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Home My WebLink About12691-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildin§ Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z12799 Date Sept. 20 84 THIS CERTIFIES that the building .. $~.r.a.g .e..(.2...c.a.r.).. ,A.d.d.i.t..i,o,n. .................. Location of Property . 5,0,7~8 ........ C~y. Ad. #48 Street Southold House No. ' ................................... I:t~l'e~ County Tax Map No. 1000 Section .... 0.5~- .....Block ...0.6. .......... :Lot ...0.0.3.: .2 ......... Subdivision X ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .S.e!qt' :..1.9. ......., 19 .8.3. pursuant to which Building Permit No..1.2..6.9.1.Z. ............. dated ........... .O. qt.:..1.3. ........ 19 .8.3., 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 ......... (Existing Dwelling)with a Two Car Garage Addition The certificate is issued to ...... p.O.E.P,.I..N.G. ,.H.E..N.R.~,,~,n.o.r,.~ of the aforesaid building. Suffolk County Department of Health Approval ....I't/..A ................................... UNDERWRITERS CERTIFICATE NO ............ N6 '~ 5.6.5. ~ .............................. Rev. 1/81 Building Inspector lrO~ NO. ~ TO~VN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 1269 Z County Tax Mop No. 1000 Section ..... f~.~"~.~. ........ Block .....~..~. ........ Lot No..~)..C.).~.:.i..~....... Building Inspector. and approved by the Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitte~pllc~-'t~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: 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. Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling/ land 3. Copy of certificate of occupancy $1.00 use--Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Date ...--.~z~'..~. ~ .~?? .................. New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ....................... ................. ~-~ ~ ~'~ ~/ ........................ House No. Street Ham/et Owner or Owners of Property ........................................ County Tax Map No. 1000 Section .~../,~20 Block Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./.2.g.~./ ,~ Date of Permit ?//72~°~7 .Applicant /~..¢~ r~/. Health Dept. Approval ........................ Labor Dept, Approval ........................ Underwriters Approval. [~J..t~.L~...~..~..~.. ,~. ..... Planning Board' Approval ...................... R qu for Te porary Certificate Final Ce tificate e est m ..................... r ....................... Fee Submitted $ ............................. Construction on above described building and permit meets all aj~plicable codes and regulations. ~,0'-'~ i ~_,qo~q Applicant .......................... Rev, 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY THIS CERTIFIES ~HAT only the electrical equipment as described below and introduced by the applicant tmmed on t~ able application number in the premises of t~rt Doering. ~n Road~ ~uth of 27-.A~ S~{O~, N.Y. it, the/ollowlug Ioc,,tion; ~ Basement ~ 1st FI. ~ 2nd F~e Sectiort Block Lot was exatnlned on ~y ~. ~ ~ ~ and /ound to be in compliance with the requirements of this Board. FIXTURES RANGES OVENS DiSH WASHERS EXHAUSt/ FANS DRYERS SYSTEMS NO. OF FEET R C A W G, NO. OF HI-LEG OF CC. COHO, OTHER APPARATUS: George E. Densing 45 N~nkee Road Blue Point, N.Y, 11715 Li¢~, 956 GmEEAL MANAGEE ~ ..~ Per_ This certificate must not be ahered in a~y monner; return to the office of the Board if ~nco[rect. Inspectors may be identified by the;r credentials. ~ ~ COPY FOR B,U LD NG DEPARTMENT THIS COPY OF CERTIF GA~E M~S; NO~BEALT~R~, N ANY~MANNER -- FIELD .~NSPE~TION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY QODE COMMENTS FINAL I~ ¢ ADDITIONAL COMMENTS FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL File No ................................ To .//,-,~,r.r.... ~..ZP..o. ~,C:/o.9. ..... · .~4..~...~.~/c.. ~..~. PLEASE TAKE NOTICE that your application dated . .~.'./4~.~'/~.~.~.'.t~,--.....d.C..., 19 .~ for pe=it to construct · ~~.. ~ff~ZY~. · ~.. ~(JZZ~. ~d~6:~7 ..... at ~ooa~Xon o, ~o~,ty. ~r ~./&~. ~..,o.. ~. vz~' ........... ~~:~7' House No. Street County Tax Map No. 1000 Section .. ~ .07'ff ...... Block ...~ ~ ....... Lot . ~.~, .E... Subdivision ................. Filed Map No ................. Lot No .................. is returned herewith and disapproved on the following grounds../lf/,&',,~/~ ~7,/~2/.~..~?.~.. ~'.r~.~.-..&~ .~... ~&~ ~-.~ ~... ~. ~ ~".~z. ~:..~,~.. .... ,,, Build~g Inspector RV 1/80 .... .,:..,... ..... · :. i¥. 7: (Building Inspector) APPLICATION FOR BUILDING PERMIT FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Rece±ved .......... 