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Home My WebLink About12191-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildin§ Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z12~.7~ ......... Date ..... JAnUArY..:3 ............... 19 .8.4. ADDITION THIS CERTIFIES that the building ................................................ Location of Property 1295 ROBINSON I~E PECONIC House No. Street Hamlet County Tax Map No. 1000 Section ....Q98 ..... Block ..... 5. ......... Lot..........2,3,4,. ..= .~-.- Subdivision... PEq]ONIO .BAY..OAKS. ........ Fried Map No.. 3d,34..Lot No .... L.10 ..... conforms substantially to the Application for Building Permit heretofore fried in this office dated FEBRUARY 15 , 19 .8.3pursuant to which Building Permit No. 12191Z dated ...MARCHi. 6 ................. 19.83, 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 ......... For a porch & deck Addition to an existing one family dwelling The certificate is issued to CHARLES & .C.O.N~. ~.E. Leu BOCKLET (owner, lessee or tenant/ of the aforesaid building. N/A Suffolk County Department of Health Approval .......................................... N623485 UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector ........ Rev. 1/81 BUILDING',I (THIS P£RMITML)$T COMPLET~ ON ~F THE WORK BE I~pT ON ' ~rl~E 12191 Z ~t'l~remises located at ~.,.., 19.,..{:.., and approved by the Inspec~ tot FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southo;d, 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 natu raj or topographic featu res. 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. Su bm it P lan ning Board app royal of comp leted site p lan 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 ail 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. Co Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling/landuse--Pre-E×±st±ng C.Oo $15.00 3. Copy of certificate of occupancy $1.00 Vacant land C,O. $ 5.00 Date ..... I.(..'-., .'~..~..-~ ?.~). ...... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property,. !.~. ~ .~. ....... ,~. PJ2i (l~ f)...& .F~... ................ ,~.(~..C,.O..t'~..l~.,c-~ Owner or Owners of Property .... C,~V. ~ ..... ~...~...C~..t~. ! .(( ..... O....~ .0...C~ l~. C~ nty Tax Map No. 1000 Section .. ~ .~..~. ...... Block .... ~.. ....... Lot.. I.i. '~'' (' d... Subdivision..~, .(~..(~l~...ff~ .... ~..0T.~.~...FiledMapNo..~..(J.-~.LJ...LotNo...~.¢...i.0.. Permit No.[ '~,~. ~J.J .... Date of Permit ~.-.I.~.'..~'.~....Applicant..~..~..~'. i Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ..................... Request for Temporary Certificate ..................... Final Certificate ...................... Fee Submitted $ ...........' ........... ~ Construction on above described building ar~f'p~,rmit rr~'.e~ alt i~,l~iq,~ab~_X~nd ragu.,z lations. Applica~~~'~Z ............. Rev. 10-10-78 Y 0 FIELD INSPECTION DATE COMMENTS ' FOUNDATION (2nd) ___ ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ~NERGY FINAL ADDITIONAL COMMENTS: ., ~ooo~4 THE NEW YORK BOARD OF FI~ ,~ UNDERWRITERS rts BUREAU OF ELECTRICITYi~ ~- ' 8,5 JOHN STREET, NEW YORK, NEW Y~)RK 10038: THIS CERTIFIES THAT only the electrical equipment as described below and introd~ by the appllca~t ~don the abo~e applicatio~ number in t~ premlses of in the following location; ~ Basome.t Section Block Lot was exa,nlned on ~r 7 , 1983 and found to be ,n co,npg,atlce w, th the re~u,rements of th,s,, oard. ~OO~ING DSCKS OVENS DISH WASHERS EXHAUST FANS FIXTURES RANGES FIXTURE OUTLETS JECEPTACLES SWITCHES NCANDESCENT FLUORESCENT VA~ 9 5 9 __ SYSTEMS SERVICE DISCONNECT NO. OF S E R ~btors~l~ H.P., 1-F. %~~r~: 24' -0", 6--lzte.s. 1-6.8 K.W. S~ B. J.: glecC. Stillwater Ave. This cer~iflcate m~st~ not be altered in any manne~; return to the office o~ the Board }f ~nco~reFh Inspectors ma~en~~ntials. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ' SOUTHOLD, N.Y, 13971 · TEL.: 765-1803 Examined .~.~ ~.~.., 19~.'~' .~'~ Approved... f/./. ...... ?..., 19 .d(. Permit No./.~.' ./~..~.