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Home My WebLink About10111-zFORM NO. 4 TOWN OF SOUTEOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCupANcy No Z-23345 Date NOVEMBER 15, 1994 THIS CERTIFIES that the building Location of Propert~ 12382 MAIN ROAD House No. County Tax Map No. 1000 Section 31 Subdivision ADDITION EAST MARION, N.Y. Street Block 14 Lot Filed Map No. Lot No. Hamlet 15 conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 16, 1978 ~ursuant to which Building Permit No. 10111-Z dated FEBRUARY 21, 1979 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 SECOND STORY ADDITION TO EXISTING OWE FAMILY DWELLING. The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 HERMIT WEA'£~u~RLOW & ORS. N/A pENDiNG - NOVEM]~ER 11, 1994 N/A Build~ TOWN OF 50~THOLD 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 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. Submit Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2, Certificate of Occupancy on Pre-existing Buildinz - $100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ~ovember 15, 1994 New Construction...YJ~ ...... Old Or Pre-existing Building ................. 12382 MAIN ROAD EAST I~RION, ~ Y Locatiom of Property · ' House No. Street Hamlet ~RMIT WEATHBRLOW & ORS.' 0nwer or Owners of Property ....................... . ........... County Tax Map No 1000, Section... 31 ]4 15 · .......... Block ................ Lot ...................... Subdivision ................................ .--- Filed Map ............ Lot ................... p lOl FEB. 21 1979 K. WBATHRRLOW ermit No.. . l..l-Z .. ..Date Of Permit ..... : Applicant ........... itealth Dept. Approval ............. · .......-. . . . Underwriters Approval ....................... . . Approval ...... Planning Board .................. ~equest for: Temporary Certificate .... [ ...... ~~aFinal Ce.rtic~' ..~ !ee Submitted: $. 25.00 ~~~ ~~ ~, ~>_~_~ co 3_g I / ' " ' ¥' ..... '" ............. . TOWN OF SOUTH. OLD OFFICE OF BUILDING INSPECTOR TOWN HALL SOUTHOLD, N. Y. 11971 TEL. 765-1802 July 11, 1980 James McGar~y- Applicant 750 Liberty Lane Southold, N.Y. 11971 Dear Sir: This is to notify you that B~ilding Permit No. 1_011~Z issued . Feb. 21, ~1979 to K. Weatherlow will ox'~i~[10~ m ~ugus~ 21'; 'IV80", - . ' ....... If more time is required to complete the job and obtain a Certificate of Occupancy, you may apply, by 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 yours, GEORGE H. FISHER Sr. Building Inspector en¢l. 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 aH 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 topograph ic 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· C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling pr land use $5.00 3 Copy of certificate of occupancy $1.00 /'~,///~ · ........ New Building ............. Old or Pre-existing Building ~. ........... acant !, .......... J. · · Location of Property...//~)~.~. '.-~.'~. ........ ~/..~?../~..~.~.~.. .... ~.~. -/~../.~. ,~. · · · · House No. . treat Hamlet Owner or Owners of Property .......................................................... County Tax Map No. 1000 Section ............... Block ...............~ Lot .... ~ ........ Subdivision ................... -. , . . .~.'. ....... Filed Map No?--~--~ . .'-'~. .... Lot No....'-'~. ......... ,,~ , Perm,t No ........... Date of Perm,t .......... Apphcant ..y ....... Approval ' Health Dept· Approval ........................ Labor Dept .................. Underwriters Approva~.. ...................... Planning Board Approval .................... Request for Temporary Certificate ..................... Final Certificate ..., ./~.....,..'. ......... Fee Submitted $..~?~.61. .~. ................... Construction on above described building an~')t meets all app, licable code~,~nd reg~j~itions. Rev, 10-10-78 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 al~ buildings, property lines, streets, and unusual natural 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 0r 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 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. 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 ~-~. //,/~. ~' ?' /~__~,~. ~/~ New Building ............. Old or Pre-existing Buildin§ .: ..... 2.-~. · · Vacant Land .......... ~.. House No, J~ / _~/~ Streetcar, / Hamlet Owner or Owners of Property....~,......~.~.~.~.?.?~'~..~.~./~.//.~. · ./~, · .......................... County Tax Map No. 1000 Section ........ Block Lot ~-~ Health Dept. Approval . .' .... .~. ......... ' ....... Labor Dept. Approval ...... ~~-- ..... Underwriters Approval ~. ....................... Planning Board Approval .......... ~.~ .......... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ..... ~.~';¢? ,~. ................. ~ Construction on above described building/ad'8~rmit meets all applicabl~e.c~des an~egulations. Rev 10-10-78 ~ FORM NO. ! ~ TOWN OF SOUTHO~-D BUILDING DEPARTMENT' TO~YN CLERK'S OFFICE 5OUTHOLD, ~. Y. Examined ~CC....~.~ ............. , 19.Z~ Application No....Z~././~ .......... Approved~...~.~. ................ , 19.~. Permit No. ~.ff~..~ ....... ~~ ~/~ ~ ~ . . , //~/~ Disapproved a/c .... ~~....