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Home My WebLink About12304-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..~?..29.'1.9. ......... Date .... g?.~P~.~.'. ?.~. ................. 190.3. THIS CERTIFIES that the building .g:.]~t)t.~.~.O3T ...................................... Location of Property . ~.0..0.8..k.w.o.o.d...&, .3.¢.5..14. e. ~. ¢.~.~.d.. ~.d[.. ........ .~Q.u.~.13.o¢~d' ........... House No. Street Hamlet County Tax Map No. 1000 Section .... .0.5.9. .... Block .... .0.2. ........Lot ....0].2. .......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in tiffs office dated .... A.~.5_.~..2..~ ........ , 19~.3.. pursuant to which Building Permit No...'1.2.3.Q ./TL.g ............. dated ...Fi.a.~. 9. .................... 19 .~.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 ......... .... 4n...&d.d. ~ .~.~.o.n...~.o..~m...e.xA. s..~.~.n.g..o.n.e...&<m.~3, y..d.w.e..~.~.~.n.g ..................... The certificate is issued to . .l~. ,..&...F~. ~.....~.~ .t~.~.S..V..~ . ~.~.Q .~]. ~. ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .IJ./& ..................................... UNDERWRITERS CERTIFICATE NO .......... ~/..g ..................................... Building Inspector Rev. 1/81 BUILDING DEPARTI~I~Ni TOWN HALL SOUTHOLD, N. Y. BUILDING, PERMITi (THIS PERMIT MUST BE KEPT ON THE PRE~IS~SUNTIL BULL THoR COMPLETION OF THE WORK AU IZED) ~.o 1230t 7 permission is hereby granted to: ~... ~.~5~.~. ...................................... .~/~:~4 ..~....~ ..... : ...... ,.?. ......... ..... ....... ~ ......... ~ ................................................................. '""~ ........ ~'""~ ................ ~ ............ t .......................... . , co~n~ ,~ ~ uo. ~oo0 s,~,o~ ........... ~... ~k .~:....~..~ ...... ~o, No.: ....................... and e, pprpp the Building Inspector. ' Building '~to~, 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 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. Bo 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 --?z"e-E×ls tlng C o O. $15.00 3. Copy of certificate of occupancy $1.00 Vacanf, ~,and C.0. ~ ~.00 , Date .~ .~..~ ~,. ~.~.~ New ~g ..... ~ ...... Old or Pre-existing Building ............ Vacant Land ............. Hou~ No. Steer Ham/et Owner or Owners of Prope~ ~ ~ ~.~. '. .'.~ ~ County Tax Map No. 1000 Section ..... ~,~ ...... Block ..... ~ ....... Lot ..... },~ ........ ~ No - Subdivision ................................. Filed Map No ........... Lot . Health Dept. Approval ..... ~ ~. .............. Labor Dept, Approval .............. -T~ ........ Unde~riters Approval ....................... Planning Board Approval ..................... Request for Temporary Certificate ..................... Final Certificate ..... ~ ................ Submitted $.. .................. Construction ~ ~_ __ , ~ '~'~' ;~J~ ':~ , on above described building~ and permit meets all applicable codes and regu.,latio~s. ,.~-~ / ~ , R~. 10-10-78 ~'~ FORM NO. 6 TOWN OF $OUTHOLD 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 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: I, 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. C. ' Fees: 1, Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling/ land use --?re-~;×±st±ng C. 0. $15 · 00 3. Copy of certificate of occupancy $1.00 Vacant land C.0. $ 5.00 Date (~) ~. '.~...~ .... j.c( .~.~, .... New ~ .......... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ~o O~-~'LOoo'~ ~2 3:~-~ L~s~:-~.~..~. 0~_c~ ~ '" House No, Street ~ Nam/et Owner or Owners of Proper .¢: .... ................ County Tax Map No. 1000 Section ..... .~-.. ?. ......Block ...... .~. ....... Lot ..... ,/..~. ....... Subdivision ................................. Filed Map No... ~ .... Lot No .............. Permit No. ~.~,°,~)... Date of Permit .~,?j,~,~..Applicant, .[~-~ ........ ,cI ........... 