The URL can be used to link to this page

Home My WebLink About12659-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z-15558 Date April 1, 1987 ALTER ADDITION TO EXISTING ONE FAMILY THIS CERTIFIES that the building ..... DWELL'%NG'. ................................. 920 George Road & New Suffolk Ave. New Suffolk, N.Y. Location of Property ............................... House No. '''' 's't/e;i .................. h~d,i.i 117 4 35 County Tax Map No. 1000 Section ............ Block ............... Lot ................. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in tkis office dated S-epteraber 21, 1983 .. pursuant to which Building Permit No. 12659 Z dated............................Oc ~; ob e r I , 1983 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 ......... ALTERATION TO ADDITION TO EXISTING ONE FAMILY DWELLING ELSIE GRATHWOHL The certificate is issued to ..................... [d~n'o'r,'l~x~Yo"tc~'lq .................... of the aforesaid building. Suffolk County Department of Health Approval N/a UNDERWRITERS CERTIFICATE NO .................. N / A N/A PLUMBERS CERTIFICATION DATED: Building Inspector Ri~v. 1/81 FOruM ~qO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12659 Z to ..................................................................................................... ~ ........ -~ ..................... at premises located · ..~...~.* CounW Tox Map No. I000 Section ........ !..(.]]. ....... Bilk .......~ ........... Lot No .....~ ......... Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR Ink, and submitted i ~ 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 unumal natural or topographic features. , 2. Final approval of Health Dept. of water supply and sewerage dlsposal-($-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 tho 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 property 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 bu'ld'ngs. 3. Date of any housing code or safety inspectio~ of buildings or premises, or other pertinent informa- tion required to prepare a certificate. 4.Vacant Land C.O. 5.updated C.O. 6. ~lteration $25.00 $ 50.00 1. Certificate of occupancy New DwellJ. ng.$25.00, Acce.,laory ;$10.00 Bustne,~.~ $50.00 2. Certificate of occupancy on pre-existing dwelling $ .50.00 3. Copy of certificate of occupancy $ 5.00, over 5 yeare $10.00 Date ..... ': .......... New C on s b r_u c~, i on ...... Old or Pre-existing Building ......................... Vacant Land Location of Property ......................................... t{ou,~e No, Street Ham/et Owner or Owner." ~f Property , · ,~.'. · ·: ................................... //'7 BIoc Lot 3 5" Count'/Tax Map No, 1000 Section ............................................ Subd~wsion.. ~.' ................ Filed Map No ...... Lot No .............. Permit No, te of Permit Aoolicant ....... Health Dept, Approval ........................ Labor Dept. Approval ........................ ' Planning Board Approval Underwriters Approval ............ , ................................... Request for Temporpry C~ertificate ......... · ........... Final Certificate .-~, .................... Fee Submitted $ · Applicant ..... -~ ~/,~.~.~; -;-; .............. a.~. 10.10.78 Co~ TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN IIALL SOUTHOLD, N.Y. 11971 TEL. 765-IE02 rhJs zn Lo adv~ne you th under build,n8 per n C no 12659Z i~s~_~.~o-~/Elsie Grathwohl o. ~0~1/~ ~or~on/ ' is completed . f'i'.~l~s~tlo.~,,~ has~ not ( X ) been done. and in order :o comp]eLe ~hia flXe, it'ia neeeaaary that ;, (;,,rc/£1cate oi Occup;~ncy bo laauod. P1eaae iill out thc cncJoaed form~ re:urn ~nme to :he above o~Eice ~ith a check for $25.00 p~)yabIe to the Torn oE 8outhold. Pteaae indicate Eo Nhom the Cer:i£1cnte of Occupancy ia to be mai~ed, and ~rr~n~e vith thla off/ce £or an inapec:~on date Occupancy or u~e ,is unlawful without a Certificate (~cc.p::ncy. !,le,~.s~. help t~ to clear up t!~ia: ma~ter so tha~ legal action doea not have to be taken. 'thank you for your prompt attention. Victor Leaaard Executive Adminiatrator VL:gnt enc]. FIEL~ INSPECTION FOUNDATION (1st) FOUNDATION (2nd) COMMENTS ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: P , v 765-X802 BUILDING DEPT. INSPECTION [~]u~UNDATION 1ST [ ] ROUGH PLBG. OUNDATION 2ND [ ] INSULATION FRAMING [ ]FINAL REMARKS: DATE ~ ' NSPECTOR .~-.-~'r,~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-18,02 Examined .. ~..] ..... 19 .~.3.. Approved . ~.....t¢~....~.. J..., 19~. Permit No..I.~. k .X~...~.. Received ....... ,19. