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Home My WebLink About12468-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. ~ .1 2.QQ 1. Date October 20 ... .......................................... 19 83 THIS CERTIFIES that the building addition Location of Property . .1.4.4. ~ ................ B..u.n.g.a. 1. ??..L.a. ~.e ......... ~.~.~.~.~. ~..ug.k' ...... House No. Street Hamlet County Tax Map No. 1000 Section ...1.2.3. ...... Block.03 .... ...... .... Lot....01,9........... Subdivision.. H.a.R ~..a .~.o.q k..~. ?.a.p..k ........... Filed Map No.. J .9. .... Lot No. , q. 5. .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... .J.u. 1. Ir. 7 ..........19 .8.3. pursuant to which Building Permit No .... ~..2 .45.8. Z. ........... ' dated ..... .A.u.g.u..s .~..8. ............. 19 .8 .3., 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 ......... a deck additdon to existing dwelling. The certificate is issued to .... JOHN F. & JACQUELINE BARRA ................. ?oYdd., ¥idd4 't ;d.b ...................... of the aforesaid building. not applicable Suffolk County Department of Health Approval ................. not applicable UNDERWRITERS CERTIFICATE NO .................................................. Rev. 1/81 Building Inspector TOWN OF $OUTHOLD IlUlLDING DEPARTMENT TOWN HALL SOUTHOLD, N.. Y. BUILDING PEIU~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 12468 ...... ..~..~t.~..~/...: .................................................................................................................... ....................................................... ~ .................. ~ ............................ ./...~.~4....~.~ Cour,~, Ta~ Mop ~0. ~00~ Se~on .../.~... ........ ~o~ ..~.~ ......... ~.ot ~o...~../.~ .......... pursuant to application dated ................................ , 19 and approved by the Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions 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 ail buildings, property lines, streets, and unusual natural or topographic features. 2. Fina~ approva~ 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 instaHa- 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 ail 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 or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date .. New Building ............. Old or Pre-existing Building(~) . ~ ..... = ZVacant Land ............ Location of Property :~,.~),,/~-, House No, Street Ham/et Owner or Owners of Property, .~J~.'..~.?....~7," ~ . .~..~.~'._,~', .~.Co~../.~;~.(~F'., .... ~.~ .............. County Tax Map No. 1000 Section ..... ¢:~. .... Block ....... ~ ...... Lot ..... ~ ~ ....... .... ......... Health Dept. Approval .~ ................. Labor Dept. Approval ~ .................... Unde~riters Approval .~ ................. Planning Board Approval Request for Temporary Certificate ..................... Final Certificat~ ........ Fee ~ubmitted $ ........ ~ 0~ ............. Construction on above described building and permit'meets all app~cabte~codes and regulations. ..... .... FIESD--I~SPECTION COMMENTS FOUNDATION (1st} FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: bo~ ?1 .~ CHARRETTE PRO.FORM 920PF PRINTED ON 920H CHARPRINT VELLUM YORK STATE. DEPART~NT OF ENVIP. ONI~NTAL CONSEI~VATION Regulatory Affairs Hnit . Bldg. 40, SUNY--Room 2)9~'- Stony ~ra~.- ~ '- 11794 ~- . ~ ~516) 751.-7900 .20 73- 1y l e'3 A review has been laade of your proposal to: Location: New York State Dep~rtment of Environmental Conservation has found the ~' parcel ~X~ project to beo .... Greater than 300' from inventoried tidal wetlands. greater than 100' in length constructed prior "t'0 September "26, Landward of 10' contour elevation above mean sea level on a gradual~ nat- ural slope. Landward'of topographical crest of bluff, cliff or dune in excess of 10 feet in elevation above mean sea level. Therefore, no permit under Article 25 (Tidal Wetlands of the ~nvironmental " .... Conservation Law) is required at this time since the current proposal is beyond State mandated J~risdiction pursuant to this act. However, any additional work or modifications to the project may require a permit. It is your responsibility to notify this office, in writing, if such additiollal work of modifications are contemplated. Very t~ly yours, ~ Daniel J?