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HomeMy WebLinkAbout11962-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.Z13525 Date June 17 198.5. THIS CERTIFIES that the building A D D I T I 05I Location of Property . . y80Q PECONIC BAY BLVD MATTITUCK County Tax Map No, 1000 Section . .1. 2. .6 ....... Block . .1. ~. ........... Lot ...0. 1. .5 ........... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... O~ ~...6. ........ ,19.8.~ pursuant to which Building Permit No.. 1. .~ ~.6.2. z. ............. dated ........ .09.~..' . ~..4 ............19.8.~, 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 ......... ... g.d,~l ~-.~£.qn..~.o..~x:i_~.t~¢g..c[~/~ }.3_.5. r~g ........................................... The certificate is issued to ... D. 9 ~.O.T.H. 7..E.:..F .Afl. L. ~..~ .................................... (owner, IE_S~)~ of the aforesaid building. g//~ Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO .................................................. Rev. 1/81 Building Inspector TOWN OF SDIJtHOI D BUILDING D£PARTgi NT' TOWN HALL ' SOUTHOLD, N!.;¥.. BUILDING: PERMIT (THIS PERMIT MUST BE KEPT ON '[H,E PP, EMIS~S UNTIL COMPLETION'OF THE WORK AUTHORiTED) No. 11i962 Z D~e Per~nission is hereby granted tO at premises located o~ Cou ty Tdx Map No. 1000 Sect ....... ~. BI ~ ...... ~ ....... ~Lot ,No. ;.~ ....... BullBIng Ihspector. : ; / Rev. 6/30~80 · Building nspectoF FORM NO. 6 TOWN OF SOUTHOLD Building 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 propertv 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 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. C. Fees: 1, Certificate of occupancy $5.00 ~ /$ 2, Certificate of occupancy on pre-existing dwelling land use ·/5' 5.00 3. Copy of certificate of occupancy $1.00 / ''~' -[ '~' Date ..... k. ......... New Building ............. Old or Pre-existing Building . ,v~,.. ...... Vacant Land ............. Location of ProperW ... · Hou~No. ,IL.)C4.oN-~.,.~ ,~ s~re~t Owner or Owners of Property .... County Tax Map No. 1000 Section .... (.J ~ ...... Block .... (./ ......... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. [~'fl ~. ~... Date of Permit/.0./,.~./~I..Applicant....~...~....~,.. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ................... Final Certificate Fee Submitted $ Construction on above described building an~'~e~nit meets all al~Plicable codgs and regulations, Applicant..,~ .~ .~..~.~..~~ ................ FIELD INSPECTION COMMENTS FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 June 11, 1985 TEL. 765-1802 Dear Gerry: I am returning check #1680 in the amount of $15 which you sent us for 3 C.0.'s Please send us separate checks of $5.00 each for Joyce Monk everything is O.K. and it is ready for C.O. amount due $5.00 Dorothy E. Farley everything is O.K. and it is ready for C.0. amount due $5.00 Kimogenor Pt. Co (G. Fisher) there is a problem on this C.O. please contact our office. I will send you the 2 C.O.'s as soon as I receive your checks. Thank you. Yours truly, Building Dept. TOWN OF $OUTHOLD OFFICE OF BUILDING INSPECrOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 Sept. 26,1984 'To Whom This May Concern, We are unable to complete your Certificate of Occupancy because of the following reasons. {! 1) The check - .Fee Not Submitted 2) No final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. Building Permit #11962Z for Thomas Farley FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT .... TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined .~2~..~.. r.~ .... ,19~.. ~- *pprovedaZ...C. . ..... l .. .Perm,t ....... .......... .......... APPLICATION FOR BUILDING PE~IT Application No ............... INSTRUCTIONS a. This application must be completely fried in by typewriter or in ink and submitted to the Buildin~ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee acconlin8 to schedule. b. Plot plan showing location of lot and of buildin~ on premises, relationship to adjoining premises or public steers or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this application may not be commenced before issuance of Building Permit.. d. Upon ~pproval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No buildin~ shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been ~anted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Dep~h,ent for the issuance of a Building Permit pursuant to the Buildin~ Zon~ Ontinance of the Town of Southold, Suffolk County, New York, and other applicable L~ws, Onflnances or Re~lations, for the construction of building, additions or slterations, or for removal or demolition, ~ handn d~cribed. The spplicant s~rees to comply wi~ all spplicab..ly laws, o~dinsnces, bul~l~ code, housing code, and regtdations, and to admit authorized inspectors on pr~rmses and in building, for necessary in~- ~ .... - ....~.~.. £ ~.~ .~Z-./~.~..c.~... ~ ~ -'7 {~;hh or applic~t, or ~me, i~ co~oration) 0~.iling address of applicant) State/~hether_applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....~.'t.. :.~. :. ................................................................................ Name of owner ofpr*mises. ~ .~). [~ .~..-~..~. ~......~..:. 7.~..~ ~ .~.y .................................. (as on the tax roll or latest deed) If a~~of duly authorized officer. · ..._~~ ( ,N~Ul~e ~nd titie ~ i~r'a~ ~ ......... Builders License No..."~..O/~F~...C~.V.~.W.G· Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which, proposed work will be done .................................................. ~i~Tu.~N.u~r ..... ~dT./''~-' .Ff~. ?/. ¢!.'/~'~'/~I~ 'r~e~t~/Z/'~' ............ ~"~t~''t/'6//'~' .................. County Tax Map No. 1000 Section....~'~.~9 ......... Block .... lJ ............ Lot../.~ ......... 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 ............ .~-. . b Intended use and occ ~ ~'~ · upancy ............................ ............ ~ .......... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration Repair ..... .~.. ...... RemOval .............. Demolition .............. Other Work .-~.~..MA~.ffL~tlT~t~.~c~t ~ I] ' Fe~..-- ti) (Description) 4. Estimated Cost.'~.. ~- ~ /;~, t~ / (to be paid on ~ing this application) 5. If dwelling, number of dwelling ttnits ............... 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 structure.s 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 construct/on: Front ............... Rear ............... Depth ............... Hmght .......... ,. .... ~Jum:ber of Stones ........................................................ 9. Size of lot: Front . '.'~ ~-5~ · ' .~. · .: ......... Rear ...................... Depth ...................... 10 Date of Purchase ' Name of Former Owner 1 1. 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 ...! ................. Address ................... PhoneNo ................ Name of Architect .......... ! ................. Address ................... Phone No ................ Name Of Contractor ......... i ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly ail lbuildings, 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 Y~RJ~/~.~ /~ COUNTY, OF ..~d~~. S.S ' being duly sworn deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ...................... [ ......;ZLz-¢'-~"' "-~,' .............. . ................................... ~ontractor, agent, corporate officer, etc.) of said owner or owners, and is dul~, authorize~t to perform or have performed the said work and to make and file this application;i 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 : .......... ~ ....... z." .day of.~j. ~. ·..&Afl...~"~-;F..~.~., Nota~ ubl IXlotarg Public, State of Nevt ¥or~ f' / (Signature of applicant) i No, 6~-0~44965 Suffolk I I O~mm sslon Expires Usrch a0, l~d'~ i: NOTE= · = MONUMENT SURVEY FOR DOROTHY FARLEY LAUREL TOWN OF SOUTHOLD SUFF. CO., N.Y. SCALE = I" = 40' SEPT. 19, 1965 GUARANTEED TO= FIRST NATIONAL CITY BANK THE TITLE GUARANTEE COMPANY LAND SURVEY~NO. 12845 RIVERHEAD, N.Y.