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Home My WebLink About12264-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy NoZq1827 ....... Date August 3 ............................................ 1983 THIS CERTIFIES that the building . .¥ .~.~.h..a..1.t.e.~.a..~5.qn./. ?.n.c. 1. o..s.u.p.? ................ Location of Property 235 Douglas Road Orient County Tax Map No. 1000 Section . 9.2.6 ........ Block ... p.3 .......... Lot...0.0.4 ............ Subdivision ..... X. ......................... Filed Map No. X .Lot No. X conforms substantially to the Application for Building Permit heretofore filed in this office dated · .~p.~..i.1..q ............ , 19~. .3. pursuant to which Building Permit No. 12264 Z dated ..... ./i .p ?.~. 1...~ .5 .............. 198. 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...o.n.e. r .~.a.m.~. ~: ¥' .d?.? .~.~?. ~.: ................................................... The certificate is issued to EDWARD & VIOLA MOSBLECH (owner, of the aforesaid building. Suffolk County Department of Health Approval ....... ~./.A ................................ UNDERWRITERS CERTIFICATE NO ............... ~ ./.~ ................................ Building Inspector Rev. 1/81 TOWH O~ ~oU~OL~ .UlLDING DEpARTMi~N1 TOWN HALL ~ $OUTHOLD, Hi Y.~ r BUILDIHG PERMIT~ (ThiS PEPu~AIT MUST BE KE~T ON TH~ ~ms~s C~PL~ION OF THE WORK ~UT~QRI~ED) ~J Z Permission is hereby granted to: ' ~ ....... ~'~.~. ~.. .,.~ UNTIL F'uLL ............ ' at p~emise$ located at ~ , ~ .~.~. ,~, ..,~.~.._..,... CoUqty TaX Map No. 1000 Section ............ BlOCk '.i...~.~.~...;... Lot No. [ ........ pu~Oant to application dat~ ...... ~ .... ;.~ ....... ~.. ....... , 19. ,., and ~ppmv~ by the Bull~ing I~SPector. .......... R~. i6/30~80 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 Wpewriter 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 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" [end uses: 1, Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 2. Sworn statement of owner or previous owner as to use, occupancy and c~ondition 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 rjr land use{'/.5- $5.00 3. Copy of certificate of occupancy $1.00 ! ~.~.~. ,.~.. Date ........... New Building ............. Old or Pre-existing Building ~ Vacant Land location of Property .. ~.,~.C... ............................ Hou~ No. Street Ham/et Owner or Owners of P roperW .~'~2~¢~4 ~(~ ... ~g. ~/~ ~ ~ ...... ~ ~.4.4~ ~.~. ......... County Tax Map No. 1000 Section .............. Block ............... Lot .............. Subdivision ................................. Filed Ma~ ~o. ~W: .... kot ~o .............. Perm it U o./~: ~ Date of Permit .~pplicant . . Health Dept. Approval ........................ Labor Dept. Approval ..................... ~ndo~rimr~ ~pproval ........................ Plannin~ Board Approval .................... . .'-~..- Final Certificate Request for Temporary Certificate ....................................... Fee Submitted $.. ,). f ........................ Construction on above described buitding and I;m~mit,,meets all applicable cod~s aQd regulations. Applicant.. ~. ~.~../,z~...~. ~..~.~..~.~'...~.. ~. ................... FIEL~ INSPECTION COMMENTS FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & FLUMBING INSULATION PER N. STATE ENERGY ~ODE Y o FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180;3 Approve~.~..t~f~-F. _.. Disapproved a/c ..................................... ............... '7~' : " i :~' ......... '~'~ t/ .... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date ................. , 1 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 premises, 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, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspe ' . (Signature of applicant, or name, if a corporation) . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......................................... Name of owner of premises ..... .~..O.~..~..~?..~~. .C.-'/..'-~.'.... ~..~. ~../-(./~ .~.~. ....--.~.. ~ .~. .......................... (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 ..... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. 0. ?''' House Number Street Hamlet County Tax Map No. 1000 Section ~ ~O Block ~ 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 ....... .~?../.V...~..~..~. ..... ])..bU.. [ .~.~...~..~.././~...~. ............................. b. Intended use. and occupancy ........................................ ~,,~; ~ ~,L~,. ~.~- /?.;'.~ ....... 3. Nature Of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... 4. Estimated Cost ......................................................... ' 7 (to be paid on filing this application) 5. If dwelling, number of dwelling finits ............. ./. Number o f dwelling units on each floor ................ If garage, number of cars ..... I ................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............... 7. Dimensions of existing structure{, if any: Front .... JT..~. ....... Rear ....~..."~. ...... Depth. i i~.' ~ ........ Height ..../. ~.. ....... Number of Stories ..... / ................................................. Dimensions of same structure with alterations or addmons: Front ..... ~5.. ~. ....... Rear .~.~. ......... Depth .... e~,~... ~ ~....=i" Height .... /.~. .............. Number of Stories .... i)ii .............. 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ '9, Size of lot: Front ...... /.~QZ/.i .... Rear ...... ~., ,~. ........... Depth~: .A~. ~ ~_ft) ~. £~,)~2 11. Zone or use district in which pr.cruises are situated ............................ ~/.. ...................... 12. Does proposed construction violhte any zoning law, ordinance or regulation: ... ~ .......................... 13. Will lot be regraded ..... ~..~_.: ..................... Will excess fill be removejil f)'om premises: Yes No 14. Name of Owner of premises . .~.~..~./~.~.~....~.F. fi.~.~ .~.~ddress .~.f.~.~.~.~..~fi..t.t.~... Phone No..3.............' Name of Architect .......... . ................. Address ................... Phone No ................ Name of Contractor ......... i ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all lbdildings, whether existing or proposed, and, indicate ail set-back dimensions from propei~y lines. Give street and block ~umber or description according to deed, and show street names andJndicate whether interiororcornerlot, i c~J'- ~Ob t~l&Xt5 I~D /][[7Ft~toR. I,o~ STATE OF NI~RK, / COUNTy.~9, F ~... wo n, (Name of individual signin~contract) above named. He is lhe~ ~traetor~ agent, corporate officer, etc.) of said owner or owners, and is dul~ 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 manne¥ set forth in the application filed therewith. Sworn to before me this ......... ..... .... , Notary~,Pubhc, ......... ~.-~c... i~ County ~/~ ~' .............. N0~RY PUBLIC, ~(ate of New YI~R (Signature of applicant) No. 52-,~125850, Suffolk Cot~ll~. / re? Expires Uareh $0, 19_~