The URL can be used to link to this page

Home My WebLink About12348-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Cedi{kate Of Occupancy No..~ ! ¢.0.9.5. ......... Date ...... .N.o.v.e..m.b.ey...2.9 .............. 19 .8.3. THIS CERTIFIES that the building .o;1. ~ .e.p.a. t: ~. pp. ................................... 55 Bartley Road Locatios of Property ...2.5,9. O. ............. .B.a.y.. ~.v.~ n..u ? ......... M a t t i t u c k Hou$~ NO. Street ................. ~'t~r~l'e~ Connty "/'ax Map No. 1000 Section ...~ .5.4. ...... Block 03 .Lot 023 Subdivision X .Filed Map No. X .Lot No. X conforms substantially to the Application for Building Permit heretofore filed in this office dated .... N..~.~y..5. ........... , 19 .~)~3pnrsuant to which Building Permit No.. 1236 8 Z dated ..... a.. 9y..2.5. ................ 19.8..3, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy ~r wtdch this certificate is issued is ......... ~.~.q~..qq.~p..~.~J;~. dwellin~ including ~ew windows, ~llte certificate is issued to .... DOROTHY K. FZGURNIAK (ovuner, 4*~s~,q>r.t~at~t) of the aforesaid building. Suf/blk County Department of liealth Approval .... .N./.3:. ................................ ~. ?end.in.5 UNDERWRITERS CERTIFICATE NO ............................................. Building Inspector Rev. 1/81 BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y.! BUILDING: P RMITi (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL F~ULL COMPLETION OF THE WORK AUTHC~RIZED) ~.o s2s4s z aa,. .... ~..:~:...~ ..: ~..~....., ............ , ,,.~ ...... Permission i$ hereby §ranted to: ...~....~'. ........... ,,~.~....~ ...... .~, .... ........... ,o..;...~L.~.~..~.~./...../.2~z..~....~.v.~.~~...i;....i.~ ......... i ........................................ at p~emlse$ located at ..~?~~..~... ~.~ ~~., .~.~.:: ............. · ' / ~ " 'i ; /~-~z~ ,,,- .,r,"~,~z-,,-,'~,,.- " ............ ............................................................................................. ;...;...;; ............. .,~/,~/.~. ~.~-,:.....: ......... Couflty TaX Map No. 1000 Section ..../...-~......~... ..... Block; .'~..~, '~....,~.,' ~Lot No. ,.O~.~. ........ pursOant t~o application dated ...~ ....~... ............. J....~ , 19 and approvtO by the, Building I~spector. } FORM NO. 6 TOWN OF ~OUTHOLD 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 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 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: J I. 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 ...... -j New Building Old or Pre-existing Building Lc(., Vacant Land Location of Property -7. ,)..~ ....... -~ · - - . ..... ~ OwnerorOwnersofPrope~ ,~-?~2~'~~ ...... ~,~-~(~ .... .~,~¢~ ~.~,~ ....... County Tax Map No, 1000 Section .~,. ~, .~. ,G~ .u, . Block ..... ,., ;~ ............ 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 per_mit meets all applicable codes and regulations. FIELD INSPECTION COMMENTS FOUNDATION ( 1 st) F'OUNDATION 2. (2nd) ~OUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY FINAL ADDITIONAL COMMENTS THE NEW YORK BOARD OF FIRE UNDERWRITERS ~'000~'~:[3 BUREAU OF ELECTRI~:iI'~Y ~ 85 JOHN STREET, NEW 'YORK, NEW ~ORK 10038 THIS CERTIFIES THAT I~ro~ F~, C/O Bay Aven~ in the follo~vi~g Ioc~ion{ ~ Basement ~ 1st Fl. wasexamincdon ~OV~/' ~ ~ OUTLETS SWITCHES FLUORESCENT ~ 2nd FI. Sec£ion Block Lot and found to be irt compliance with the recluiretrvertts of this Board. RANGES OVENS DISH WASHERS EXHAUST FANS DRYERS OTHER APPARATUS: V I C AW, O, OF Hi-LEG AW, G, OF NEUTRAL Per~ This certificate must not be altered in any man~e Board if i~corlect, Inspecto~ may be ~ml~ cre~h~ls. ~ ~ ' = FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined,5' . .. . 1 Approved /~ .~.~. ~.5-. ..... 1~?.~. Permit No./~.~...