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Home My WebLink About9616-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22128 Date JANUARY 28~ 1993 THIS CERTIFIES that the building ADDITION Location of Property_ 12975 MAIN BAYVIEW RoAD House No. Street County Tax Map No. 100D Section 88 Block 2 Subdivision Filed Map No. SOUTHOLD, N.Y. Hamlet Lot 13 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 3, 1978 pursuant to which Building Permit No. 9616-Z dated JANUARY 31, 1978 was issued, and conforms to all of the requirements of the applica?le provisions of the law. The occupancy for which this certificate is issued is BATHROOM ADDITION TO EXISTING ONE FAMILY DWELLING The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/Sl GEORGE & MARGARET SULLIVAN N/A N/A //~uil~ing Inspector 'TOWN BUILDING TOWN SOUTHOLD, BUlL. mNG (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9616 Z Building inspector, /~ Fee $ ........................ pursuant to application dated ................................. ,,~,~....r.'~:....~/., 19,.~...~,~ and approved by the '.,:i.,.~?~ ~t~.-:...:.'....~.:.!: ................................... ~,: ·Buddtng ~j nspecto~: Porto No, 6 TOWN OF SOUTIIOLD BUILDING DEPARTMENT TOWN I{ALL 765-1802 APPLICATION FOR CERTIFICATE OF i. OCCUPANCY \. This application must be filled in by typewriter OR ~nk 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 lines, 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 instal, lation 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 C,~pliance from archiuect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and 'pre-ex,sting land uses: 1. Accurate survey of property showing ali 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. .. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. ' 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 OVer 5 years - $10.00 4. Updated Certificate of Occuphncy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 , _Date ..... ............ ew Uonstruction .... . O1~ ..... .~ ~ ~ ~_ ~ ~ ''.~ ..... · "'72'' 0cat,on of Property...~.~.J~.~ ,,~ ., ' ......"~Y .................... -~ ~ ~ I y ........ " qwer or Owners of Property ..... ,unty tak ~lap No 1000, Section.~g~,~p .... nlock..~.~O~ ~bdivision .................................. Filed blap ............ Loc ...................... ,trait ~o. ~gl ~ ...Oa~e Of permir..j~.3j./ZS.... , .... alth Dept Approval ' ' ' .................. ' Usderwrirers Approval anning Board Approval quest for: Temporary Certificate ........... Fioal Certicate ........... Submitted: $ 765-].802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [ '~INAL DATE FOILM ~qO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ..~-~ ~ f 7 !..~...'.~ . '-/ ~ ~/~ ~ ^pp.catien .o ................................. Approved ........t ................ ~ ~../...., 19 ...... '~Permit No ..................................... Disappr~ed al~ .......... ~:.......~,.~_~./~~ .......... APPLICATION FOR BUILDING PERMIT 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 o~ areas, and giving a detailed description of layout ofproperty 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 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 o 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) If opplicap'p i~ a corporate4 signat~ure of duly authorized officer. ........ ........................ (Name and title of corporate officer) Builder's License No .......... ~..~.. .................................. Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed wo?k will be4one. Mqo No,: ........................................ Lot No.,..,* ................... ........... .~...~/__~x~...,,,,,, /, _ .x~.~_~. ......................................... Municipali~ ........ Street and Number 2. State existing use and occupancy of premis~ aod in.*ended use and occupancy of proposed construction: a. Exisiting use and occupancy ........... ~~ ......................................................................................... b. Intended use and occupancy .................. ~ .~.~.-.~,2'. .............................................................................. 3. Nature of work (check which applicable): New Building'. ................. Addition ......¢~. ....... Alteration ................ Repair .................. Removal ........... ~ ...... Demolit~or. .................... Other Work ................................................... ~4 , ~ ~f~ (Description) 4. Estimated Cost .~.~ ...~...¢~... ~ ~.~.. .............. i........Fee ....... .i.(...Z...~.........~...... ....................................................... (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 ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth .............. Height ...................... Number of Star es ............................... 8. Dimensions of entire new construction: Front ....~ ............................. Rear....:.&. ..................... Depth .....?.. ................ Height .....~'.~..~ ......... Number of Stories ................... ~ ............................................................................................... 9. Size of lot: Front ........................................................ Rear. ......................................... Depth ................................ 70. Date of Purchase ........................................................ Name of Former Owner 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded . ........ ..~.....~. .......... ~Will excess fill be removed from premises: (,) Yes ~' No 14. Name of Owner of premises~...//C~...~f/jF.~-- '" ...... Address .~.r... ,.~..~?~.~..-- ~-- Phone No Name of Architect .............................................................. Address .~;c~¢r~.~,~ ......... Phone No ....................... Nome of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil 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 lo~. STA"I'E OF NEW YORK, lc c COUN-r¥ .............. ....... , ............................... ~~!.%;-..~..T..... ....... being duly sworn, deposes and says that he is the applicam (Name ~'dual signing contract) ............... ............................................................... 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 tk~af the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ,r~f/,~_ ',--~ ~~ ........................ day of ............................................ , 19 ........ Notary Public, . ................................................... County ............ % ................................................................................ (Signature of applicant) Approved '. ~;1>(-;. ~7~ n~/:;:..r'.'I/';:'~'#. ftNIK IfO. I Y ~.~// t..-::-T', f?L'-LJj, , __ . . _..