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Home My WebLink About10392-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No..Z~.79~ ........... Date ...... D..e.O.O.~.b.O.lg. ?.7 .............. 19.79 THIS CERTIFIES that the building ................................................ Location of Property .... .~.2fi. 5.. ~.:[.~.e.. ~l~ee ROad Cu~oho~t.les Ig.Y, House No. ' ............ '~'t/o~i ..................... [~r~l'~i County Tax Map No. 1000 Section .... 9~. ..... Block . . .~ ........... Lot ...007.o.0.'~ ...... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated .... g, llglJI/I.~ .:~cj ...... , 19 .~.~ pursuant to which Building Permit No .... .'l 0~..92Z ........... dated . ·. SOp. gellab.e.~./~ ............ 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 ......... l~,t. vat:e One Fa~atly. I)welling w/Add~.tion The certificate is issued to ~Wa..V.d[ .~.l,.8. b.~.~.~.y .............................. ........... ' ....... (owner, ~ of the aforesaid building. Suffolk County Department of Health Approval ............. .~/.R. ......................... UNDERWRITERS CERTIFICATE N~ ..................... .I~../{. ~..~./~ ................... Building Inspector Rev 4/79 FOE~I NO. 2 TOWN OF $OUTNOI. D TOWN CLERK'S OFPICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) / N? 10392 Z ore .~.~~~.. ............. , ~ 7'? pursuant to application dated ...................................................... , 19...7'.~.~.., and approved by the Building Inspector. ~ ~ ' / Building Inspector December 17~ 1.°;79 Re: C.0. Z979~ D~ck: The ,T.0., ~ ~ot~d ~bove, i~sued this~da~e Please note the correct County TaxMa~ n~her on the enclosed, "09" is not'the~ ~ection for the Cutchogue ~rea. Corrected C.O. enclosed herewith. enol. FORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No...Z.~.7. 9 .~ .......... Date ....... D..eg.e.~.b...e.l,' .1.7. ............. 19.7.9 THIS CERTIFIES that the building ......... 1215 Pine Tree Location of Property House County Tax Map No. ]000 Section .... 0.?.. Block . Subdivision ............................ .~iled Map NO ......... Lot No .............. conforms substantially to the ~n for Buildih~ heretofore filed in this office dated dated September, 6 of the a Hamlet .Lot .... 0.0. ..... Private One Permit No ..... .1.0.~.9.2..Z .......... and conforms to all of the requirements this certificate is issued is ......... The certificate is issued to .. ~ F_ztwa/2d ..................... of the aforesaid building. Suffolk County Department of Health Approval ..... .I}1/~. ............................... UNDERWRITERS CERTIFICATE NO ............ ~ ./~. 5.~1~.~. } ............................ Building Inspector Rev 4/79 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 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 or land use 3, Copy of certificate of occupancy $1.00 $5.00 Date.. g~.~../../.,. 1.~ ~.~ ......... New Building ............. Old or Pre-existing Build~ng ............ Vacant Land ............. Location of Property . /.~ ! ~-- . .~.~,~-..~.~.~.~ .~o~ .~ ............................ '~'~a~'~)~m/e Hou ..... Street ; Owner or Owners of Property ... ~r ............................................ County Tax Map No. 1000 Section ............... Block . .C).d)..~ ......... Lot../:~..~..'..~.-~.... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./.O. ,~.~..~,... Date of Permit ~?.4i7~...Applicant.//[4., ~o/~¢,~..~. -~P.~. 5'. .............. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval .~, ~.-~ ~.~. ............. Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate Fee Submitted $. ~ ~.)~'-~ .................... Construction on above described building an~ meets all applicable codes and regulations. Applicant .~. ..... ZC,z~v~... ................................. U, TOWN OF SOUTNOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, H. Y. Examined~..~....,.Z. .......... , 19:~.(.~, Approved ~.,d.M....~.. .................. , Ig.~fc.:.. Permit No. D~sapproved 'a/c Inspector) APPLICATION FOR BUILDING PERMIT Date ................... . ..... INSTRUCTIONS a. This application must be completely filled in by typewriter at,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 oF areas, and giving o detailed description of layout ofproperty must be drawn on the diagram which is part of this application. 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 apphcant. 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 o 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 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, hou,,~ code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections.,///// ................. ........ ....................................... (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or butlder. Name of owner of premises -- -- if applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. I ~ (~ Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1 Location of land on which proposed work will be done. Mop No.: ....................................... Lot No ......................... Street and Number ....................... .~.W~..,.,.~?,,c.,...;~..~g;~ ...~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Exisiting use and occupancy ...... (~.¢.~t....~....£.¢.~,~..~...e, ec- ................................................................................. b. Intended use and occupancy ..... J~.('AW. .....(~.~>. .c~.- ................................................................................. 3. Nature of work (check which gpplicoble): New Building ................... Addition .i...~.. ........... Alteration ................ Repai,r .................. Removal .................. Demolition .................... Other Work ................................................... (Description) 4. Estimated Cost .... 0.~ ..................................... 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 nature and extent of each type of use ............................ 7 Dimensions of existing structur, es, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stones ................................................................................................................ Dimensions of same structure with olterahons or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ..... 15..-.9 ....................... Rear ..... ............. Depth ........ Height ...].~T.~ ....... Number,'of Stories ..... ! .............................................................................................................. 10. Date of Purchase ................. ~ ...................................... Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construchon v~olate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded ....~.9. .................... Will excess fill be removed from premises: ( ) Yes (xN) No Phone No. Name of Architect ............... ' ............................................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and Neck number or descriphon according to deed, and show street n~mes and indicate whether interior or comer Io~ STATE OF NEW~P,,I~ .. ~ S S COUNTY OF ...~.L~..'~..~...~2).~r ' .............. i .............. ..~(....t..¢-.~.~..~....~/~..,...~... ............................. be,rig duly sworn, deposes and says that he ,s the applicam (Name of individual s~gning contract) above named , ~- ,~.~ He is the ................................................................................................................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have per[armed the said work and to make and file this application that all statememts contained in this application are true to the bes~ knowledge and belief; and that the work will b~erformed in,the manner set fo~h in the application filed there~th. ~ Sworn to b~fore me/this ~, / / ........ :::: ........ .......... ................ .................... ROBERT JAMES WIESEHAHM NOTARY PUBLIC, SJqie of Ne~ Yo~k No. 5~.46J2739 Qualified in Suffolk Counly ~/ Commission Expires March 80~ 19~