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Home My WebLink About10507-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy Z10~17 No ........ : ......... Date December 19 19 80 THIS CERTIFIES that the building ................................................ 1010 Hiawatha P~th, $outhold, N.Y. Location of Property ............................................................... House No. Street Hamlet County Tax Map No. 1000 Section . . .'~ ....... Block ..... 3 ......... Lot .... ~.0.~ ~ ......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated May ~, 79 1021_3 Z NOV.. 28, ............ 19.79pursuant to which Building Permit No. 1D507. Z. ............. May lZ~ 79 dated . December./4 .............. 19.. 7~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 ......... Addition to Dwelling - Wood B~rning Stove The certificate is issued to Joseph H. Kollen (o wner, ~ of the aforesaid building. Suffolk County Department of Health Approval . .N/~: ..................................... UNDERWRITERS CERTIFICATE NO....N/~ ........................................... Building Inspector Rev 4/79 FOl[l~ NO. 2 TOWN OF, $Ou~HOL~ BUILDING 'DEi)ARTMi~t? TOWN CLERK'S OFFICE SOUTHOLD, ~ Y. BUILDING PERMIT' (THIS PERM!T MUST BE KEPT ON THE PP, EMIs~S COMPLETION OF THE WORK AUTHORIZED) UNTIL FULL N? 10507 Z Permission is hereby granted to: ~ --~ ' ........ ../..~.:~.....~ ..~o. ~./~. ............ /. o~ o. . . . . ~. ~,~. ~. .,~. ~,v~ ~ . . '~.~.~ ~.~ to .../~~.~ ...... ~.o.~m ...... ~.~.~~.....~2:~.~ ....... /~ ............... .... ~z~r~.? ........ ~...~.~ ~....~.~zz~ ................................. pursuont to oppficotlon d~ted . .... ~ .... , 19 , ond opproved by Buildin~ Inspoctor. FORM NO· 6 ToWNi n~rl~n ~ r~ .~ oF ~OUT $outhold,: hLY2 11071 APPLICATION FOR CERTIFICATEOFiOCCUPANCY InstrUctions A. This application must be filled in Wpewriter OR'ink, and ~u~)m{tt~d in dudlicate to the Building Inspec- tor w~th the following; f~r new buildings or new use: 1 Final survey of propd, rty with accurate location of all bu'~ild~g~s, propeity lines, streets, and unusual natural or topographi~ features. 2JFinal approval of Health Dept. of water supply ahd sewer{ge~i~posal~(~!-9 f0rr~ or equal). 3~Approval of electrical installation from Board~bfiFi~e ~d~r~ri,ters. 4, Commerc a bud ng~, ndustria bud ngs, MUltiple ~Re~C~,bs and sim lar buildings and installa- tons, a cert~hcate or,Code comphance from the Archl~te~t ~r ~Englneer~ responsible for the buddmg. B~Submit Planning Board approval of completed si{e plan requirements wh~re apPlicable. B. F0i' existing buildings iprior to April 1957), Non-conf0r~ir~ Uses, or )3a d ngs and "pre-existing'' 1. Accurate ..survey of ~eoperty showing all property lines e buildings and unusual natural or · t. opogr~phic featu res. ' 2~ Sworn statement of o~ner or previous owner as to Use.; (~c~u~ancy and C0nditiqn of buildings· 3. Date of any housing code or safety inspection Of §u~ldin,gs ~r'premise~or other pertinent informa- tion required to prepare a certificate. C. Fees: ~ 1 Certificate of occupar~cy $5.00 2. Certificate of occupar{cy on pre-existing dwelling or land use $5,00; 3. Copy of certificate of!occupancy $1.00 ' d~te .......... New Building ........... Old or Pre-existing . ... ,~ ...... cant Land ............. House ~o. ' Stre~ Ham/et Owner or Owners of Property ..................... . ;..~ ............................... CountY:Tax Map No. 1000 ~ection ............. ; r Block ,. . ~ ...... ................. Permit No ........... Da~e of Permit .......... Apphcsnt ~,..,%, ~ ....... ....... ............... Health Dept. Approval .... ................... ,Labor DePt. ~proval . .'. .... ................. Unde~riters Approval .... ~ ................ .. iPlanhmg B~a~ Approva!j. ..................... Request for Temporary Cert,~icate .............. ' .......,F in~l ~e~tificate '. ..... ................. FeeSt~bmitted$ ...... ~ ...,. S~a~n Construction on above descri ~ed building and perr~i1~ n code d re'gulations. Rev. 10.10-78 Applicant ....... FOUNDATION FOUNDATION (end) ~0~0~ ~ pLYiNG INS~TION P~ N.Y. STATE ~GY CODE FINAL October 10, 980 Joseph H. Kollen Hiawatha's Path Southold, NeW York Dear Sir: OFFICE OF BUILDING IN~,P~¢TOR ; TEL. 765-1802 Thxs i.s to notzfy you that Building, Permit No~.. 3Z 1.ssued.___Ma.y: 4¢ 19.79 to ' , .~a~e~ wzll expire ob ..... November '4, -IVOq !.. '~ If more time ~s required to Comoieteit} Certificate of Occupancy, you m~y ap~i~ six (6) monthlextension. ~ ' If the work i~ not completed~nd theiC~ not issued after the six (6) ~month ?~t~ than required~to apply for a new bui~idi Very truly yours, Sr. Building ~nspector GHF/mw .e Job. ~d o~taln a ~, by le~tter, for a rtSfic~te of Occupancy ~ion p!eriod, you are ~g pe rm~i t. FORM NO. 1 TOWNO 71 $OUTHOLD: BUILDING DEPARTM~N~ TO~N~-HALL ! !~ SOUTHOLD, N,Y. 1197'~; XEL.: 765:1803: isapproved. c'.--. ........... · ........... ,:. ........ /" i: APPLICATION FOR BUILD'lNG ~ERMIT INSTRUCTIONS ~ a. This application must be c~mpletely filled in by t~pewriter o~ i~: iCh and Obmitted in triplicate to the Building Inspector, With 3 sets of plans, accurate plot plan to scale. E~ accord:i~g t~ Schedule. ' b. Plot plan showing location ~f lot and of bui~ldings on premises,ire!~tionship t~ adjoining premises or public streets or areas and giving a detailed description of layout of property mu~tibe ~l~awn on the diagram which is part of this appli- cation.' · c. The ~0rk covered by this application may not be commenced b¢~or~ issuance ~f Building Permit. d U~on annroval of this an~li~ation the 'Building inspector Will i~su~ ~ Buildin~ Permit to the applicant. Such permit shall be [ep':f o~n' the :premises avh~il~Ne for inspection throughoutlthe e. No building shall be occupie~d or used in whole or in part for any p~rpose wha{ever until a Certificate of Occupancy shall ha% beei~ granted by the Buil~ling Inspector. APPLICATION IS HEREBY blADE to the Building ]Dep~rtmen{ ~or ~e issuanc~ of a Building Permit pursuant to the Buildin Zone Ordinance of the Town of Southold, Suffolk Countyi New, York, and other apphcable Laws, Ordinances or Regula~ions~ for the construction ~f buildings, additions Or alto.rati°ni, o~ for remoo~al or demolition, as herein described. Th~ applic~{ agrees to comply with all applicable laws, 0~d~naneeS~ ~uil~ifig code, housing code, and regulations, and to admit authbrized inspectors on prelnises and in buildings for nec~ssar9 inspections. ..... ,..~,,.~../:..x~,.,,: ............... (Si,~n~ture of app!icant, or name,j( a corporation) ~ ! (Mailing address of applicant) State whether applicant is owner lessee, agent, architect engine*r~ ~en}r~l contractor, electrician, plumber or builder. Name of owner of premises ..... ~T~f., ..... · ............................. (as:on the ta~ r~ll or latest'deed) If applicant is a corporation, signature of duly authorized officer. [Name and title of corporate officer) Builddr's License No. . · Plumber's License No ...... ~ .................. , Electrician's License No .... , .................. Other Trades License No...? ~. ~.~f.~.~. ........ 1. Locationof land on which prot~osed work will be done: ' · ,/. ~../~!.., ~-0~7-,/-f~'¢~ · · 7~'~ ............. · .... ............. ..... ...... '. ..... : ........................ House Number i Street ! !~amlet. ' ' ' :' ' ' . . , Lot ................... County Tax Map No. 1000 Sec on .......... .~ .... .., Blo¢le .~..} !'....... Subdivision ............... ~ ................... ,. ~ Filed M~p' . .... i .... Lot ............... :. i(Name) : 2. StateeXistlnguseandoccupanCyofpremisesandlntend~d;us~an&: : : ,. troposedconstructi°n: a. Existing use and occupancy b. Intended use and occupancy i 3. Nature of work (check which applicable): New Building .......... Addition~tl''' Alteration Repair .............. Removal .............. Demolition ........ ..... [ Other Work ............... .~..~. e:~ ~'~ ~-. . /~" ~ ~. (Description) 4. Estimated Cost ........ i ................ 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 structure~, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... i · Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ! ............... Number of Stories ........................................................ Size of lot: Front ...........i .......... Rear ...................... Depth ...................... Date of Purchase : lq, a~e of Former Owner Zone or ustc.district in which premises are situated ................. · .i ........................... Does proposed construction violate any zoning law, ordinance or regulation: ....A~. O. ....................... Will lot be regraded ......... ................... Will excess fill be removed from premises: Yes No Name of Owner of premises ... ' ................. Address ................... Phone No ........ ........ Name of Architect .......... i ................. Address ................... Phone No ................ Name of Contractor ....... ~ . Address ................... Phone No ............... PLOT DIAGRAM Locate clearly and distinctly all ibuildings, 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 12. 13. 14. interior or cgrner lot. STATE OF iNEW YORK, iS.S COUNTY OF. 8l~ppot.t{ ........ .. ....... '...~,~. gOhl~EN...! .................... being duly: sworn, deposes and says that lie is th~ applicant (Name of individual sign:ing contract) above named, He is the (Contractor, agent, corporate officer, etc.) of said owfier or owners, and is duly authorized to p~rform or have performed the said work and to make and file this applicationl that all statements contained in this application are tree to the best of his knowledge and belief; and that the work will b& performed in the mannOr set forth in the application filed therewith. Sworn to b~fore me this 28f. h day o~ . Novo..mber . ., 197.9.. (Signature of applicant) ' 0.0 TEST HO£E send wet$F HIA WA THA ~, el.:l~.?' ' Well ,,,~ .; ; john SOU~HOLD ANIT,~ f(O~L;EN S~;,KE O= PIPE MAIN- 3OOO~ t R VERHEAD SAVINGS BANK ,JOSEPH H. KOLLEN ~AN TA KOLLEN , - - ~ ~knee=~ j : ~IVER~E~ N~W YO~-K- ....... ' Chie~ of uone ..... . r~-'.,'": :': -:(:, -' 'i. ;~}-~ : I NO Services , [- '