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 Depar~tment 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 regu!ation~, and to admit authorized inspectors on premises and in building for necessary~.//~ ~ ('~ ~ //? 7 oq (Mailing address of applicant) 7 /g V/d- State whether applicant is owner, lessee, agent, architech engineer, general contractor, electrician, plumber or builder. Natne of owner of premises .../:e: Oy'.~...~:....~.qe.¥ ( .~. p ............................................... (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...~..~g~'. ~. .............. Electrician's,License No. ~..~. ~....~ .'~/(2'~'~'5 Other Trade s License No ...................... ,/ 1. Location of land on which proposed work will be done .................................................. . . .z. >. . . . .,e??. d ........................... :.,.¥.t4/.4 ......................... House Number Street Hamlet County Tax Map No. 1000 Section ....~..'~../ .......... Block ...... ~. ........... Lot...O.:9. ¢.-.~ ....... 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 .~.../~.r ~t ~' ~->' .T/..o..r~:/~ ,4~,.vq ........... ',*.'ad r~ ?m,q~.~...q .~.~. ............ b. Intended use and occupancy .............. ff..a..~.~. ~..e... ........................................... 3. Nature of work (check which a~plicable): New Building .......... Addition.. ,~ ..... Alteration .... ~... .... Repair .............. Removal .............. Demolition .............. Other Work ............. .~.' ~13000! ~ ~ .~,__~,, ~ (Description) 4. Estimated Cost , Fee ' . ..... (to be paid on filin~ this application) 5. If dwe!ling, number o f dwelling iunits ............... Number of dwelling units on each floor ................ If garage, number of cars .... q: 'F..~'??. ............................................................. 6. If business, commercial or mixed occupancy, specify natur, e and extent of each type of use ..................... 7. Dimensions o~f existin~ structures, if any: Front .... J.J ........ Rear ... ~'.4 *. ....... Depth .. ,~T~..r ........ Height . ~o.~.:....d ...... Num her of Stories ...Z .A4-. .................................. Dimensions of same strpcture w,ith alterations or additions: Front ... 9'7.$: .......... Rear ....,~.~ ......... !!epth ..... ;....4 .~. ......... Height .......... ;, ........... Number of Stories ................... 8. t~imen'sions ct entire new construction Front .... ~.~...: ..... Rear .... 24.t ........ Depth . ,,7,2. ~ ......... Height . .............. Number of Stories ..../. ................................................ 9. Size of lot: Front ..... /.~. g. :;o. .......... Rear ..... /.-3. ?.'.~. ........... Depth ~.._7~. ,../~....~...~. ?'.d.,..J? ' 10. Date of Purchase ....~'.'fi./. 7. ,~...~. ............... Name of Former Owner ~..~.~...'~..~.~[~(..~'.q~.~. 11. Zone or use district in which premises are situated ................................................. 12. Do~s proposed construction vioiate any zoning law, ordinance or regulation: . i ii~ ................ 13. Will lot be regraded ........ i ................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises /~t.~.~.3'..C.: .~.~..~.~ 1~ ~ Address*,~,~ ./~?.~ .~.~.~. ~.~4~.~YPhone No ~.?...~':.'~ Name of Architect .............. '. ~. ........... Address ................... Phone No ..... .% ~. ........ Name of Contractor ........... ?.r. ........... Address ....... .r. ~. .........Phone No ..... ~..' ......... PLOT DIAGRAM Locate clearly and distinctly al! buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block.n,u, mbor or description according to deed, and show street names and indicate whether interior or corner lot. ~,a/Y/L , g~'~,(/ - C, /?-~ 5r ~' STATE O F iNEW YORK ] S. S COUNTY OF...%?..~../~ ........ i ....... /~. ¢~.~.~/...~.:..~. ~'..v. t'~-iI ~ .................. being duly (Name of individual sign'iflg contract) above named. : sworn, deposes and says that he is the applicant He is the ......................................................................................... (Contractor, agent, corporate officer, etc.) of said owger or owners, and is duly authorized to perform or have performed the said work and to make and file this apphcatmn; that all statements continued m th~s application are true to the best of his knowledge and belief; and that the work will b~ performed in the mannir set forth in the application filed therewith. Sworn to before me this ........ ..... .............. Nota P ~~ ~ ublic~~... County ~ publiC;, 5~te Ol / / RODERI£K VAN T?~YL, P. ,~, THE W, SYSTE~ CONFO SUFFOi (si SUFFO[ SERV, CONSTI DATE:_ H.S. RE APPRO\ SUFF DIST. OWNER.~ DEED: L TEST~