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Home My WebLink About11963-zFORM NO. 4 TOWN OF 50UTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall $outhold, N.Y. Certificate Of Occupancy No. Z12939 Date Oct. 29 ., 198..4. THIS CERTIFIES that the building Addition · 1265 Shi ard Lane East Marion Location of Property ..... . ..................... PY. · ._ ................................ HOUSe mo. Street Ham/et County Tax Map [No. ] 000 Section .... .0.3.8. .... Block ... 0..~ .......... Lot .... .0.~.3. ......... Subdivision × .................... Fi]ed Map No. .Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated · 99.t. ql¢..e.r ..... .8 ....... 19.8.4. pursuant to which Building Permit No....1.1.9.6. 3. .~ ............ dated October 15 19 84 , 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 ......... Unheated Addition To Existing Dwelling WALTER SOSNOWSKI The certificate is issued to ..................... ?t~n'o'r,'l't,~'~rZt6~'n~ ..................... of the aforesaid building. Suffolk County Department of Health Approval N/A N/A UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev, 1/81 No. :~1963 Permission is TOWN:OF -~OU~HO~D BUILDING D~~ TOWN HALL $OUTHObD, Ni. ¥. ~ BUILDING PE~I~ (THIS PERMIT MUST BE KEPT ON TH,E PRE~IS~S UNTIL ~:ULL COMPLETION OF THE WORK AUTHORIZED) :, County ~ ~ : ~" Tqx Map No. 1000 Section ~,.~, ........ ~,. BIo~:E .~......; .... pors~uont ~ro opplicotlon doted ........... ...4 ....... 19 Buil~flng Inspector. e;$ ;..., ~.: ........... FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY BLDG. DEPT. TOWN OF SOUTHOLD ~nstrttctions 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 p~operty 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 $15.0 0 3. Copy of certificate of occupancy $1.00 .~,,7~/..0~,,~..// 4.Vacant Land C.O. $5.00 5.Updated C.O. $15.00 Date ............... New Building . ...% ....... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ...-- .~...~..~-~.'.~. ~-~ ~ Hour, ;v;.' ...... A;t ................ Ham/et %. .U. Owner or Owners of Property ... (~,.~?~.~...0.,~.. '~'" ~ . ..."~..~.....: ...... ! County Tax Map No. 1000 Section ....... ~...-. .... Block ...... · ........ Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. Iff .(~,..~. Date of Permit .......... Applicant..2. ,(:~.~,, ,~...~0.~.1~.0...~D, .~. ,~, .1:. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate . .~ Fee Submitted $ .~. ........................... Construction on above described building aJ~ permit meets all applicable codes and regu. lations. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ~uthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A, This application must be filled in typewriter OR ink, and submitted-~'~llc;t;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, §. 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: 1o 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. 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 Vaoant la~d C.O. $ 5.00 Date New Building ..... ~ ..... Old or Pre-existing Building ..................... .... Vacant Land Location of Property.,./~,~2. ,~.,,, .~j~t~, ~, ,~., ~,, no,,~~o. ~ ' ~ ,s~r,~,, ~'' .-:- ' '' - Owner or Owners of Prope .. .aO. ...... County Tax Map No. 1000 Section ...(~. ......... Block ~ I Lot O / .~. Subdivision.. ~ ....... ~,, ................... Filed Map'No...~ ....... Lot No ....... Permit No. /~, ,(¢.~..:~YDate of Permit .J.¢,Z'/,~..Z;.Applicant .,~..~. ,d~. ,~.~[i i~ Health Dept. Approval .... ~'~(~ .............. 7,Labor Dept. Approval .............. Underwriters Approval ................. Planning Board Approval ........... Request for Temporary Certificate ..................... Final Certificate .... ~ ............... Fee Submitted $..~...~ ................... Construction ~,U above described building and permit rrj~ts all apj~licabk~codes and regulations. ~. ~%q $c~ Applicant ......... i.. yy../.t~/.L...~ t,v ~'~ d"~),~ ~ ~",~ ~ --7 ..... t ...................... I~ev. 1040-78 [ l\ FIEED INSPECTION FOUNDATION ( 1 St) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING COMMENTS INSULATION PER N. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: 76S.~1802 BUILDING DEPT. ~ INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION :)ND [ ] INSULATION FRAMING £'~FINAL REMARKS: DATE, INSPECTOR , ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HAL1 SOUTHOLD, N.Y. 11971 TEl..: 765-1802 · .~-.-.~--~,... ,~' , .~~.