...P.t....q .1.u.b..P..v.o~p...,...Filed Map No..~.5..6 .... Lot No...9.9. ......... Amended Map g conforms substantially to the Application for Building Permit heretofore f'ded in this office dated Jul7 2.0. 7.8. p gP itN ~870 g .......... ,19 ursuant to which Buildin erin o ...... dated ...g.u.~.y.. 2..8 .................. 19.7.~., 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 ...a.n. .... addition to existing one-family dw..ellin~: The certificate is issued to .............. g. ~ .T.H.O.N.. ¥..&..M..A.R.Y..D..e.N.I.S.~. 9 ................... (owner, le~ee e~.teaa~ of the aforesaid building. Suffolk County Department of Health Approval .... l~/,fi. .............................. UNDERWRITERS CERTIFICATE NO ............ I~. fi2.5 3 9B. ............................ Building Inspector Rev. 1/61 TOWN oF SOUT,OLD BUILDING DEPARTMi~NT TOWN GLERK'S ~FIGE SOUTHOLD, N.. Y. BUII~DING PERMIT (THIS PERMIT MUST BE' KEPT ON TH,E PREMISES UNTIL FULL COMPLETION OF THE WORK AuTHoRIZED) t N.o 9870 Z Permission is hereby granted to: Dote pursuant to 6pplication · Building Inspector. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted in duplicate 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-IS-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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-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. Co Fees: 1, Certificate of occupancy $5,00 / 2. Certificate of occupancy on pre-existing dwelling / 3. Copy of certificate of occupancy $I,00 landuse--Pre-Existing C.O. $15'.00 Vacant land C,O. $ 5.00 Date /~ /°0- .~,,~ New Building .~OId or Pre-existing Building .. ~ .... Vacant Land ............. Location of Property~-I~u'se'~' '~'~'~'~'' '~4 No. . ~T~.~.~.?.~...~.~..l:.~'.~./.Street '' C '&'~" ~-~ ~' ~" Owner or Owners of Property .'~. ~. i~. L.O Fl .y. ~[..I.~ ~_J~,,~y~ ... b ?--..//~. ]'~'..~ f,~ ................. County Tax Map No. 1000 Section ....... fi/,~. .... Block ..... ~ ........ Lot .... ,~ .......... Subdivision .~. O~,S ~: ,~, ,~.'.. ~~.~_ile~d ~ap No../5.~1 .... Lot No .... Permit No.~. ,~.7.9..~.. Date of P~;n~;~. ~,~'~,~ .~.~,-.A~ppli~;nt. g: ~,'..(~, ', ,0~,. ,~'i ....... Underwriters Approval. ~..~. ,~.?, .~..~...~, ........ Planning Board Approval Request for Temporary Certificate ..................... Final Certificate . Fee Submitted $ .... ~, ,~..~,, ................. Construction on above described building and permit meets all applicable codes and regulations. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW '~C)RK 10038 THIS CERTIFIES THAT only the electr~ ~uip ~er~t as de~H~d below end introduced ~ the applicant nam~ on the above application number in the premises of in ~he foHowlng ~ocat~on; ~ Basement ~ 1st FI. ~ 2~d Fl. Section Block Lot DISH WASHERS EXHAUST FANS DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R ~V I C R OTHER APPARATUS: OF CC, COHO. NO. OF HI4EG: A. WG NO OF NEUTRALS A.W.G- OF HI-LEG OF NEUTRAL This certificute must not be altered in any manner;, return to the office of the Board if may be c;'edentials. MANNER, " ~IS'I;,ICY.,C,f'.EC'[; ilS,~L.5,L01G ~oo Lo i 5 r-,,',x,'~ D J, d BELl A L, RICE~.E Lot ~_~_ TOWN OF $OUTHOLD BUILDING DEPARTMENT ~/~np ~ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 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 (~djoining premises or pub{lc streets m areas, and giving a detailed description of layout ofproperty must be drawn on the 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 permitb'J 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, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with ail applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and ir~ buildings for necessary inspections. ........ ............... ( 'g of aj~pl.icant, o!nar~ if a corporation) ~/~aaress at applicant] State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buJJderr~ Name of owner of premises ...... ~ .......... ~ ................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of co rpora, te officer) ~.(~,~ --~ ~~ Builder's License No ....... ~.~.~. Plumber's License No...Z.~.P..C~-~.d~ Mu~icipali~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. [xisitlno use ond occupancy ...................................................................................... b. Intended use ~nd oecup~ncg 3. Nature of work (check wBich applicable): New Building,. ................. Addition ..... Alteration ...: ............ Repair .......... ~,,. Removal .................. Demolition .................... Other Work ................................................... ~ ~)~t~ g:~"~'~ ~:~ /L~-'..~,,.~ (Description), 4. Est mated Cost ,~1~ "'(~"('~/'~¢~_:.i:~ ......................... Fee ..~..../.:.G~....~.~ ............................ ; ........... ,. .................. //'~ ~ (to be paid on filing this appdcation) 5. If dwelling, number of dwelling units ..,..~...../~.....~.. ........ Number of dwelling units on each floor ..L~,...~.....~.. .......... If garage, number of cars ................... ~..,Z~...,.-~... ......................................................................................................... uslness commerc a or mixed occupancy, speci y nat,ure and extent of,each tr,,ac of use 6. If b ' · ' i~ ~,- ~' ~-'-,- .... 7. Dimensions of existincl structures, if any: Front ..~..,~....':m....._.~.. ...... Rear .~-~...~.....'m'......~3. ......... Depth .~...~i~...-:..L~ Hei,~ht ,~ ~ ~. ~' Number ~f Stories .~/-,~-....~,~.i~.,.~.. · ............ ., ..................................... t ........... 9. S 10. 12. Does proposed construction violete ony zoning Iow, ordinance or regulotion: ....... ~..