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Home My WebLink About12288-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Ne. Z123.29 .. March 8, 1984 ................ uate ................................. 19... THIS CERTIFIES that the building Garage addition to existing dwelling 465 Tarpon Dr. Greenport Location of Property/~$s~ County Tax Map No. 1000 Section 053 .Block 05 .Lot 005 Subdivision Southold Shores Filed Map No. 3.85.3 .Lot No. 48 conforms substantially to the Application for Building Permit heretofore filed in this office dated April. 28 12288Z ..................... ,19.8.3. pursuant to which Building Permit No ...................... · dated .. Ap;:.il. 2.8. ................ 19.8.3., was issued, and conforms to aH of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... .......... ad,d. ition to existin.g dw, elling · Ga?age ................................................................. The certificate isissued to Leonard & Betty Walters (owner, lessee or tenm?t} of the aforesaid building. N/A Suffolk County Department of Health Approval .......................................... 624023 UNDERWRITERS CERTIFICATE NO .................................................. .... Buil~i~g Inspect~; Rev. 1/81 T°WN oF BUlLmN(~ D'P,~RTMi~N~ TOWN HALL SOUTHOLD, N. Y. BUILDING pERMIT' · (THIS PERMIT MUST BE KEPT ON THE PP, E~IS~S UNTIL ~ COMPLETION OF THE WORK AUTHORIZED) i :~ ILl: N~ 12288 Z ~t. ..... ~,~. ,,.[~f Permiss!on is hereby granted to: ~ }~ ,~ , ~ ...... ~ ~ ~. ' ~ ;~ ~ m....:~.~. ~..~ tO at premises located at ................. :, ............ .... ........ ..................... ................................................... ................ .......................... ~ Ta~ Map No. 1000 Section .;~ ...... Bilk .~...~ ....... t~t No. ~...~... p~rs~ant ~b application dat~ ...~~....~..,.:...~,..?~...., !9~and ~Pprov~ by the Bulldlng I~spector. ~ .... . ........... , .... ~. ~/3o/~o ~ ~: FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall ~outhold, 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 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. 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 featu res. 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 Vacant'land C.O. $ 5.00 Date... ~,~. ~, ~.~ .~. · ......... New Building .. ~ ....... Old or Pre-existing Building/~ .......... Vacant Land ............. Location of Property .. ,~..'..~ .... /, .~/~¢¢. ~/~, ,~, ........ ' House No. / , /.~. , -- ~ Street ~/ Hamlet Owner or Owners of Property · · .~. · .~, · .'. ~. · ~. .... · .~, ~~ .......................... County Tax MAo. No: 1000 Section . .~,~. ,~. ...... Block .... ~7,, ,,~,---, ...... Lot... ~, ¢~2.~, · ..... Subd,v,,,on. Ma; No. No... ...... Permit No ........... Date of Permit .......... 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 and permit/~eets all applicable codes and regulations. Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRfC)T~ THIS CERTIFIES THAT only the e~c tricot equlpmen~ as described b~ and interlaced by the applicant nom~d on the ab~ application number in the premises was exatnlned on and /ound to be in compliance with the r~quirements of this Board. FIXTURE OUTLE~[S DRYERS FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS DIMMERS SYSTEMS SERVICE DISCONNECT S E R V I C OF NEUTRAL OTHER APPARATUS= l-G, F.C. I o Tarpon ~'tve ~tMld, N.Y. llgT]. GE~R~L This certificate must not be aitered in any manner; return to the office of the Board if incorrect, Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. T~IS COPY OF C~RTIFIC MANNER. FIELD ~INSP~EC TION FOUNDATION _~(l~t) COMMENTS FOUNDATION {2nd/ 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY q?DE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180;~ · ' ' (Buil~in~Insnector) ' APPLICATION FOR BUILDING PERMIT Application No.../..c~..~..~...~. ..... Date ...7./f../.~.. ......... , 19~. 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 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 co31je, housing code, and regul}t~ions, and to admit authorized inspectors on premises and in building for necessary inspe~on, ff,/ ~,/(~g~..