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Home My WebLink About10282-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z. ! .3.0.1.6. .......... Dat~O.V.q r~.b.e.r.. THIS CERTIFIES that the building.. $.c.r.e. go~.cL .l~9r.c.h, ............................ LoCation of Property .7.5..B..i.l.l.a.r..d..R.d. :..&..8.9~. Pine· Tr~e .t~cl, ..... Cu.t.qhoga~ ...... House No. ' .... S~e~t ' ' Hamlet County Tax Map No. ]000 Section ! .07 ......... Block ...0.1 ........... Lot . OP.z~. ............ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·..J. 90.e..a~ ........... 19"/9. pursuant to which Building Permit No...LCl~a~. ............ dated ...... .J!~;l.e.. ~ 9 .............. 197.9., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ·..5. c..r.e.e.n.e..d.p, qr. ~..~ ~t~.cL .tO..qrle. f.ar~$ ly..clwe'L.l~.ng ........................... The certificate is issued to ........ .E.r.n.e.s..t..P.q u..1.s.qn. .................................. ~ow. er, ae~seec~-Xeoatmk x x of the aforesaid building. Suffolk County Department of Health Approval ......... .N./.A. ............................. UNDERWRITERS CERTIFICATE NO ................. .N./?. ............................. Building Inspector Rev. 1/81 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'$ OFFIGE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 10282 Z Permission is hereby granted to: ..... · '-.~¢./4~.~..~.)......~....~-..rr~.~ ................ ~x' ~"7.~ B',~','~'~/~'f P,~'~ ...................................... I.~.~..7~ ............................... ff lJ 7 t"tl ~ .... ;;~ ....... .............. to ...... ~)..~,..~. ............ ,~ ............ ~.£/.~..¢..;~.:/~.D .... ~ ~' ~ f"~/ '~' .?.. ......... ................... .~.~./~ ............ .lT../)..~.!/,.:~ ....... ~.. X~(£. L .L../...,Y..,Cm ............................................................. at premises located at ................................... ,.~ ............................ .~.. ............................................. ]L~/~ r~ pursuant to application dated ............................. .~...~....~..~...~..~., 19....~..., and approved by the Building Inspector. ......... FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ~=uthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitte~;~cctc 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 survey 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 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 / 3. Copy of certificate of occupancy $1.00 land use --Pre-Existing C.O. $15.00 Vacant land C.0. $ 5.00 Date ,, )! ..................... New Building ............. Old or Pre-existing Building ............ Vacaqt Land ............. Location of Property .. t~F:~ '~\~'~'~-(~ '~ L~'[cY'~ ~ House No. Street Ham/et Owner or Own0rs of Property .... ~.. ...................................... County Tax Map No. 1000 Section ~ Oq Block ~ t Lot. (~6::>4-' Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. ,.O..'.,~.~.'~..-~-;... Date ff Permit ! .App,icant ..... ..................... Haalth Dept. Approval ...... ~. ................. Labor ~ept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ..~ .......................... Construction on above described building and permit meets all applicable codes and regulations. Applicant..../~..~...~-~-~... ..................................... Rev. 10-10-78 TOWN OF SOUTI~tOLD OFFICE OF BUILDING INSPECTOR TOWN HALL SOUTHOLD, N. Y. 11971 TEL,. 765-1802 November 12, 1980 Richard Romeo Box 111 Southold, N.Y. 11971 Dear Sir: ~ This is to notify you that Building Permit No. 10282Z issued 6/29/79 , , to ,,add sc~egao~,,in po~6'h will expire on ..~ 12/29/80 If more time is required to complete the Job and obtain a Certificate of Occupancy, you may apply, ~y letter, for a six (6) month extension. If the work is not completed and the Certificate of Occupancy not issued after the six (6) month extension period, you are than required to apply for a new building permit. Very truly y~ours, GEORGE H. FISHER Sr. Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL.: 765-1802 Examined .... Disapproved air.. ~~2 .................... ' .............................. ~PPLIC~TIO~ FO~ BUILDING PERM IT Application NJ?..~. ?...~. ........ Date 't::g 19 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 Pen-nit. 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 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 authorized inspectors on premises and in buildings for necessary inspections~/2 ........ ..................... (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nmne of owner of premises ~c~> ~ ~ ~ (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. I I ~ Plumber's License No ..... ??.o.~. ?: ............. , ~,O o~z Electrician s License No ....................... Other Trade's License No ..... O..o.~ :4 ........... 1. Location of land on which proposed work will be done .................................................. House Number Street Hamlet ...../ ..... l ........... Lo,..¢.. ............ County Tax Map No. 1000 Section '"' · · 't'' Block ....... Subdivision ..................................... 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 ...................... ~ .............. ............................ b Intended use and occupancy ,~,~ ~ (,4r~Z~~ ~..~~ . Z 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... 4. Estimated Cost ,t~ ~' Fee ] ~9/ (Description) (to be paid on filing this application) 5 I f 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 typevof use ..................... 7. Dimensions of existing structures, if any: Front .... .k~ 7.0..~.... Rear ...k.~.?..~ ..... Depth ...~.a. ?~..~.. ...... lteight ~ k, ' ,~ ~ Number of Stories ~ Dimensions of same structure with alterations or additions: Front k, ~- - ~ *~ Rear ~ a, .,, t Depth ..... 4..~.: .a .g .......... Height ... i .~.'?..*, ............ Number of Stories ..... ~. ................ 8. Dimensions of entire new construction: Front .... L~ r.o ....... Rear .... ~. ~ .~ ....... Depth ...~?..~ P ........ Height .~.'k.*.,~ .~4 Number of Stories ~ 9. Size of lot: Front .... L~.: ,~ ............ Rear ..... !'.'57.: .~ ........... Depth ....~..'?. '..u ............. 10. Date of Purchase ............................. Name of Former Owner ............................. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... .~.~. ........................ 13. Willlot be regraded .......... ~..~ ................ Will excess fill be removed from premises: Yes ~ N~ 14. Name o f Owner of premises ~ .~q,~ .~ .~. !~.~.,~ '? * .~.... Address~?.~ ¥ ? .~':~. ~?. ~ :? ....... Phone No. '3..~..~.: .~.o,.. q .1... Name of Architect ....,.~ ....... .'T' .............. Address ....... .~. .......... Phone No. ,...~.. ..... ; .... Address ~ ~ 4,.~ ..... PhoneNo.~. ?..~...~..~.~. .... Name of Contractor/~ .~.k~ ?.~*.. ~. ~.~.~.: ......... ? .................. 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 number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW VeOR]( COUNTY OF....~..~.'.e~z... ?... . b.~ 2,9 [Ctetmetc~ [tT'rnte-o ............... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ....................... ~.~;~.~ ~ ................................................. (Contractor, agent, corporate officer, etc.) of s~d owner or owners, ~d is duly authorized to perform or have perfomed the said work and to m~e and file this application; that all statements contained ~ this application are tmo to the best of his knowledg~ and belief; and that the work will be perfomed in the m~ner set forth in the application filed therewith. Sworn to before me this .............. ~'. .... day of .... ~ ........... 19~ Nota~ Public, . ............ ~..~~ .... County ROBERT JAMES WJESEHAHN ~ ~ ....... NOTARY PUBLIC, Slofe of New York ....................... No. 52-4612739 N (Signature of applicant) Ouolifled [n Suffolk Counfy ~mmi~sion Expir~ March 80, .!