~. y APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This a~pplication 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 issue 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 Southotd, 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 regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections· .. (Signature of applicant, or name, if a cor~,~ation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer ge~-~neral contract~, electrician, plumber or builder. ........................................................ ................................ Name of owner of premises ...... .~-~.].~..5,...~....d.O. tA'.~%.~.'~. .... Lq..'x~...~'~.O.¢_~/~/,.,,[..~,..~. .... (as on the tax roll or latest deed) If aP..~.~, o~e of duly authorized officer· " (X~Zld~;~;~;/ai; ;~fi;;r') ......... Builder's License No ....... *.~.( .co...'~. ...... Il Electrician's License No ....................... Other Trade's License No ...................... a. Existing use and occupancy .. b. Intended use and occupancy Location of land on which proposed work wilt be done ........... ............. ~ ....... ~ ................ ..... l.~.. ................... ~,..~,...~.,~ ....... ,:,..~ ................................... Honse NumberStreet Hamlet County Tax Map No. 1000 Section ..... .O...~..~. ...... Block.....~· .......... Lot .... .c~..O.~...).'.~.. ..... Subdivision. .~..C 9~.4.q'- .... gC&4..~).~5.,~... Filed Map No....~).t~. ~.z[.... Lot ..... I.,..I.O .... (Name) t State existing use and occupancy of premises and intended use and occupancy of proposed construction: ' · r..... ;..d..?.~..~_ ............................................... ~.~.,: ~ ~?,-~.. ~.,~.."~..~. ~ ..~..~.. d~.~,..~ 3. Nature of work (check which applicable): New Building .......... Addition...~,... Alteration Repair .............. Rembval .............. Demolition .............. Other Work .... 4. Estimated Cost ..... "~r~~. ~ 5. If dwelling, number of dwellin~ units ......... (Description) Fee ~ (to be paid on filing this application) .... 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 ..................... .... ' ' ~ C~O. pth 7. Dmaens~ons of ex~st~ng structures, if any: Front .......... Rear .......... De ........... Height . .~,D~,.~ ......... Number of Stories ........ ~ ............................................... Dimensions of.s~¢e structure With alterations or additions: Front .... ,.~ C:~ ......... Rear ..... ~'~. .......... Depth ...... ~..~ .......... [... Height ... ~:v~r'. ~,~... ~ ......... Number of Stories ..... ~ ....... .,..,,..*.,... 8. Dimensionsof entire new const~ction: Front ..... ~ . . Rear . . ~ ~ ....... Depth .. ,,~. ~...~ ..... Height ...2~.. ........ Number_of Stories ....... iii. ii ) ...... i ....... i ........................... 9. Size of lot: Front ..... tt. ~..~..~ ......... Rear ........... /..~..~ .... l~th .... ~,Q.,: ............. 1 0. Date of Purchase ...... . ....!. · ~..~. ............ ,~ame of Fqrmer Or/ncr a.'~..~. ~ ~ ........ 1 1. Zone br use district in which p~emises are situated... ~.-{~,~ {.{~. ~ .0,4'.,/. ................... ~. ........ 12. Does proposed construction viqlate any zoning law, ordinance or regulation: ...... .~. ~.. ..................... 13. Will lot be regraded ........ i.~,~al~.~ ........... Will excess fill be remove~l from premises: Yes 1 4. Name of Owner of premises .C~. [~-&..~*. */tJ J ddress Phone No. .... l Name of Architect ...,,,, .............. ,~ ........ Address~...-=~. ........... ~/.. Phone No ................ Name of Contractor . ~-,-,~ tJ.[k~.~. ~.v~,~.. ~,~... Address . ~/~ ~ .~x~..~. · · 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 number or description according to deed, and show street names and indicate whether interior or corner lot.. ..... r .... XT~-~' ' 'j.' ,x: ~ ~ ~~ff~. berg duly sworn, deposes and says that he is the applicant t~ame oi~nu~vla~ slgmng contract) above named. He is the ....................... ~ ~ '. ~ ................................................ ~ ( ~ontract~ent, corporate officer, etc.) of smd owner or owners, ~d ~s du~y aut~to perform or have perfo~ed the said work and to m~e ~d file this application; that all statements contained '~ this application are true to the best of his knowledge and belief; and that the work will be perfomed in themann, ~r set forth in the application filed therewith. Sworn to before me this ~0~g,v ¢u~ue~t~ 0~ ,ew vorg ' / (ffignature of a hcant , ~o. $~.81~s850/Suffolk Co~ / ~mgn~ pp )