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Home My WebLink About9972-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall $outhold, N,Y. Certificate Of Occupancy No..Z. ]: .2,3.5,6. ......... Date . .M.a..r g.h.. 1. 4. ,..1.9. ~ .4 ............... 19... f~¢~ly, d 1 lip,~ THIS CERTIFIES that the building .. Q~a.e ........ .w.e. ........................... Location of Property . Ib.~l~¢.lJ-.g. ~.e.a. ql3.1R.o.~ql ....................... ~' j-g,l%~]7~...l~J-g,nd House No. Street Hamlet County Tax Map No. 1000 Section ...1.1 ........ Block ...3_ ............ Lot ...5 .............. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... .D.e.q,..4 ........ 197. 8, pursuant to which Building Permit No. 9 ~.7.Z$ ................ -dated ...D.e.c.:..4 ................... 19.7. .8, 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. oae . family..dwelling ....................................... George & Lois De Menil The certificate is issued to ..................... jo~n'o),'I~s'se'o't~r't~t~a'o't} ...................... of the aforesaid building. N/A Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO .................... ~ 5 62.5.¢ 2 ...................... Building Inspector Rev. 1/81 F~ so. ~ TOWN O~ SO~V~Oa~ BUILDING DEP~RTMENT TOWN CLERK'S O~ICE SOUTHOLD, N. Y. BUILDING I~ERMIT (THIS PERMIT MUST BE KEPT ON THF PP, EMISJ~S UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) 9972 Z Dote ...... ' , .................................. : ................ 19 ........ Permission is hereby granted to: 'Building Inspector. /~' FORM NO. 6 TOWN OF SOUTHOLD Bu ilding Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. 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 featu res. 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 "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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 dwelling / 3, Copy of certificate of occupancy $ 1.00 land use --Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Date ................... New Building ............. Old or Pre-existing BgJL~ing .. ~ ....... Vacant Land ............. Location of Property .... · ............... House No. ~ $&eet . ~ Ham/et Owner or Owners of Property ........................................................... County Tax Map No, 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map N~,~ ..... ~7,cl~ot No .............. ........ Apphcant ............ ,. .................... Health Dept. Approval ...... .~.l.~. ............. Labor Dept. Approval ...... ./vH/?. ............ ~/~(~q~ t,( 56')':~,'', ~.. , .:~f~.~- Underwriters Approval ........................ Planning Board Approval ............. Request for Temporary Certificate ..................... Final Certificate .... ~- ................. Fee Submitted $ .... ~.; ~.O. ................... Construction on above described building and per;~m:ts all applicable codes and regulations. App,icant .~,.. ~.. ~' ..................... LJ. McGovern President AJ. Reed GeneralManage~l~ Mr. & MrS, Ge6rge De~inil F,O. aox il? ~ Fishers Istan~, N.Y. The ]~ew York Board Under~WrilerS BUREAU OF' 85 JOHN .STREET NEw YORK, 'N. Y, lop3(8' tns~ellation~t the not in compliance with ~h$ ~ec~l olad ca, leis hOC :usages as appXied. lc 11 be before we can.isSue a ' Not~ftcatioz and to d~teWgheve no= bean White Gables electrical items ~aee) corrected i~0 =he applicant corrected, TOWN OF SOUTHOLD BUILDING DEPARTMENT , TOWN CLERK'S OFFICE Diso~pm~ed o/c .............. ~;57:~ .................................................... ................................................................ .............. ................... ~~..~ ............... {Buildin0 Inspector) A~plication No ................................. APPLICATION FOR BUILDING PERMIT Date ......... Augm~£..B.l;h ..................., 19....~ ..... 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 p. lan showing location of lot and of buildings on premises relationship to a~joining premises or public streets o~ areas, and g~ving a detailed descriptioJa 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 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 lows, ordinances, building cbde, housing' code, and regulations, and to admit authorized inspectors on premises and ir~ buildings for necessary inspections. . A...Iohn gdda..gma.exaJ...l,~.onl:zacl;lng.,..lnc ................. (Signature of applicant, or name, if a corporation) ~,~b.