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 meets all applicable codes and regulations. Applicant ................................................... Rw. 10-10-78 FIE~ I~SFECTION FOUNDATION (1st) __ FOUNDATION (2nd) ROUGH FRAME & PLUMBING COMMENTS INSULATION PER N. STATE ENERGY C. ODE FINAL ADDITIONAL COMMENTS: RONALD B. DI/LENBECK~ R E., L.S. Pine Road-Wesland ,Soulhold, N.Y. 11971 LUNDBERG ~nd YOUN~ COURT STREET RIVERHF~AD, N. Y. ARTHUR H, LUNDB£RG CHARLES H. YOUNG, JR. JOHN M. KING, JR. June 28th, 19~? Mr. Charles V. Nickey~ 85-21 Lefferts Blvd~ Kew Gardens~ N.Y. Re: Title No.8760 Gagen tp Hiekey ' . Dear Mr. Hiekey:- Enclosed find survey description of the premises covered by the above numbered trsnsaction whichlis to be conveyed to you by &rthur F. Gagen. This description has beeu approved ~ us~ and upon it being used in the closing deed, objections and l[ in our report under the above number will no longer apply and will be omitted. This letter is being written directly to you because the name and address of your attorney is not available to us. A copy of this letter~ together with a copy of the enclosed survey description~is being sent to Mr. Arthur Fo Gagen. Very truly yours~ LUNDBERG & YOUNG &HL:ec enclosure 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FRAMING REMARKS: FOUNDATION 2ND [ ] !NSULATION [~' FINAL DATE ~//~/~"~//*~ INSPECTOR FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined ....... Approved .............. 7' 'ermit Disapproved a/c (Building Inspector) 'APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No. /r~='~h 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, l~qu$iqg~de, ~and regulations, and to admit authorized inspectom on premises and in building for necessa~~ ~.. ~.//.// (Signature of applicant, or name/~a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (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.. .b..-~.. ! .) ..~. ,./.I Plumber's Lic~ .......... ~... 1. Location of land on which proposed work will be done ....... ..... ............. g, ................... House Number Street Hamlet County Tax Map No. 1000 Section .... (~. ~-..~. ...... Block .... .~..?~. ........ Lot ..... ). ~., .O. ...... Subdivision .~. ........................ ;~. ......... Filed Map NO ............... Lot ............... (Name) 2. State existing use.and occ. upancy of premises and i~-e~ded use and occupancy of proposed construction: a. Existing use and occupancy .... b. ~).~.~..~-./...t~../...~ . . . .C~...~..(. l .)..r~.' .................. b. Intended use and occupancy . .~.. ~)~./51-. ~. ~-~ .... . .~?..1~..'.1~. ~ .E .d.C~.. ........................... 3. Nature of work (check which app!icable). New Building .......... Addition...~...x.. .... Alteration .......... Repair .............. Remo~al~ .............. Demolition "~,F ......... Other Work ....... .. ....... _ ~ ,i ~ ,~, /00/ (Description) 4. EstimatedCo}t...~..~...~....i ........................ Fee...~..~...~.. .......................... : (to be paid on filing this application) 5. If dweiling, number of dwelling umts ............... Num'ber of dwelling units on each floor ................ If garage number of cars .%. 6. If business, commercial or mixed ioccupancy, speedy nature and extent of each type of use ..................... 7. Dimensions of existing structuresi if any: Front ............... Rear .............. Depth ............... Height Number of Stories Dimensions of same strncture with alterations or additions: Front ................. Rear .................. Depth ..................... ~. Height ........ , ............. Number of Stories ...................... 8 Dim i ti F R D pth · ens OhS of entire new construe on: rent ............... ear ................ e ............... Height ............... Number of Stories ........................................................ 9 Size of lot: Front Rear Depth 10 Date of Purchase i 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: ................................ 13. Will lot be regraded ......... 4 .................. Will excess fill be removed from premises: Yes No 14 Name of Owner of premises Address Phone 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, an& 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 OF ./¢. ...... S.S ....................... i' ~ .................. 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 duiy 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 ..... ...... ' NOTAI~y PUtlLIC, state of/gew ¥o~ : No. 52.4§24771i ........... " ..... · .... i'''i ppl cant Commission Expires Mar~h, C L; U ~.5 I iU