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink find Submi'tted 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 Buildihg Zone Ordinance of the Town of Southold Suffolk County, New York,. a~d other ap~plicgble Laws, Ordinances or Regulations, for the construction of buildings, ad&tions or alteratmns~ or for re _mpval or de~fiol)fion, as herein descn ed. The applicant agrees to comply with all applicable laws, ordinances, buildi~ cod'e, housin~c~e, and regulations, and to admit authorized inspectors on premises and in building for necessa~/inspeg~i~nS(.~'~ //£ ~ ~ r~ ~ (~nat'ure of appli~fint, or name, if a corporation) State whether applicant is owne~agent, architect, engineer, general contractor, electrician, plumber OT builder. Name of owner of premises . g~'ff~.~.,..~ .'.~r'('..~'-'. 'i . ~.'....~.~f~...~.~. · .~..~..~. · '~' ........................... (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. Locationoflando~.lgchproposedworkwillbedone...~?..~...ff~.....~·,~..../~.,~...~....~.~t..~...~..~..~....~...~.~:>..... ........ ................ ................... House Number Street Hgmlet County Tax Map No. 1000 Section ...... ~ [ .'-]. ........ Block ....... .~. ......... Lot... J~.. ~ Subdivision.· .~..~7..~ .~...~..~. ~?'~.. ~.. ~-~..~. · ...... Filed Map No .... .~.~. ....... Lot.. c~ .......... . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....~...Z~.~..~.....~.,~.....~.~. ~.__.~...~.~./'..~.~ .................. b. Intended use and occupancy ...... .~. ~/5'J'_~ .~. ..... 3. Nature of work (c~eck which applicable): New Building .......... Addition .......... Alteration ~ ....... Repair ..... k~. ....... Removal .............. Demolition ......... Other Work ............... 4. Estimaied Cost ....... ~ ~,. 0'~ Fee i (to be paid on filing this application) 5. If dwel!ing, number of dwelling Cnits ..... [ Number of dwelling units on each floor... If garage number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ........... 7. Dimensions o,frexisting stmcture~, if any: Front...~.t..[..~.~._... Rear . .~.~.4-. ~N..--... Depth . ~.IF.~(~.'~.+. Cb..'7. Height . .~.[~ .q".02,..-- .... Num~ber of Stories ...,S~ .................................................. Dimensions of same structure with alterations or additions: Front . ~.~q~.. ......... Rear . .~..~-Ol~ .......... Depth !...~7~r,t'R..~. .......... j.. Height ...~.,q-tiq~- ............ Number of Stories .. ~-.~'..~..&". ........... 8 Di ~io of ti ' ' R pth · men ns en re new construction: Front ......... , ..... ear ............... De .............. Height'. ........... ~. Number oLStories .................................... c~ ~.~, '~'~,' ~ ..... 9. Size of lot: Front ..././i"0...~. . .-/-..O~.. .......Rear .../.~.O.,.~ .~..~..--~. ...... Depth ~'~ r 10. Date of Pu chase .............................. Name o_[Former Owner ............................ 1 1. Zone or use district in which premises are situated. ~.~./~J..C..(~.l.. ~-.pt~?,/~,~_.....~_2...E~.../~.~d~/.~.~j~., ........... 12. Do~s proposed c6nstructio~ violate any zoning law, ordinance or regulation: .. ~..~. ........................ 13. Will lot be regraded ......... ! ................... Will excess fill be removed from premises: ~--~?~,~ No 14. Name of Owner of premises .~..~./~. ~)'J//~/.OJt/~,.. Address/IJ~../~.~/d~{~.. 4[~,y. Phone No.."~,.~ ~../~... Name 9f Architect .......... J ................. Address ................... Phone No ................ Name of Contractor . F.~/~/I{,~. ~-, ~.~.~/f-Z', ..... Address ~.,~,Y~-./. F(-"~rT.~w. .....Phone No.c~.gO~.r ~.~..~.~... PLOT DIAGRAM Locate clearly and distinctly allI buildings, whether existing or proposed, and, indicate all set-back dimensions from property li~reet and block ,number or description according to deed, and show street names and indicate whether interior or~ STATE OF NEW.YORK, , COUNTY OF..~.'.t/~A-t~.~ · .Z~.. .... S.S Cc) ........... .~.T.~.~)~.~ ............ ..... g duly sworn, deposes and says that he is the applicant (Name of individual sig~ing contract) above named. He is the .............. ; ................................................................... · (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have perfomed the said work and to m~e and file this application; that all statements cont,~inefl ~ this application are true to the best of his ~owledge and belief; and that the work w~l be perfomed in the m~ner set forth in the application filed therewith. Sworn to before me this :of~ ~~, ~ ....... . ~d~...day 19~ ~ -' '~'" ' ~,~w~T~'~'~ County_..~~. .... '' '~ ' ~ ' ~ ~"~ YORK' ' .- ' I NOTARY PUBLIC STAT~F N~W ~u~ No 52 982~[[58 ............ ~ ' ~uah ed ~n Suffolk County ~ (Signature of ~pplicant) ~ss~on Exp~re~~Ma¢ch 30 [9~