-'~. . ~ ~_ . ·. ~~,-,...; .... (Building Inspectoz) AI~ICAT~I. ON: ~OR BU I LDI NG PERM IT a. This application must be completely idled in by typewriter orin ink and submitted to the Bulldin~ Inspector, with 3 sets of plans, accurate, plot plan to scale. Fee accordin~ to schedule. b. Plot plan showin~ location of lot and of buildin~ on premises, relationship to adjoinin$ premises or public streets or areas, and ~iving a deteiled description of layout of pwperty must be drawn on the dis~r~m which is part of this appli- cetion. c. The work covered by this application may not be commenced hefor0 issuance of Building Permit. d. Upon approval of this application, the Building ~ 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 ~ have been ~mted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Dep~h~mnt for the issuance of a Bulid/mg Permit pursuant to the Buildin~ Zo~ Oe/ia~ce of the Town of Southold, Suffolk County, New York, and other aptgicable Laws, Ordinances or R~htio~, f~ the construction of building, additions or alterations The applicant ~ to comply with all ap.p. licable laws, ordinance~,~ admit authorized inspectors on premises and m building for neee~ .5'~ or for removal or demolition, ~s herein described. code, housing code~ and re~$alations, and to nature of applicant, or. n)dfie, if a corporation) -- (Mailing addres~ of applicant) State w~.~ther applicant is owner, lessee, a~ent, architect, engineer, ~eneral contractor, electrician, plumber or builder. Name of owner of premises...~/}~.~.--~.....~2JAT~, l~. ,i .............................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer· (Name and t/fie of cgrporate 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 work will be done .......... ~ ........... / ................. .................................................................................. House Number Street Hamlet County Tax Map No. 1000 Section .... ~ ........... Block ...... ! ......... '.. Lot .... ! ''~ Subdivision ......(Name) Filed Map No. Lot ~, ............. 2. State existing use and occupancy of premises and intended use a.n. d occul~ancy of proposed consttuction: a. Emsting use and occ~p. Yan¢ ................... v/.~... ~ .... ., ........................ ~, ~-~ ." .............. ~... ~"~.. ~ ~!.:'" ,.~.~,/~ ~ 3. Nature: of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair: .............. Removal .............. Demolition .............. Other Work ............... ' (D ripti ) i ~ esc on 4. Estimated Cost .............................. Fee ................................. (to be paid on filing this application) 5. If dwelling, number of dwelling ¢nits ............... Number o f dwelling units on each floor ................ If garage, number of cars ..... ! ................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each typo of use ....... 7. Dunens~ons af ex~stmg structureS, if any Front (~ Rear ~ (~ Denth ~.~.' HeightI . .~. [ ~ ..... Number of Stories ........ l ................ ~ .................... ~ .......... DimenSions of samr/~ectructure with alterations or additions: Front ..... ~.(P.: ....... Rear .. ff...~ ' . ..... Depth .................... ~:.. Hei~lt ..... /.'k.~ .~. ~t ... Numbero~tStories ..... /... /. . 8. Dimensions of entire new construction' Front .~. ~ ~? Rear ¥.t ~- De th ~ .......... Height ... J0 .......... Num, ber of Stories ........ {.. ..................................... ,9. Size of lot: Front ....... -]ir0.1 ........... Rear /.'.0~.'. ............ Depth ....... 10. Date o~ PurchaSe ........... :'. ................. Name ~f Forme~ Owner ............................. 11. Zone Or use district in which premises are situated ........ /ffCt~//).Ot/~-/..~. ............... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ~ ........................ 13. Will lot be regraded ....... '~,'~' · 'z '~"-'" .... tr ..... Will exce_s~ fill be removed from premise'~:., Ye~ ~ ' No Name of Owner of premises ~/~4el~. /¢0.~..A~..~t Address ..~ ~[~.. /'g-- PhoneNo ' ........... ' ./.0[~0~, ~i . ] it[ i~ [ ..... Phone No' ~7'~'' '~' ....... 14. N~tme of Architect .... ~...~"¥....,.. ]]Address Name Of Contractor..~.l~. [~./~.~{ffS'[ ~>2 ........ Address ./.~..C .~SfiO.. ~lJ~J~[:::: Phone Sci PLOT DIAGRAM Locate Clearly and distinctly all lbuildings, whether existing or proposed, and~ indicate all set-back dimensions from property lines. Give street and block r~umber o ..... r descnphon accordmg to deed, and show street names and ~nd~cate whether interior or corner lot. Term E~plres M~rch' ~0, STATE OF B!EWkYORK, COUNTY O~~.~! ~t~x ix,x. ........ ~ .':-e'~ ~-..,-~e'~c'r ~ ................... being duly sworn, deposes and says that he is the applicant (Name of individual sig~g contract) above named.. He is the ' I (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 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 ........ day of; ....... Count.~....~.~ .~...~..-. .......... . J/(Signature of applicant)