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Home My WebLink About12763-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z13010 Date Nov. 21 8.4. THIS CERTIFIES that the building . .A.d.d.i.t..ig.n. ..................................... Location of Property . .1. 0..2.0 ................. .P.v.t.:..Rd.:. ~.3 ........... .C.u.t..c.h.o. qu..e., i'.. House No. Street Ham/et County Tax Map No. 1000 Section . .t.q 8. ....... Block .... 0..3 ......... Lot . . .1. 3.: .8 .......... Subdivision ........ .X. ..................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated .... .N.o.v. ~ ......~[ O .... ,19 .8.3. pursuant to which Brtilding Permit No ...... .1.2. 7. .6.3.Z. ........ dated .........................N°v' 21 .....19 83., was issued, and conforms to all o f the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Addition to Existing One Family Dwelling The certificate is issued to ........... SCHWARZ, ROBERT & PATRICIA (owner, te~ee~t" terrernC) of the aforesaid building. Suffolk County Department of Health Approval ........... N. [.A. ........................... UNDERWRITERS CERTIFICATE NO ................... P..e.n.d.i.n. g ....................... Building Inspector Rev. 1/81 FOUnt NO. ~ 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) 12763 Z Permission is ~....~ ~ ............................................ ~'"'~' ' hereby g rant~:L~o: ............................. .................................................................................. at premises Iocote~d at J..O...~U..~.~..'~o~.....~.;..~., County Tax Map No. 1000 Section ..... J,~...~.. ........ Block ...... ..0.....~.. ....... Lot No..J...~..'...~,...~,..~..,, pursuant to application dated .... ..~...~~.....l....~, ............ , 19.~..~, and approved by the Building Inspector. Fee $ ...................... Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall ~uthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submittedc--i~=ctuf~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 featu res. 2. Finer 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 Amhitect 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 att property tines, 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. Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling/ land use --Pr e-Exis ting C. 0. $15.00 3. Copy of certificate of occupancy $1.00 Vacant land C.0. $ 5.00 Date .......................... .4 ~.b l'TIO ,t.~. New Building ............. Old or Pre-existing Building ...b~. ........ Vacant Land ............. Location of Property /O ?- O .~.'~- ~) ~ ~ ~ .q'~¢: .l~o ~c~-. .......... House No. Street Ham/et Owner or Owners of Property ......... -.'Y.F.),. I.~ .~ .~. ..... ~.C.' -~/c) ¥.-~ ......... County Tax Map No. 1000 Section ..//.O..~. ........ Block .... .~. i~. ....... Lot.. l .~ .,. ~ .O..~... Subdivision ................................. Filed Map No ........... Lot No .............. PermitNo. l~7~.Z ........ Date of Permit /(/~../.[.~...~ ................................... Applicant Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ......... .~. ........... Fee Submitted $ .~..~?~- .................. Construction on above described ba tiding an~me~ I~/~ca/l~/e/godes and regu lations. ~L-~-- ~),,'t~ ~fl Applicant ....... ~.C~... ~.~.....~.~ .............. Rev. 10-10-78 FIELD INSPECTION COMMENTS FOUNDATION FOUNDATION 2. ROUGH FRAME & (~st) (2nd) PLUMBING INSULATION PER N. Y. STATE ENERGY QODE FINAL ADDITIONAL COMMENTS: ~Ol~f · ~o~P~ pod (N. y~. t~te 25) FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y, 11971 TEL.: 765-1803 Approved ~J ............ , 19~$ Permit No Received .......... ,q9... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT sets or a carl( shall shall Build Regu The , admi INFORMATION FOR BUILDING DEPARTMENT WE ARE OF ISSUING A CERTIFICATE OF coMPLIANCE FOR TIlE ELECTRICAL INSTALLATION AS coVERED IN AN APPLICATION FILED WITH OUR THE NEW YORK BOARD OF FIRE ~'NNDERWRITERS ~ whatever until a Certificate of Occupancy ' ' and other applicable Laws, Ordinances or %,g%s/r ¥ .. .. do oliti , as herein desc bed. ~' ~ ~~ ~ ~: ~e~e :sa.,, ms,,ac~o.,,t ~/~'' ~in~/~ °d/~d regulati°n~' and t° (Mailing address of applicant) submitted to the Building Inspector, with 3 ship to adjoining premises or public streets on the diagram which is part of this appli- race of Building Permit. lding Permit to the applicant. Such permit State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises..~ .qk:~..~....Ti. ~ .... !;..~.~[..C.{..~...~: ...... ~...~/./..~....P~...~...~x~.. ....... (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 Plumber's License No ..... .~... O..O~...~..%~r~.... Electrician's License No ..... .~.. ,~...O..t~...~3. ~ Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. ..... l.o. .~. .o. ....... >~. . L.v/. .,'):~:. . . ~. . . . ~. . .:. .......... .~. ~/?~o.c>:. ........ House Number Street Hamlet County Tax Map No. 1000 Section .................. Block .................. Lot ................... Subdivision ............... Filed Map No ............... Lot ............... :. :&'~;d~) ................ State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ... · .'~[~.~-~.~. ..... .2~...~.././.r ~. ..... .~..r~..~...~./..~..~.'~ ................... b. Intended use and occupancy · .~.~. ·~.c-~.d~. .~.O. .~). ....??.~-'. .....~ .~.~?(~..~.. · .............................. 3. Nature of work (check which applicable): New Building .......... Addition . ~ ..... Alteration ...~. ..... Repair .............. Removal .............. Demolition .............. Other Work ............... t~ _._..~ (Description) 4. Estimated Cost ...... ~50~(~ Fee..~.~. (to be paid on filing this application) 5. If dwelling, number of dwelling.units ...... '.'~ .:~. ..... Number of dwelling units on each floor ............... If garage, number of cars ........ ,.~ ............................................................. 6. If business, commercial or mixed occupancy, specify naturq and extent of each type of use ......... 7. )imensions of existing structures, if any: Front ..... .~...~ ..... Rear ...~_~..ti.. ....... Depth.. Height ..... l.~ ....... Number of Stories ............ ~. .......................................... Dimensions of same structure with alterations or additions: Front ... ~..~g.x~...,.~-. ..... Rear ................. Depth ................... ,.. Height ...................... Number of Stories ..................... 8. Dimensions of entire new construction: Front .... ~ ~., ..... Rear ....~.~, ......... Depth . ..~.. {D ......... l~eight ...... ~.~'~ ...... N~mber qf Stories ......... ~ ............................ , .....,,. ~ ......... 9. bize of lot: Front ........ ::~.~.~. ....... Rear .... ,.~ .t:~. ~. ........... Depth .... '/..~..5 ........... 10. Date of Purchase ............................. Name of Former Owner . .~.~"T4'../,4..t~.... ~O..~.. ....... ..... hp ' ' 11. Zone or use district :n wh~c rem~ses are situated ..................................................... 12. Dobs proposed construction vio'Iate any zoning law, ordinance or regulation: ... ,~.~ ....................... 13. Will lot be regraded ............................ Will excess fill be removed from premises: 't'es No 14. Name of Owner of premises ~.,.,~.e..tJp:J...~L~. 7~:.. ..... Address f~. ~.~.2..7. C.'q'.7.q...hfs.. ?. Phone No. ~..~...,~...O.$7~. Name of Architect .......................... Address ................... Phone No ................ Name of Contractor r,J~ ]~.e· .~/t q.~./g.t-././d. ...... · Address-$.~..~.~.tPL°..s.~.. Y?... i Phone No.-,5~5~./..~.&7.ZT.~.. PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and. indica property lines. Give street and block number or description according to deed, and show sb interior or corner lot. :e all set-back diml ~'et names and indi, nsions from :ate whether STATE OF NEW Y~RK.(/ above named. ....... being duly sworn, deposes and says that he is the applicant He is the ......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly 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 .......... '~' ......... /7 /'/-~-~" ..day~_~of ..... ~19.77'./~--~') · t y blic, ~;. . ~ounty JUDITH T, TERRY g0ta~ Public State of New York ' ~mi~lon Expires maroh ~0'