~~.,..:~ ............. , ..... ~ ____ _. ,a,9 ......... ....... ...................................... ...... W ......... INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to ihe 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 o~ areas, and giving o detailed description of layout ofproperty must be drawn on the diagram which is part of this applicatlon. 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 Ord nonce of the Town of Southold, Suffolk County, New York, and other op~l~cab, le Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or c-c-c-cJ~olitior), as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, hou~;~g code, ~nd regulations, and to admit authorized inspectors on premises and in buddings for geqessary inspections. / /'" ""~/" 'i~'f~'~'~'t U re o" "'~'" 3' '~'~c~ ~'r' '~ r~'~'"~' '~"~'~'~r~i'~ ~'f ........ .' / - / - (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... - ./' Nome of owner or premises .,~:......¢~.~ ...........~L~/~'m~..I..~ ................................................................................................ I~ a~iicant is a corpor~s~gnqt~¢~ of dgJy authorized officer. ':y' ..... (~"~;~Tg/f corporate officer) Builder's License No ....... ~ ....... ~..T~..:- ............. Plumber's License No .................................................... ~ Electrician's License No ...... ~ ...................................... Other Trade's License No ............................................... Location of land on which proposed work~;ill be, done.~,Mcp No.: ....... ;.:..~ .......... '., ................ Lot No ......................... Street and Number .../...°~..~..'-~.?......../.?.?.~..././.~..~/.,.,.~:'/'/''~'''''~'~'~''~'''~'/' ..................................................... Municipality State existing use and occupancy of premises , in.'er, ded use and occupancy of p,r~posed construction: a. Ex,siting and occupo cy ........ ........ ...................................... .....~. ,nteno~o use OhO occupancy ...... ..'...~...:....::.:..'~'"~'.:.: ........ :.~?:::::..~, ~_:.....~:.::::~ ................................. . 3. Natur~ of wc~rk (check which applicable): New Building .................. Addition .......:..,,Z ...... Al~eratlon ... ,.~...., ...... Repair .................. Removal Demolition .................... Other Work/.~..~..Z'..d.~.~.(..~..].~.. :~...~..,z'~... ...... .................. (Description) 4. Estimated Cost .... .~.,..(.)..O...]~.,.,: ................................ Fee ............................................................................ // (tO be paid on filing this applicatio,~, 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 ex]sting structures, if any: Front ........ ~..:~'.......~ ..... Rear .......... ~ ............. Depth .......~;..?~/... ..... Height ........... /:.~ ...... Number of Stories ....................... .~... ..................................................................................... Dimensions of ~,,~e structure with alterations o/r additions: Front .................... .~. ............ Rear ........................... Depth .......~......-'./(/ ........ He ght .......... ,.,~.....c~... ....... Number of Stories ....... ./....~--: .................. rio ~ront ~ Rea r ~ ~ Depth 8. Dimensions o!/ontire new construe' n: I- .............. ~z- ......................................................i ............ 9. .~lze of [at. Front ............ ; .................... ~ ........................................ :"~Z.: ............ ~ .......... 10. Date of Purchase ............................................... Name of Former Own? ;','r .................................................... 11. Zone or use district in which premises ore situated .......... ~"~,.'~.~../.~]-.,~..4~...~.../,~.!,./-~.,~.~.~,.~:~,- ...................................... 12. Does proposed construction/vi~late any zoning law, ordinance or regulation: ................. .,(~.., ............ ~;~,~; .............. 13. Will lot be regraded .... _.~...,,.~,~,,,,.,,.,~..,.,V)/ill excess fill be removed fro~,~arem!~es: ( );Yes (/) No 14. Name of Owner of premises ...~ ............ 2'.. ....................... d Name of Architect ............................................................ Address ....::zzu ........ o.',."~ ..... 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 b~ock number or description according to deed, and show street names and indicate whether Interior or corner lot. qTATE OF NEW YORK, //('~ c S ~'~ · .............. ;. ....... ..... (~ ..~, ~_~, ..~./..~'.,,~.//~./ ~Z" ..... being duly sworn, deposes ond soys that he is *be apphcan. of i.d, S abo~named. He is the ............................................................ (Contractor, agent, corporate officer, etc.) nors and s dui authorized ~o perform or have performed the said war, nd to make and film ~f said ?~nT.r or ,~,,v~ ,~ .... +~Y~,=~4 n this annlication are true to the best of hi~n~wledge and belie~; ant that the work will be performed in the manner set fodh in the appncation tiled tnerewlm. ~ ............. o, .................................. ....... . : ................................... LI LL_~/.,;'~ W. V,/EA,7-HE f.:¢_ LOW