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Home My WebLink About11711-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. No. Z12617 Certificate Of Occupancy THIS CERTIFIES that the budding Add. to Garage .17..1:.0 Pike St. Matt. Location of Property .. .......................................................... MOUM )VO. Sb'eet Hamlet County Tax Map No. 1000 Section 14,0. . .Block 03 .Lot 03.9 Subdivision .................... .X .......... Filed Map No ..... X....Lot No. , .X. .......... conforms substantially to the Application tot Bugdin$ Permit heretofore t'ged in this office dated M. 9¥ 3 19 .8.2pursuant to which Building Permit No ................ dated .... June 8 19 8..2, wu issued, and conforms to ail of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Add. To Garage The certificate is issued to .~OSE J. H. & K. H. ............ ' ....... ~o'~'~. '~,'~, '~', ~/ ..................... of the aforesaid building. Suffolk County Department of Health Approval .' .... .I~/.A ...................... UNDERWRITERS CERTIFICATE NO ...... ~/./~ ....................................... . Building Inspector TOWN"OF SO THO ~ BUILDING DEPARTMI~N~ ~ TOWNNALL ii $OUTH'OLD, N Y~ I BUILDING P,E~!~ ; (THIS PERMIT MUST BE KEPT ON TH,E P~E~IS~S UNTIL ~ULL COMPLETION OF THE WORK AUTHOR ZED) ~ ~ N°. }:1711 Z ~otel ~-~,c.-.....~ .............. , ,~.. ~ermission ts hereby gronted to: / ~., ~ · ..................." ~ ...... ~ ..... ~'"; ":'""7 ..... .... .............. / ' ...................... ~:2'"".-2 ........ 7'Y'"'::'¥'"~I~'-': ..... ~'~, (~$-/~-~ ,,-z .~/~ ~.~ :l ..~ ..... __ ........ · ; ' ~ ~i, i ~, i ................... County Tdx Map No. 1000 Sechor~ .~ .................... ,. Dlock < .... ~:.......~Lot No .................... : :' ' I and a roved by the pUrsUant to app icot on dated .............. ,; ............... ,,...~ ..... PP : / ; , FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall · ~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted~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. 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 bu ildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. Fees; 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling/ land use 3. Copy of certificate of occupancy $1.00 --Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Date ... ,Tu3,:~. ~.r~L 984 ........ New Building I//...~, Old or Pre-existing Building .... Vacant Land Location of Property 3.7.1,0..]~$ke..:Streat,. s/~ · · · M~tti~u~_-k ,N,~. ........ ,,~tcJ~ ........ House No. Street Ham/et Owner or Owners of Property . J,~ .&, ~.~,. ~se ........................................ County Tax Map No. 1000 Section .... 140 ....... Block ... 05 .......... Lot..019 ........... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No..3,3,7~.~, .2~. Date of Permit (;,/~.~2...Applicant .... ~,s .~bo.~.e .................... Health Dept. Approval ...=/.a~l~],~.ea~].s ........ Labor Dept. Approval .. ~/.~p~;f-~b3-e ........ Board of Appeals # 298~ dtd. Underwriters Approval . . no.t .nee&ed .......... Planning Board Approval .5/4/E~..a~. ap:pr,. ~./4/82 Request for Temporary Certificate ..................... Final Certificate ~. ~ ................... Fee Submitted $ 5,OO ........................ Construction on above described building and per/nit mpts all applicable co< Applicant .... 'r~. /.J.' ,~T*.~ ....... Rev. 10'10'7S ~t~.~/ ./~. f TOWN OF SOU~_T.' FIELD ~SP~CTION FOUNDATION (1st) FOUNDATION ( 2nd ) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C,ODE FINAL IDATE COMMENTS ~ ~ ~. · , ~ ADDITIONAL FORM NO. 1 BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Appro,.X .. l a. This applicaffon must be completely ~led ~ by typew~ter or in ~k and submitted in triplicate to the Buildin~ Inspector, with 3 sets of plans, accurate plot pl~ to se~e. Fee according to schedule. b. Plot plan show~g location of lot and of bufld~ on premises, relationship to adjoin~g prem~es or public street~ or areas, and ~ving a detailed description of layout of prope~y must be drawn on the diagrm which is pa~ of this appli- cation. c. ~e work covered by this app~cation may not be commenced before issuance of Building Pe~it. d. Upon approv~ of this application, ~e Building Inspector will issue a Building Pe~it to the applicant. Such pe~i~ shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in pa~ for any pu~ose whatever until a Ce~ificate of Occupanc5 sh~l have been granted by the Bufld~g ~spector. ~PLICATION IS HEREBY MADE to the Building Department for the issuance ora Building Pemit pursuant to thr Building Zone Ordnance of ~e Town of Sou~old, Suffolk County, New York, and other applicable Laws, Ordinances o~ Regulations, for ~e construction of burden, additions or alterations, or for removal or demolition, ~ herein described. The applicant agrees to comply with all applicable laws, ordnances, building code, housing code, and regulations, ~d tc admit authorized inspectors on promises and in buildings for necessa~ ~s~ections. .............................. ~ignature applicant, or name, a if ~ail~g address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .. J o ii...