-.. ~r~_ ...: ,~:,~,~~=P!f!7~-~~ {;.~ g, 1r ~Oi.D,N.Y. ~8~ ~ ............'7.,...' 19~... . 961' -r ~ca;:;;jl~.~~~;:.;.Z:.; .. ........................, 19....~Perrnlt No. .................................... , .1. _. -:-. . ~'JI~~ i f,- ti Disapproved ole .......................... ...;......... ............. , "- l\. 7' '<t . ~' Exomined ........................................,..;...............~............................................................ ~~~~- ........... ..................(.ij~.ildl-.;g. I ...... ~;i.... ; ........................ APPLICATION FOR BUILDING PERMIT " h JRII 3' 7$~ Dote ................................................, 19.......;.... "l . U, INSTRUCTIONS ,\ a. Thisopplicotion must be completely filled in by typewriter o~ in ink and submitted in triplicate to the ~Ul~r Inspectar, with 3 sel'sof P/afls, qccurate plot plan to scale. F.. according to schedule. . . , b. Plot plan showing localian of lot and of buildings on premises, relationship to adjoining premises or public streets o. i' areas, and giving a detailed desCription of layout of property must be drawn on the diogram which is part of this application..! . c. The work covered by this opplication may not be commenced before issuance of Building Permit. '. . d. Upon approval of this applicotion, the Building Inspector will issue a Building Permit to the opplicant. Such permit j shall be kept on the premises available for inspection throughout the work. t e. No building shallbe occupied or used in whole or in port 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 descrl"ed. 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. 7b 5-- ( :-:1!L ~ r--. _ / ,.-. ".~:2'fdl.'..?1/.C.~.......~4!.......~~&t (Signature of applicant, or name, If a corporation)" .' .a~..{t.~...iAdd~'Appii~~.~.....~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................................................~I).~...................................r2": 72...M........................................................ Name of owner of premises ....illL..t.&r:...............q;a.~.s;;tk{f!!..~................................................... :~.4..~~~.~:.~..~~..:~:~..~~:~~~:~~ officer. (Name and title of corporate officer) Builder's License No. ..........I?$................................... /000 - 0 l?ft- :2. - 13 Plumber's License No. ................................................ Electrician's License No. ............................................ 1. Other Trade's License No. .............................................. Location of land on which proposed work will be do~~a~~'?:_........................................ Lor~.:;1Z'..7..;>j....... Street and Number .......................':/11~..../..:7:J:'.~.......................................~....:." Munk:ipality . :tat~i::::~:g u:e a:d :c:::~ .~~..~.~~.);J.~~..~.~~..~~~.~~~=~~~..:~.~~:~..~.=~::~~:=:................ b. Intended use and occupancy ...............fJ:w.~.................................... ................................................ ' 2. .~~ t.- -----"..__c....l..._.._... .~__. Nature of work {check which applicable): New Building' .................. Additian ......~...... Alteratian .............. . Repair .................. Removal.................. Demolitior..........,.......... Other Work ................................................ .... !I!f - oV (Description) Estimated Cast . ......... ..3..l.C'!?:..":'Y?....................... .Fee ............./ .!l.....~.. ..........:............. .................... ........ (ta be paid an filing this applicatian) If dwell\~g, number of dwelling units ............................Number of dwelling units on each f1aar ............................ If garage, number af cars .. ..... ...................... ......... .,....... .............................................................................................. If business, commercial or mixed occupancy, specify nature and extent af each type of use ............................ 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 ................................ ..' . ~, sl 11-" Dimensions of }!ntlre new constructIOn: Front ............:::::...................... Rear ............................ Depth ........................ Height .....f........... Number of Stories ................./... ............................................................................................... Size of lot: :ro,:,t ........................................................ Rear .......................................... Depth ................................ Date of Purchase ........................................................Name of Former Owner ........................................................ Zone or use district in which premises are situated ..................................................................................................... Does proposed construction violate any zoning law, ordinance or regulation: ................~................................ Will lot be regraded .........61.0.......... Will excess fill be removed from premises: ( ) Yes ~No Name of Owner of premises~/!.(~~.J~.Jk.... Address ~tkU.....~aiPhone No. ...................... Name of Architect .............................................................. Address ..Jd.~....... Phone No. ...................... Nome of Contractor ................................... ....................... Address ................................ Phone No. ...................... PLOT DIAGRAM Lacote clearly and distinctly all buildings, whether existing or praposed, and indicate all set-back dimensions fram property lines. Give street and block number or description according to deed, and show street nomes and indicate whether interior or corner lot. 3. 4. 5. 6. 7. , 8. 9. 10. 11. 12. 13. 14. STATE OF N~W Y RI<. tss COUNTY OF .... ..... .......zt2..)Q. .. J':;--- ...................... ... ......................./..':.~~.............being duly sworn, deposes and sol's that he is the applicant (Name of individual signing contrad) :beO~: ;h:m.~.~:..............~~fc-&2t~~:..:ji~~.~i'fi~.~;:.~t~..;............................................................... of said owner or owners, and is duly authorized to perfarm or have perfarmed the said work and to make and file this applicatian; that all statements contained in this application are true to the best of his knawledge and belief; and thaT the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........................ day of ........................................... 19....... f7 II /7 /,]. ~ Notary Public, .................................................... County ...................~~..I.~~................. (Signature of opplicant)