~'~ of applicant, or nam/~, ifa corporation) . (Mailing address of/at~'plicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· ....... ............................................... Name of owner of premises..O~-Z,'~L. ~.'.~ .~,~z~-/..~ff.~..~: ................................ (ad 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 Licens~lq~~. ...... ? .~.~.~.Z7 .... :-i. i:... Electrician's License No ....................... Other Trade's License No .... 1. Location of land on which pr6posed work will be done .................................................. . .(. ...................... , : ....................... House Number Street HaVmle t County Tax Map No. 1000 Section.... 0,~.-~5. .......... Block .... ~).~.~. .......... Lot...~.O..~. ............ Subdivision .~..~.~.~.'~." .~..~'. ............ ~1' z. Filed Map No. ~ ~..~. ....... Lot .· . ~.dv. ........ (Name) 2. State existing use and occupancy of premises and ii, tended use and occupancy of proposed construction: a. Existing use and occupancy .... ~ ............................ b. In ten d ed use and o ccup an c y ....... '~~' ~'~'~,~, ~, ~.,.~,,729 ,, (' ~ '~' ''' .... 3. Nature of work (check which applicable): New Building ..... ~ Addition.. ·../~.. ~.. Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4. EstimatedCost ........ ~.d.O~o, ~ Fee ~...~.~..~..'. (to be paid on filing this application) 5. If dwelling, number of dwelling iunits ............. ,. Number of dwelling units on each floor ................ If garage, number of cars . /t~4.4 ~ .................................................. 6. If business, commarciaiormixe~occupancy, specffy nature and extent ofeach type ofuse Depth..~. ......... 7. I)imensions of existing structures, if any: Front ..... .~./. .... Rear .............. ' ........... '/ ....... Height ............... Number of Stories ..... ~.. ................ / ................................ Dimensions of same structure w}th alterations or additions: Front ~. J~'. ... Rear ................ Depth ..... ~..~.... ........ i.. Height ...................... Number of Stories..../ .................. 8. Dimensions of ehtire new construction: Front ............... Rear ...... Depth .............. Height ............... Number of Stories ...... ~. .... 9. raze of lot: Front ....... /~ O ........... Rear ....... ,/2~../. .... i... Depth'.....~?.~?..( ........... 10. Date of Purchase .......... : .................. Name of Former Owner ............................. 11. Zone or use district in which premises are situated ............ ; ~..'. ................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .~..O ........................... 13. Will lot be regraded ...... o~r ~.~f~ ......... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises . .'..~g~..~.. ~ ~,~ Address ~6~.~n~'~. · .n ~.... ~ Phone No..~.77:/J'.~. '~ 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 NEW YORK,.-- ,'~, - - COUNTY OFde, ~'~,-:?~ ,S.S ...... C~~ '7~' ~&'~'' ~.~f~ZiJ" 72.~7.~.'.~.'~ ............. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ...................................................................... (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 manne~ set forth in the application filed therewith. Sworn to before me this ......... .......... day ........ 19~ stay t. W~L~S . .. County~ / // /~ Notary Public, ... ;~o~v ~o~ue, st~ 4 ~ ~ew~o~ .... ~' · ' //~'/Y~ I ~/' (Signature of applicant) NAP OF PF~OPEf~¥ ¢ _~U£2.VEY ED FOr2_ -- 5c)0,0 'FO I~I^IN b?.OAD 4 b NL 6B'$2' 30'v~ 120.6~0 ~ 1-a[aPON DIaIVE NOTIFY BUIL~Im 765-1802 9 AM TO 4 PM FOR, THE FOLLOWING iNSpECTIONS: FOUNDATION - ' .~. ~O FOR pOUR~ CONCRETE 2. ROUGH - F~MING & pLUMBING ~. INSU~IQN ' :" 4. FINAL - C~NSTRUCTION MUST BE CoMPLEtE FOR C: O. ~LL- C~NSTR~CTION sHALL MEET THE REqUIREMENtS:OF ~HE N.Y. ~ATE CONSTRU~ION-~ 'ENERGY CODES. NOT RESPONSIBLE DESIGN OR CON.RUCTION ERROR~. 4-::4