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Home My WebLink About10361-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No .... ~9~.9 ........ Date ...0'.~.~.u..~?y..~.~ ................... ] 980. THIS CERTIFIES that the building ................................................ Location of Property ....~ 5.7.0. O~Le · Ju~Le · Lane ................... ~I~..~i~;¢.~.k,. ~q.,.~ ~'. House No. Street Hamlet County Tax Map No. 1000 Section ... '1. ~ ...... Block .... ./k .......... Lot ..... ~ ........... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·...~.Llgl~lO~..'1.6 ........ 1 ~.9.. pursuant to which Building Permit No ..... J.0:56.'1Z. ......... dated ... ~qlP¢l~'l:. ?.O .............. 19 79., 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 ......... ...................... P.~.fv~:e. One .l~artfl.ly. 13~el~.tng ......................... The certificate is issued to .......... ~Tolm~ .B~o~hal~cl. ................................. (owner, of the aforesaid building. Suffolk County Department of Health Approval ...~.-.$0.-.'[~... UNDERWRITERS CERTIFICATE NO .......... ~ ./~67~.6.~ .............................. Building Inspector Rev 4/79 FO]~ ~0. ~ TOWH OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL. FULL COMPLETION OF THE WORK AUTHORIZED) Building Inspector. ' ...... 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 Architect 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 s~rvey of peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of bu ildings. 3. Date of anv 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 or land use $5.00 3. Copy of certificate of occupancy $1.00 Date./.~...~. ?...~. ~.~.' .......... New Building .... .~.. ..... Old or Pre-existing Building ............ Vacant Land ............. 16-7 ' ' Hou~ No, Steer Hamlet Owner or Owners of Property ...~ ~ ~.. ~.'. ~.~.~.~ .~.%~ ....................... County Tax Map No. 1000 Section . 1.~ ....... Block .... ~ ......... Lot .... ~ ......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No..( 0.7.~i.. Date of Permit~J~/y..~.~.Applicant..~--~../~.~ ........ Health Dept. Approval . ~.--~..O...--.{ ~' .......... Labor Dept. Approval ........................ Unde~riters Approval ~1. ~. ~.~.~.~ ....... Planning Board Approval ...................... Reque~ for Temporary Certificate ..................... Final Ce~ificate ...~.. .............. Fee Submitted $. ~ ~ ..................... Construction on above described building and permit meets all applicable codes and regulations. C, 2 New York State Department of Environmental Conservation Regulatory Affairs Bldg. 40, SUNY - Room 219 Stony Brook, New York 11794 516-751-7900 Commissioner Robert F. Flacke June 8, 1979 Gary Flanner Olsen, Esq. P.O, Box 38 Main Road Mattituck, New York 11952 Re: TW 15275-0117 John Brochard Dear Mr. Olsen: As the deadline for comments for the above-referenced request for modi- fication expired June 6th, 1979 with no response, we are now able to modify the previously issued approval. This~letter shall serve as an amendment from the previously approved location of the proposed home to 48' from the marsh-upland interface . This letter and original permit must be kept on the site during the con- struction of the home. ~Very truly yours, Alternate Loca~ Tidal Wetlands Permit Administrator RLH:ll Memorandum from .... BUILDING INSPECTOR'S OFFICE TOWN OF SOUTHOLD TOWN HALL, SOUTHOLD, N. Y. 11971 765-1802 'a~ *v'"'~-'~ I t-I 5 o/..~. T I 0 t-:l Al) DI'F~r_~MAL- · ), FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ~ dc) , 19 7 ~ Application $o.,~. ~.~..~./. ......... APPLICATION FO~ BHILDI~G Date INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate 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 Tswn 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 regulations, and to admit anthorized inspectors on premises and in buildings for necessary<in~B-s~u~tions. ,~ ..... . . .(~...'~.. ~d../~. ~..~.' .~..~r oratl ' ...... (Signat ~uzd of, gpplicant~ or name, ~,.f~ co p 'p~) State whether applicant i~-,owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......... ........... iiii"i i i ................. ............................................... i~. ~i (as on the tax roll or latest ) officer. ..... .... (Name and title of corp~ate officer) Builder's License No ........................ Plumber's License No .... .- .................... Electrician's License No. ~ .................... Other Trade's License No ...................... Location of land on which propos~c[ work will be done ..................... . ............................ · House Number Street Hamlet County Tax Map No. 1000 Section .................. Block ................... Lot Subdivision ..................................... Filed Map No ............... Lot ........ (Name) State existing use and occupancy of premises and intended~ a.n.d.~cupancy of proposed construction:~r-~ ~ ~ ..'~ {/.a...4'] b. hltended use and occupancy .... : · .~. :~..~.~.. · ./~- .~. · .'fi~-. · .~~~. 3. Nature qfwork (check which applicable): New Building ....~. ..... Ad~htion ~ ....... Alteration .......... Repair Removal Demolition . .~j~i~/.(ll.]~. · Other Work ............... 4. ,~s,maa .......................... i (to be paid on filing thi~altt~li~tt[o~ .: . i . '~7 ber of dwelling units on each floor .. If garage, number of cars ..... ~. ~... · .4/~4..2 · · · ~. · .'..~ ........................................... 6. If business, commercial or mixed 9ccupancy specify nature and extent of each type of use ...................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. De,,th ........ I. Height ........... ,~ .......... Number~ of.Stories .......... ~..._.! ....... 8. Di~enli;n~ ~f,~ii~; ~ construiction: Front..· '~' '~'2'~ .... ,,. Rear. .... ~./ ....... Depth ...'~.~ ........ 9. Size of 10t: Front ..... ./.4 ?. ............ Rear ..... ./. ~ .O...? ......... Depm ... ~ .~ ................ 10. Date of Purchase ............ I ................. Na~;e of F(lrmer Owner ............................. 1.1. Zone or use district in which premises are situated .... /.~f~.~. .............................. 12. Does proposed constructi..gA[, violalte any zoning law, ordinance or regulation: . .:'~{~ .......................... 13. Will lot be regraded ...:..~:~. · · ~ ............. ~ ..... Will excess fill be removed from premises: Yes No 14. Name of Owner of premis~ . .~.~.4/..~..~.../Tf.,e.<?.) Address ....~..~.ff.~.~./(~¢.4~ .... Phone No ............... Name of Architect . . ./f~../. · ..~a.~./. ~t ......... Address ....... ?;: ............. Phone No ............... i PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all 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 ~,O.R.K~ , ,_. .~ S COUNTY,I~F ·. ~,,~ ... r-- ,,. ~.- ,~ '~~~'~': .~/' '. .............. being duly sworn, deposes and says that he is the applicant (Name o~ inaiviuua sign!ua comract) above named. ' He is the .................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul~ authorized to perform or have performed the said work and to make and file this ; that all statements conthined in this application are true to the best of his knowledge and belief; and that the ~,~ performed in the manner set forth in the application filed therewith. m to before me this .... /.?. .......... d~y o~..~<..-<~ · z ............. ..,- /I .. ,' ,hli~ . .s ,,..~ County . /Z_ · 5/ . ~ / ~//'/~Pa/~_~,, '. ,~A~Tr~ ~ L~OltmO'g.... ................... -/ ......... : .... · ,~ /,~7// c,-~,~/--'~/ NOTARY PUBLIC, State et Now Y~t~ ~ (Signature of appl, cant) ~d~.~f,x't---'/'~''-~ / Suffolk Comity No. 52-$,~92t11]~