~?f Disapproved a/c ........... . ................. .~). · · ;~.. APPLICATION FOR BUILDING PERMIT .... INSTRUCTIONS Application No. l~t~-w~.~k~.. ...... a. Tins 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 sl/all have been granted by the Building~lnspector. 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 inspections. /~ ~, , (Signat~:~6'f~ appJi6ant, or~l~, if a corporationy (Mailing address-df applicant) //~'5- ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... .zw/2 .................................................. i ......... ............... Name of owner o f premises~).~CC~'-. ~.,.~5~...~(a s~s o~n.~i ~; iX~t,d~d~5 ~.~.. ~5~/~_~ ......... If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No.. ~ .~.~ ...... ~.t. .... o Plumber's License No ......................... Electrician's License No ....................... Other Trade's L~cense No . . ~~/~~ House Number Hamlet County Tax Map No. 1000 Section ,/.~..~., .~ff~). ...... Block .(~ ~...O..O. ....... Lot ~.c~.. 3...~.O.O. .... Subdivisi°nX~'/~9' '~2~(~' }ne~)~/-"~'Tfl~-~'~/a .... Filed Map No...¢7.t0 ..... Lot . · ../. ·~. ........ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... ~ .~.../~...~.. b. Intended use and occupancy ..... 3. Nature ofwgxk (cheek which applicable): New Building .......... Addition ........... Alteration .~'.... .... Repair, ~ ........... Remo~val .t-~"....~.~3~E~.. Demolition .............. Other Work ............... (Desc~ption) 4. Estimated Cost ..................................-- -- Fee.~..~..~ ......................... ~ (to b~ 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 ~ 6. If business, commercial or mixe~ occupancy, speedy nature and extent of each type of use ..................... 7. D~ensions of existing stmcture~, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Sto~es ........................................................ D~nsions of same structure wffh alterations or additions: Front ................. Rear .................. Depth .................... .. HeiSt ...................... Number of Stories ...................... 8. Dimensions of entire new const~ction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Siz~ of lot: Front ........... ] ........... Rear ...................... Depth ................... ~.. . 10. DateofPurchase ..~..~.~.~?~..~ ......... ~..Na~eof~o~rOwner~/~-~.~~5~l 11. Zone or use district in which promises are situated .~J~ ..................................... ~... 12. Does proposed construction violate any zoning law, ordinance or regulation: ~ ............................. 13. Will lot be regraded ~ ~..~..: ...... ~[ ........... Will excess, fil~be removed from premises: Yes 14. N~e of Owner of premises~ q .~C~ Address~ ~~one No. ~.~f.~.~.~. N~e of Architect .......... ~ ................. Address ................... Phone No ................ Nme of Contractor ......... { ................. Address ................... Phone No ................ PLOT DIAG~M Locate cle~ly ~d distinctly fll] bufld~gs, whether existing or proposed, and. indicate ail set-back d~ensions from property lines. Give street and block humber or desc~ption according to deed, and show street names and indicate whether interior or corner lot. cou zy t .....s.s '(Name of ind~idual signing contraS) above named. sthe ' ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is d~ly authorized to perform or have perfo~ed the said work and to m~e and file this application; that all statements cont~ned ~ this application are true to the best o~owledge and belief; and that the work w~l be perfo~ed in the m~ner set forth in the application filed therewith. Sworn to before me this ............ ....... ..... , _~l~H ~ ~IrL~ / ~ ~ ~ignature of applic~t) Ne. ~-8125850 Suffok Cou~v/ Term Expires Uarch 30, 19~