~kin Regional Supervisor of Regulatory Affairs DJL:RNT:cz FORM NO. 1 TOWI~ OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted 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 pr~mises, relationship to adjoining premises or public streets 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 approval 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 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 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, bulld/ng code, housing code~ and regula, tions~ and to admit authorized inspectors on premises and in building for necess~.~y..h~pecti.0ns. .~.^ ,., ~.~.~ .~..~,,.X'..~..,.4....3'.~,.... {Signature:Q$ a. pplicant, or name, if a corporation) (Mailing address of appllc/llTP~ State whether aPplicant is owner, lessee, agent, architect, engin~lectrician, plu/mb~-r~'rTuil~"er. Name of owner of premises ..... ~ .~....~..~'..~../~.~. "~: (as on the tax roll or latest deed) ~ '-~ ;~ '~'o~~;r'~- Builder's License NO... ~ ,*.¢<.,..~....~.'$.'7.~..~..... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ...... ...~ ....................................... ../ .4/.. c4'¢.'' ..................... i ...... ..... House Number Street Hamlet County Tax Map No. 1000 Section ... -re ~' ~ ....... Block ~ Lot..../~.. . .... ~ .....................,q Subdiv~ion..... ~... · ~.-.. ~'~ ................... Filed Map No...~.~ ......... Lot .... ~. ....... (N~e) 2. State existing u~ ~d occup~cy of premises and ~tended use and occupancy of propo~d cons~c~on: a. Existing use and'occ.p.cy :. .... ~h~. ~ia~' (~ b. intended Use ~d occup~cy .~.~. ................. . ........................ 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration , ~ ..... Repair .............. Removal .............. Demolition .............. Other Work ............... d~...~ (DesCription) Estimated Cost ..... ~.,~..~ .................... Fee .~. ............................... ; (to be paid on filing this application) If dwelling, number of dwellingiunits ....... [ ....... Number of dwelling units on each floor ................ If garage number of cars If business, commercial or mixed occupancy, specify nature and extent of each type of use Dimensions of existing structures, if any: Front .... .~..O .t ..... Rear ... ~ ...... Depth .. ~-~ ......... · /.'~ N mb fSt ~ Height ............. u ero ories ................................................ Dimensions of same structure with alterations or additions: Front ..... ~ Rear .................. Depth ................... ~.. Height ........ ~-h ............. Number of Stories ...................... 8. Dimensions of entire new construction: Front.. '~,~/4t.:4-'/~ · ' Re~ar .~;~.~ .... ~'5: .~e~pth ............... },t. eight ............... Number of Stories.. e...~/...~-~..... ~ .... ~_,.2~ ~ ...... 9. Size of lot: Front ...... /2t~..~ .......... Rear ...... ~'. ~.../ ....... D~pth .(./i..~ ........ 10. [)ate of Purchase ........... ............... Name of V~rmer O,-ner .... ~.. ". .......... 11. Zone or use district in which pr~mises are situated ......... /~. ~i ~ .................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........ ~ ................... 13! Will lot be regraded ... ...... ,.~1~.. ~ ............ Will excess fill~be re,~ove_d fr~m premises:, Yes No 14. Name of Owner of premises ~./.~..~ .... Address ./~.. ~ ff.~'~YPhone No. ~ ~.~...~ Name of Architect .................... Address .... Phone No ..... / Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM 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. STATE OF NEWYOllKa - ~ S S ...... i . '. '.. i'. '. '. '. '. ............ being duly ~worn, deposes and says that he is the applicant ' ( me of individual signing c~(ntract) above named. He is tlie ~& ...................... .... ............ ' ................ of said owner or owners, and is duly autho'~'l~o 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 wi/1 be performed in the manner set forth in the application filed therewith. Sworn to before me this . ........ /..' ............ :.day 0~/. ..: ....... 19C~... ......... iln'.;u ilt3 o,~allfled in Suffolk iCoun~ / %. Ill ,7,¸