~. .................................... 13. Will lot be regroded . ....... ~..~. ........... Will excess fill be removed from premises: ( ) Yes ( ~'~o Name of Architect .............................................................. Address}~...~Z~..~..t~.lx/~,~. Phone N~...~.l~...c~. ........ Niarne of Contractor ............................................................Address .L.~...~'-'-~/~, ..-~'~l~Phone NL..~...~....~..~, .... , PLOT DIAGRAM /'¢" ~' Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fram property lines. Give street and block number or description according to deed, and show street names and indicate ~hether interior or corner lot. STATE OF NEW Y_.,OjRK., I. S S COUN'FY, , _ ,,~. ~OF...~](~/.. '.~lL.~l.....~' ' ........ ~.~..~...Z:: ....... : .............................. being duly sworn, deposes and says that he is the applicam , (Name of',,iQ~ifl~ s[~in9 contract) above named/ He is the . . ' , ' (Contractor, agent, corporate officer, etc.) of said owner.or o~qer~,;,~ is du[~ a~horized to perform or have performed the said work and to make and file this applicatioN; cha¢ all sf~t~t~'~ontaioed in this application are true to the best of his knowledge and belief; and thor the work.wiH'~b~efi'f~'m~d'i~ manner set fo~h in the application filed therewith. ...... ............ co,, .... .... ~ JOAN I(ENY~N / (Signature of applkant)~ FOH, M~ NO, ! TOWN OF SOUT~OLD SUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ......................................... 19 ........ Application No ................................. Approved ........................................ , 19 ........ Permit No ..................................... Disapproved a/c ............................................................................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building Inspector, with 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 at areas, and giving a detailed description of layout ofproperty must be drawn on the 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, 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) .............................. ......................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................ .......... ................................................................................. Name of owner of premises .................................................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No .... .~.~£ ........ I..~.,.~...?.. .... Electrician's License No ........ .../~....~. ......... ~...~,.?.~...~. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ........... ./..~...~. ..................... Lot No...?...~. ................ Street and Number ...... .'~.~.'.~......~.~.~..~......~x~t.~ ................... ~...~.~..~ .......~...e.!.n~.~ ....................................... Municipality 2. State existing use and occupancy of premises and in.~ended use and occupancy of proposed construction: a. use and accupanc ..................... ................................................ b. Intended use and occupancy .................................. ~..*~Im~ .............................................................................. 3. Nature of work (check which applicable): New Building'. ................. Addition .....)~. .......... Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work .................................................... (Description) 4. Estimated Cost ~' '~,~'00 , . ............ Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units ....11~!¢~ ................ 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 . ./.~...~[ ............. Height ..~/.~.:~/.. Number of Stories .......... ~ .................................................................................................... 9. Size of lot: Front .............. ~.~.~ ................................. Rear ........ ~.~.~..t. ......................... Depth ....~../~.~..~ ................... 10. Date of Purchase ...... ~c~.~...../.,../.~..?.~. ...................... Nome of Former Owner .,,~t,,~l,~.~,~,..,,~.~. ................ 11. Zone or use district in which premises are situated ..................... ( ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........... ~6~..Q. .................................... 13. Will lot be regraded .....,~.¢~ ................ Will excess fill be removed from premises: ( ) Yes (~) No 14. Name of Owner of premises~q~.,,lb...¢...~,¢~.~.~.~..~'~. ...... ,~ddress .,~.~.~',¢~F... Phone No..~....:..~.~:~]..2.'~ Nome of Architect ............................. ~.~. ............................... Address ................................ Phone No ...... .~ ............. N~m~ of Controctor ............................................................ 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. STATE OF NEW YORK, lc c COUNTY OF ................................ ................................................................................................. being duly sworn, deposes and says that he is the applicam (Name of individual signing controcf) above named. He is the .......................................................................................................................................................................... (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 ali statements contained in this application are true to the'best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........................ day of ............................................ , 19 ........ Notary Public, . ................................................... County (Signature of applicant) 5 NAME SECTION C_-]]]]]] DATE_ _ 7