~x~.. I.~.1.~.4.,.. ~.~..w...¥.o..~.~.......o..6..~.9. 9. ................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...................... f~ral,.~oz~t, rae£or ........................................................................................................................................ Nome of owner of premises George and Lois deMentl Family Trust if applicant isza corporate, signature of duly authorized officer. .... ................................... ~ (Nomo ond title oFcorporate officer) Builder's kiconse No ........... ,2.~.1...:..~..I. .............................. Plumber's License No ....... g~6.Z.P ................................ Electrician's License No. 296-E Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Mop No.: ........................................ Lot No ......................... Street and Number Park Area Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ttesidental b. Intended use and occupancy ...... e,e~a~ .................................................................................................................. 3. Nature of work (check which applicable): New Building'· ................. Addition .......X.. ......... Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................ (Description) $39,000.00 $15.00 4'./ Estimated Cost ............................................................ 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 use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ....... s~..pT, an6 ........................................................................................ 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 .......... ~.e..e...p..1..a..n.~ ......................................................................................... g. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ............... 19.72 .................................. Name of Former Owner ..lansan..tlo.~es..[s~:a~:~ ................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .......... ~.q .......................................... 13. Will lot be regraded . ......~..o. ................ Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises .................................................... Address ................................ Phone No ....................... Name of Architect ..~/J,:l.~..ll,..~b~; ............................ Address ...i~zl~.t;~z~..~,I... Phon~ No. Zion & Breen ~ome of Contractor ............................................................ Address ................................ Phone ~o ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or I~roposed, 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. Breakfast room addition 14 X 15 Dining room addition 5 X 20 Deck 2800 ,square feet STATE OF NEW YORK, lBS COUNTY OF ...:.-?,..~.C./.--.c~.A-..K ....... ........................ ~.......~,~.OJ.~,..)......(.~.~Z;~/ZL....~.~.Z~..// ~-~ ................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. /.~ ...~... He is the ......................... (Contractor, agent, corporate qffi.c~r, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and fiFe this application; that all 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 ~ ~;~'. f',~ ~.~' ' ' Z 197 Notary Public, . ..~.....~,(.~.~,.~/,~. ............. County ....... ~~..-..~:~.~.* .................................. · ...............~,/ /" ) ~ . ,, / (Signature at opf:flicant) NO ,.5~-~9r~0 DA ., NOTIFY BUILDING DEPARTMENT AT 765-2660 9~ to 4P~ 'FOR REQUIR. ' ED tNSPE~IONS~ t' BEFORE BACKFILLING FOUNDA- TION OR START F~AMIN~ 2. E~AMING I~PECTION 3. BEFOR~ COVE~iNG PIF~S OF ANY ~e 4. FINAL W~EN JO~ 'COMPLETED NOT RESPOHSI~LE FOR DESIGN OR CONSTRUCTION ERRORS ~. ALL CONSTRUCTION MUST ME~ REQUIR~E~?S OF' N,Y. STATE CODE A~D TOWN HOUSING CODE & ZONING '1 ,i _L ,/ t ~PPROVED ,AS NOTED NOTifY BUILDING DEPARTMENT AT ~'~-'2660 9,~M ~'e ~PM FOR REQUIR. INSPECTIC~IS~ B~CK~IL~LiNG FOUND,~- ~TION OR STAR1~ FRAMING '~RAMING INSPECTION 'BEFORE COVERIrtG PIP.~S OF ANY . W~EN 205 COMPLETED ~OT RESPONSIBLE FOR DESIGN ;OR CONSTRUCTION ERRORS ALL CONSTRUCTION MUST MEET N.Y. STATE CODE h 4', ,/ / / :~>./ /-- .. .... / (b