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Home My WebLink About10919-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.. Z.1~486 ......... Date ......... [,tag..8, ................ , 19.8l THIS CERTIFIES that the building ................................................ Location of Property ...7.. 72 ..... .~p.u.n..d y.i.o~..~.o.a.d., ......... O.r .t.e.n.~' ,..lq.e?.. ~.97.~ ...... House No. Street Ham/et County Tax Map No. 1000 Section ,..1.5. ....... Block ........ .3. .....Lot ....... .2.8. ....... Subdivision,,O,~,~e,n..~..B.7. 'bhe Sea . .Filed Map No. 2777 .&L~ 25 conforms substantially to the Application for Building Permit heretofore filed in this office dated .... 0c.tloi0ex'..3 ...... , 19. i$.Opursuant to which Building Permit No .... ] 09.1.~g ........... dated .O.c t, ob.o.~.. 15 ................ 19.80, 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 ......... One Family Dwelling The certificate is issued to ...... JOhn. l~.o.u,r o~.,s ....................................... (owner. l~a~.o& t.,e~la~t.,I . . of the aforesaid building. Suffolk County Department of Health Approval ............. J.0.-.s. 9.-.6.8' . .4[.2./.8..1..}:. ,.~....~. $1la UNDERWRITERS CERTIFICATE NO .... .~t,51 .~ J 5.8. ..................................... Rev. 1/81 FORM ~0. TOWN' OI BUILDING TOWN HALL ~ SOUTHOLD, N, Y.~ BUILDING (THIS PERMIT MUST BE KEPT ON THE p~,E~IS iS UNTIL ~ULL COMPLETIQN OF THE WORK AUTHORIZED) Permission is hereby granted to: ...../.:~zz.~..x.~c~.q.........~......~ ,o .......C.~.~...~./~..o. .... ~ ~.~.....~_,.~.~.., ....................................... , .......... ~.a'~../.~. ....... .~..~.~ o, premises located at ...~ .~.......-~'.~.-(~.-~",'~"~"~" Building Inspector. Fee (.~.~.(~.~.~. ......... ~...,~..,.,..~ ~ ............ ~ .......... , .x...~ Mop ~o. 1000 Section .... ;. $~k~L.. ~. ........ ~Lot ~o....~ ........ ..... , ....... ~--,-d ,, ;' ' ~ , , 19~; ~nd approved by the Rev. 6/30/80 nsPe~tor ~ . 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION []FRAMING ~ FINAL ~:~// REMARKS: ~J ./~.... ~~_ DATE INSPECTOI~j FIELD INSPECTION FOUNDATION (Ist) FOUNDATION (2nd) 2. C01~ENTS ROUGH FRAME & PLUMBING ~NSULATION PER N.Y. STATE ENERGY CODE - , , . ' ~DITZONAL" CO~TS :' ~ ~, 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 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 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 featu res. 2, Sworn statement of owner or previous owner as to use, occupancy and conditio~ 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-ex~sting dwelling or land use 3, Copy of certificate of occupancy $1.00 $5.O0 Date . .~p~.~.3~. ~.,..~c2.8.~. ........ New Building ××× Old or Pre-existing Building Vacant Land Location of Property . ,7.'7.5..$.o.tz.~.d.. V.~.e.~, RPP. d,. O~ien.t.¢..~,~' ............................ House No. Street Hamlet Owner or Owners of Property . ~.o.~?...~,o.u..r.~.~.s. ............................................ County Tax Map No. 1000 Section 15 Block ,3 Lot Subdivision ................................ Filed Map No.2,?.?'.7..& .... Lot No...2.5. ......... 3444 Permit No..~.qg~)~.. Date of PermitlOJ.15/B.Q .Applicant . .Iz~l~nd .~omes,. ~,nc ............ Health Dept. Approval . ~.0,'.S. 0.'.0.8. ............. Labor Dept. Approval ....~../..a ................. Underwriters ApprovalN514158 3/26,/81 Planning Board Approval yes Request for Temporary Certificate...~.o ................ Final Certificate ... ,Y.~ ................ Fee Submitted $5 .OD. ........................ Construction on above described building and permit me~ts alt app~'_~ble codes and regulations. Applicant ...~~..'~.¢'~..~..-~-~... ....................... Robert E.' - ' ''Hiltz - k~nland Homes, Inc. Rev. 10-10-78 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examine .......... , 19~.~7.O & Approve Z2 ..... , 19 Permit No. / Disapproveda/c .. ~'~-"~"'i~"'~/: APPLICATION FOR BUILDING PERMIT Application No ........... 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 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. (Signature of applicant, or name, if a corporation) ':i;9. ........ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. John Bournas Name of owner of premises .......................................................................... (as on the tax roll or latest deed) If apphcant ~s a corporation, signature of duly authorized officer· ~.~o't~,'..: t; ~ ;~. Il:: J_'~ ~ :'-.TQm;. (Name and title of corporate officer) Builder's License No. "' Plumber's License No. 5~ '1.,'~' Electrician's License No.,..- %, .: ............... Other Trade's License No ...... :. .............. I. Location of land on which proposed work will be House Number Street Hamlet 15 3 .~ County Tax Map No. 1000 Section .... ~ .......... Block .................. Lot~ .......... SubdMsion .~'/. . : ...... 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 Vc c-;~"~ b. Intended use and occupancy .... 'i 1r,,.mJ 3. Nature of work (check which applicable): New Building . x × x Addition Alteration Repair ........ ... .....Removal .............. Demolition .............. Other Work ............... ' .J/ .~ t2 (Description) · e,.o, ooo.oo 4. Estimated Cost..." ........... , ........................ Fee ............................ (to be paid on filing this application) $. If dwelling, number of dwelling u~its... ~ ........... 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 structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ..................... i. Height ...................... Numl~g of Stories ......... ,.~ ........... 8. Dimensions of entire new construction: Front .... .2.6. ........ Rear ............... Depth . .~.? ........... Height ............... Number of Stories ........... ~3 ....................... ][53 ................ 9. Size of lot: Front ............ .~.e.o ....... Rear ...................... Depth ............... 10. Date of Purchase ............ , ................. Name of Former Owner ............................. 1 I. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate 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 premises ... ~ ................ Address ................... Phone No ................ N~mae of Architect .......... ~ ................ Address ................... Phone No ................ Name of Contractor .. 1 ~ ar.~c.1 ~ .I{qm?~.~..Z.~3.c.,... Address ~9~] ~. I~.*-.~. UP)~ .... Phone No..P:9~:'.~6.~?.6 ..... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, m~d, 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 YORK, COU~Y OF .$~:(~c?]-¢ ........ ...... ~ .: ' ... ' ; .. ~eing ~uly sworn, deposes and says that he fs the applicant (Name of individual sigu~ng contract) above named· (Contractor, agent, corporate officer, etc.) of s~d owner or owne~, ~d is dul~ authorized to perfo~ or have perfo~ed the said work and to m~e and file this applieationTthat ~1 statements eont~ned ~ this application are true to the best of his knowledge and belief; ~d that the work wffl be peffo~ed in the m~ne~ set forth ~ the application filed therewith. Sworn to before me this Nota~ Public, ... 53V~ ~gJ~ ..... ,.. ............... Count Of app~c Inland Itomes~,, Inc. ~d 0 0 ..< ~8 < O~ _ >TON '0' > 0 0 7 0 -< < ~o m~ ~ o c