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Home My WebLink About12169-zFORM NO. 4 TOWN OF SOUTHOED BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z~..q6.83 ......... Date .......... ~ay..20 ................ 19 83. THIS CERTIFIES Shat the building -Addi.t. ion ... 7~5 Osprey Nest Road ~ ~ - Gree~port Location oI ~roper[y ............................................................... House No. Street Ham/et County Tax Map No. 1000 Section . . ,~.~ ....... Block .... .6 ......... ]Lot ...... 2F~ ......... Subdivision .Clea~.es. ~.sim~; ............... Filed Map No.. 27.~2..]Lot No ..... .~2. ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... l~shruary .8 .... , 1983. pursuant to which Building Permit No..~2~[69Z .............. dated .. Ha rolo..2 ................. 198 }., 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 ......... .......... Add£~io~ .~o. axx. ex££trin~ .dwelling ................................ The certificate is issued to .. Ik;e .&. ~.8ulSn. o I~iB. sol ................................. (owner, lessee or tenant} of the aforesaid building. Suffolk County Department of Health Approval ... t$/.A ................................... UNDERWRITERS CERTIFICATE NO. I~ENI)ING ixI8768~7 Rev. 1/81 Building Inspector (THIS PERMIT MUST BE KEPT ON COJ~PLETION OF 7 ling I~sPectcir. NO; and-~3pproved by the LOT :~. ,! t FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter 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 natura~ 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: I. Accurate survey of peoperty showing all property lines, streets, buildings and unusua~ 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 requ ired to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 / ~-/e 2. Certificate of occupancy on pre-existing dwelling c~r land use 'i~/ 5.00 3. Copy of certificate of occupancy $1.00 New Building ............. Old or Pre-existing Building(X) ...... ~/Vacant Land House No,I Street Ham/et Owner or Owners of Property . .~.~ ~ .~./~.~..: .c~._._ ~,//~, .~.....//..~../?..~.<~..{~. ............... County Tax Map No. 1000 Section ....~..~: ..... Block ...... ~ ....... Lot .... .?-7.~-, ...... ./' .... Filed Map ~o ........... Lo ....... Permit ,o/~../..~ ?, .~-.. Date of Permit 7/.~../.~.Applioan, 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 permit'meets all app~cable~oodes and regulations. APplicant Rev, 10-10-78 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions A. This application must be filled in typewriter 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 Architedt 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: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling ~r land use~'/S-/ $5.00 3. Copy of certificate of occupancy $1.00 Date .. ~y ~;~_~ .. New Building ............. Old or Pre-existing Building(Z). ~ ..... ~ ZVaeent Land e .a.e .... Property ............... ....................... ~_____~,~., .~, .~,~, .~ ~. Location of HOU~ No, Street .... Owner or Owners of Property )~Z~~' ~: .~ .... [~'./2~ 5~ ......... ' ...... County Tax Map No. 1000 Section ...~ ...... Block .... ~ ........ Lot .... )~ ...... Subdvson ~<~~O[~5~edMapNo~ LotNo Permit No/~/~ q~ Date of Pe mit / 3 Health Dept. Approval ........................ Labor Dept. Approval ......................... Unde~riters Approval ........................ Planning Board Approval .................. Request for Temporary Certificate ................. :...Final Certificat~ ................. Fee Submitted $ ....................... Construction on above described building and perm i~ me~s all ap~Cabl~doS and regu lations. Rev. 10-10-78 FIELD INSPECTION FOUNDATION (1st) FOUNDATION ( 2nd ) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C~ODE FINAL COMMENTS ADDITIONAL COMMENTS: FORM NO. 1 : TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined .......... ~.~.~-..., I9..c~. Approved .......... -.~.~..x~.., 19~...~ffPermit No../..°~../...~. ? Disapproved a/c .........~--.-..-..-.-.-. (Building Inspector) APPLICATION FOR BUILDING PERNIIT Date . .~.~. ~ ~ 19 ~. 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 Department for the issuance of a Building Permit pursm/nt 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, ~t regulations, and to admit authorized inspectors on premises and in building for necessary . .. ~'~~. ,. ': .'