~. K ..... Ro s~ ....................................................... (as on the tax roll or latest deed If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No... ~orl~ .by. o.w~er ........ Plumber's License No ......................... Electrician's License No. ~ ............. Other Trade's License No ..... : ................ 1. Location of land on which proposed work will be done .................................................. ......... i.72~0. Pik~. Strget., i,i~t t it ~e~k, lfew..York, ll9 5 2 .................................... House Number Street Hamlet .... / .~..0. ........ Block ....... ~.~' ....... Lot .... (2~. '7 ........ County Tax Map No. 1000 Section Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . .Re~.idma~:d,a't. ,-. t~nex'. ~e¢,.~p;La~. .................................. · b. Intended use and occupancy .sara~.. · ..... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .×x ....... Repair .............. Removal .............. Demolition .............. Other }York ............... . _~ (Description) stimated Cost .... . .................... Fe /. . .'7 .............................. (to be paid on filing this applicatioa) 5. If d,:,'e!LLnT, ::umber of dwelling units .... r~/.a ....... Number of dwelling units on each floor.., ri/?4 ......... If garage, number of cars ...two .................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .... -:~ r.- ............. 7. Dimensions of existing structures, if any: Front... 2.6 ! ........ Rear . 2fi.' .......... Depth . 32.' ........... Height 2L~ ~. 2 '.'..%o. rict,?Number of Stories ... one ................................................. Dimensions of same structure with alterations or additions: Front ...7-6 ! ........... Rear . .2fi:~ ............ Depth. Jig ~.. 4." .............. Height ~.@ '. 2 !'..to. ri&ge ..... Number of Stories on~ .................. 8. Dimensions of entire new construction: Front . .%* ............ Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front;3.$~, ~.9).~ ./~ ~, ......... Rear .151,3.7.& ............. ;~Dt:pth..,Z2A.~,l ! .............. ............... Name of Former Owner ~.~. ~,~ .Z,. ~J~ ........ 10. Date of Purchase }..~.. ~/f.2~.~. ~r ~ mn I 1. Zone Sr use district in which premises are situated...aze~£~t,ez~;i'~,l, ................. ~ ................... ..... mnsu_ z. mo .~ 12. Does proposed construction violate any zonmg law, ordinance or regulation'. ,y. ee,-... :near. ~.a~i~'?i~n'~h.~. _ $~¢ 13. Will lot be regraded . no.~. meed~i ............... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .J.H....&. Ir.. ii.P, oa~. Address ................... Phone No.. 29~~80~fi. .... Name of Architect . .nor~e .................... Address ................... Phone No ................ Name of Contractor . ~eXci .&. ~ ............. Address ................... Phone No ................ ** proDOsS tO add " sh$ct " type extension of approx.~'~" x 11' 6"" to rear o: exm.~tzng garage zo accomm~liS~$~fi~tor home of 31' 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. see attached survey STATE OF NEW YORK, S.S COUNTY OF...~uffoZk ...... ............ J..I~.Ros~. ........................... (Name of individual signing contract) above named. being duly sworn, deposes and says that he is the applicant He is the .......... o~rn~a~. ....................... ' .................................................. (Contractor, agent, corporate officer, ¢t¢.) of said owner or owners, and is duly authorized to perform or have performed the said work and to mak6 and ~e 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. Sworn to before me this ........ ~a:¢ ............. day of .:{~y ................. ,19.8~. Notary Public, . .~ .... S~;foll~ ................. County .~ /I ~[/ , ./ .N2_ dOAN H~DERMANN ' ~. ~j ff..~_ ................. KJlj //adg Pu.t,c,.s.,. ,; ......... : ~, ,//U/~ ~ ~S~ ~ · (S~a~ of appU~t) ~ '. , ' '- Corem · ~un~ ~ ' ' --=-.'~ .... ~R r z~Z ~ , !~ 76S-1802 BUILDING DEPT.' *INSPECTiON FOUNDATION 1ST [ ] ROUGH P~,BG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: DATE