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Home My WebLink About12353-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall $outhold, N.Y. Certificate Of Occupancy No. ,Zl 176,7, ......... Date ....... ~J.un~. 3.0 .................. 19133. THIS CERTIFIES that the building ... a c c.e.a s o ~'¥.. s b e.d. ............................ Location of Property ... 362.5 ............... LezS_~e. Rd ................ ~ec.o.r~:[C ....... House No. Street Hamlet County Tax Map No. 1000 Section ... DA6 ..... Block .,. 0.4 .......... Lot ... 0D,8. .......... Subdivision ........ x ...................... Piled Map No... x ..... Lot No .... x ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated · gay. 6 ............... 19 .@3pursuant to which Building Permit No. J 22.5.3~ .............. dated ..... ~a~¢, ,3 l ................ '19 .$ 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 ......... · ~.oeee,,~ovy. ~3~ ¢~'a.g.o. ah~d .................................................... The certificate is issued to THOMAS a FELICIA GEIGER (owner, of the aforesaid building· Suffolk County Department of Health Approval ............ g/~ ........................... N/I~ UNDERWRITERS CERTIFICATE NO .................................................. Rev. 1/81 Building Inspector vow. o' soU .o BUILDING D£PAR*M~N* TOWN HALL $OUTHOLD, N. ~.o ~12353 Z Perr~ission is hereby granted to: ..... . ..~./~'~.;~., BUILDING PERMil~ (THIS PERMIT MUST BE KEI~T ON THE PRE~IS~S UNTIL ~ULL COMPLETION OF THE WORK AuTHORizED) ~ to at p~em,ses Iocoted at ...~.., .~..~j~...../w.~.~././A~. ..... 'r ........ ~'/'"~*"'~'" County Tax Map No. 1000 Section ......... . Block .~;...~.~.~... ...... ~Lot No ........ pursOarit fo application dated ..~..~...~ ...... g ................ l'"'t"'", 19 ndi: ~ approved by the Bull, ling IOspector. ' !' } Fee If..~..~.~. ............. Rev. 16/30~80 FORM NO. 6 TOWN OF SOUTHOLD I~u ilding Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY A, This application must be filled in typewriter OR ink, and subr~itted 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 equat). 3. Approval of electrical installation from Board o1: 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 8oard,approval of completed site plan requirements where applicable. B. For existing buildings (prior to Apr'ii 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 buildlngs. 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 3. Copy of certificate of occupancy $1.00 ct land u se $'15't$5.00 Date ..... , . . New Building .............~ Old or Pre-existing Building(:~) ._. ...... =/Vacant Land ' Location of Property ............ -~. ........... ........ ......./-/~- ..... .... ~ ........ Owner or Owners of Property ....O..¢~.~r~ ~-,~ l~-I/~ .~..~-!.~..~ ~'~ County Tax Map No. 1000 Section (]~) ~ (~ Block (~ /---Jr Lot Subdivision ................................. Filed Map No ........... Lot No ............... Health Dept. Approval ................... : .... Labor Dept. Approval ......................... Underwriters Approval ........................ Planning Board Approval ......... : ........ ~ .., Request for Temporary Certificate ............... : ..... Final Certificate ........ - ......... Fee Submitted $ ...................... Construction on above describedbuilding and perm~:~e/ets all appl~cable~j:odes and regulations. Rev. 10-10-78 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Sou:hold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and subr~itted in duplicate to the Building Inspec- :or 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 ins:alia- 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: I. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statoment 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 SB.00 J J~ 2. Certificate of occupancy on pre-existing dwelling pi' land use'E/Z- 5.00 3. Copy of certificate of occupancy $1.00 J Data ..... New Bui!ding .... .~. ....... Old or Pre-existing Buildlng{X) ......... = ~Vacant Land ............. Location of Property ' House No. ~ Street Ham/et County Tax Map No. 1000 Section ............... Block .............. Lot ............... Subdivision ................................. Filed Map No ........... Eot No. Permit r, o. I ..Z. Da 0 of Permit .......... Apphc nt .......... i Health Dept Approval ' LaborDept Approval Underwriters Approval ........................ Planning Board Approval ......... : ....... ~ .., Request for Temporary Certificate..., .................. Final Certificate ........ - ......... - FeeSubmtted$.....~.,. ... ........... . .... Construction on above described building and permi~tLmeets all apP!~cablg,_codes,and regulations. Applicant ., .,. ~,~:., ~.,.f. .................... Rev. 10.10-78 FIELD 'I~SPECTION COMMENTS FOUNDATION (1st) F'OUNDATION (2nd) 2. ~OUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY q~DE FINAL ADDITIONAL COMMENTS FORM ~,'1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-180:3 Disapproved a/c ............................ ~...../.. .... : ........................... (Building ~hspector) APPLICATION FO~U!LDING PERMIT INSTRUCTIONS Application No../. ?..~...~'-~.. .... Date ......... , 19 a. This application must be completely filled in by typewriter qr 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 applibation, 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 ~lterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordi. nances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (~ature of applicant, or name, if a corporation) (Mailing address 6{ applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...... 1'--7..4..~..Oap~. ..... ~.~'{ 3?. 6 . .~.....~.~.[~'/'.~ .... .~.~-/~e/S ...... (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 ............................. , ..................... .. 37..3..f. ............. Le %e cO. c. House Number Street Hamlet County Tax Map No. 1000 Section 8-6 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 .......... 4.....~. ......... '... q .............. t'~,t')~,~ tq ................ b Intended use and occupancy ./.'O.X'..~...?.L9..~.~.~...~?.~.c.~..~..~.~..~....~O..,~..../.~00.Z.~'...O.C/.'~. ............. 10. 11. 12. 13. 14. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. RemOVal .............. Demolition .............. Other Work ............... ( C{ 0 ~ /. 0 (Description) Estimated Cost ..... '. ...... , ......................... Fee .................................... : (to be paid on filing this application) If dwelling, number of dwelling units ............... 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 ............... Rear .............. Depth ............... Helghti ....... Number of Stones ................ [hmens~ons of same structure w,th alterations or additions: Front ................. Rear .................. Depth .............. . ......i.; Height ...................... Number of Stories ...................... r)imensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ Size of lot: Front ...........: ........... Rear ...................... Depth ...................... Date of Purchase ........... i .................. Name of Former Owner ............................. Zone or use district in which pr~mises are situated ....................................... .............. Does proposed construction vioiate any zoning law, ordinance or regulation: ................................ Will lot be regraded ........................... Will excess fill be removed from premises: Yes No 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 alli buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street mid block humber or description according to deed, and show street names and indicate whether interior or corner lot. .... ' .....~~Y. '. '.~'. '..'. '.; ................. being duly sworn, deposes ~d says that he is the applicant (Name of individual signing contra~t) above named. He is the ................... ~ ...................................................... (Contractor, agent, corporate officer, etc.) of said owner or owne~, ~d is dul~ author~ed to perform or have perfomed the said work and to m~e and file this application;that ~I statements contained ~ this application are true to the best of his ~owledge and belief; and that the work will be perfomed in the manne~ set fo~ in the application filed therewith. Sworn to before me this [ N0~25850, Suf~k .,m ExOi:e~ March 30, 19~