~. ~ .... . .'rxw". ......... (Signature of applicant, or name, if a corporation) · (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~dneer, general contractor, electrician, plumber or builder. /-7 Name of owner of premises ..... /../~.Zd. Ce././ed...= ................................... (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.' ' '~' 'O' '7" ' ' '~' '~<~'~5~'~' ~' ' ~2:2~ Plumber's License No...."~ .................... Electrician's License No ....................... Other Trade's License No. 1. Location of land on which proposed work will be done .................................................. ......... ....... ....... .... House Number ' Street Hamlet ' County Tax Map No. 1000 Sectional/ ...... ~.¢~,. ...... Block .... ...~. ......... Lot...~.~. ........... Subdivision..~ ~.~.. ~.~(~.~ .... ~.~.-. g~ 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 .~. ~ ~c ~ .. ~ ~.~ .Z~ ~ b. Intended use and occupancy .............. ~.~./~ ......... ".' ......~,,~, .~'zA .................. 10. 11. 12. 13. 14. Nature of work (check which applicable): New Building .......... Addition...../-:~..... Alteration Repair .............. Removal .............. Demolition .............. Other Work .... ' ~ ~ (Description) Estimated Cost .... ~_/~.~r.*r.-x. ........................ Fee ................................. (to be paid on filing this application) If dwelling, number of dwelling iunits .... ~..~2. ?.~..... 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 ex~stlng structures, ff any' Front ~5 ~ Rear ~ ~ Denth Height .... 4 .......... Number of Stories ......... <7'~4. ~ ........... ; ............................ Dimensions of same structure with alterations or additions: Front ..... m~'..~. ....... Rear .... .~. ~..~ ....... Depth .... .~.~ .............. Height ...... ./.~. f ........... Number of Stories .... ~?~...~'..~.. ......... Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height Number of Stories . . Size of lot: Front ....... .~..~., ' Rear . ./. ~ ~. / Depth . /. ~-.~. ) [ ate of Purchase ........... ~ .................. Name of Former Owner ............................. Zone or use district in which pr6mises are situated ...... ~.--.../~..'~..~./.~.*~.-c/. rT. ~ .~ a~ ...................... Does proposed construction violate any zoning law, ordinance or regulation: ... fief. ~ ......................... Will lot be regraded ....... .~.~ ................ Will excess fill be removed from premises: Yes No Name of Owner of premises ./4.!~..~ .~.~?.~.4. ~./e~¢~ddress . .~-* .~ .~.~.~,'7...~'.)~:~Phone No. ~. ?'F.z .q. ~..sT.~?. Name of Architect .~.. ~,~.,t .-q.~../67.-. ~..~.~.<-g-.~-.. Address A,q.,.~/.I.'t'.,'.a. .~.~..~-4~¢~.e. Phone No. ?d.~.?..5.~..~.~.~..~. Name of Contractor .../q_-c'. ~ ~...~?.~..,~.<-7.~.-~.:-.... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all! buildings, whether existing or proposed, and, indicate ail set-back dimensions from property lines. Give street and block ~umber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ".S COUNTY OF....~. ~./.~ .%~. ~¢.. ...... ~./~ .~...~.~7~77. ~7:...~..'i .F~.~..~..~..~. ......... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. H isth /..7~../~. c~ (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 : .............. 8~:la ....... day ofI. ?.~lp~:p.a.r.~ ........... 19 .8.3. Notary Public, . .~ ~ g fJ~.~,~; ....... BA~A~A A. NOTARY PUBLIC. State of'New York No. 4~'3009~; ~ ,~ ,~ ~z~.rr ' '~'/~c,-~J4 (Signature of applicant) Qualified in Suffolk CountyO : Commlsston Explre~ March i30,1~...~ T~A~T z '-'i -fi-cPU I:::~LA ht Architect end Engineer's Seal and Signature only good for initial use of drawing. Changes, elterotiens m' re- visions to or re-use of drawb~s with- out Architect or Engineer's Approval voids Seal and Sigoa[ure on same, "Alteration of this Document except by an Architect or Licensed Profes- sional Engineer, is illegal", Section 720g, Subdivlsion 2, N,Y, State Education Law, ]~copper tubing is used For water distributing system; p~plng shall be o~ types K or L only AP~OY2D AS NOT~'D DATE: FEE: ~ BY: NOTIFY ~UILDI~ DEPART~EHT 7~5-1802 ~ AM TO g P~ FOR THE FOLLOWING GARRETT A. STRANG architect Main Road P, 0. Box 14~2 Southold N.Y. 516- 765 - 5455