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Home My WebLink About10672-z FORM NQ. 4 i , TOWN OF SOUTHOLD BUILDING DEPARTMENT T own Clerk's Office Southold, N.Y. Certificate Of Occupancy Z10153 Date, . . .. ,. ., . .1?~P~~I!I1:>~:r: .??I. ..",19.89 No..,. ...'.'.' ,. THIS CERTIFIES that the building. , . . , . . . . . . . . . . . . . . . . . . . . , , . . . . . . . . . . . . . . , . . , . . . LocationofProperty ...... .'7'- .~g~J,9"\'1. .lt~!9"........ .~~1i't~~q~.............. House No Street Hamlet County Tax Map No. 1000 Section .,., .1,~~. , . .Block ...9'...., . . . . .Lot .Qq? . . . . . . . . . . . . Subdivision. . , . . . . , . , . . . , . . , , . . , . , . . . . . . ,Filed Map No. ....... .Lot No. .......,..... conforms substantially to the Application for Building PermIt heretofore filed in this office dated . . ~~~.? . . . , . . , . . , . ., 19 ,~qpursuant to which Building Permit No. .. ~9.&7.:?:2. . .. .. . .. . . dated ..,. .~~Y. :1.3., ' . , , , . . , . . . 19 . .t:!Qwas issued, and conforms to all of the requirements ,,,,..,;~ . , of the applicable provisions of the law. The occupancy for which this certificate is issued is . , . . . . . . . , . . . . . , , . .~~ !!,~~ly .I!'.'I~~:l:i~~. ,C,I?~~k. .~c:'4~.t~C?~,>, . , . . , . . . . . . . . . . , . . . . . ., . , . . . The certificate is issued to ...... Pe.+!'1. .E!~~g~A . , . . . . . . . . . . . . . . . . . , . . . . . , . . . . . . . . . . . . . (owner,le~ of the aforesaid building. i - Suffolk County Department of Health Approval ................" , . . , . . . . . . . . . . . . . . . , . . . . UNDERWRITERS CERTIFICATE NO.. . " . .. . .. , . ,. :". .. . , . . .. . . . . .. . . . .. . . . . . . . .. . . .. . /f , i /, i JL~'</' , (y/ -."L/---'/.~ t v/WI' ';1./ /. / </0 J I /,. ~ _" _ / . ...................................... .. Building Inspector Rev 4/19 , ,,,,I, ':L , j , j FORIII NO. 2 TOWN OF SOUTH OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE pREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) r:> N? 10672 Z Date ......HA.Y......I.~................., 19.([0 Permission is hereby granted to: ......qe:u.~~.G.,...4~~:>("JKt? ....~r.~.6<.Q....A.v..i?:.............. . .. , , ......~.6J.'1I/..ruc.../.c.-I..).;. .~':-:1~ ' , , . ' to ...r:..U,.IJ.t.:i.l7.GD.C:r.:..C&,....N/;)./.,?/.71.G.Ll..,7U....,ZXI:5Z.l.I.Y...(j.. ,. .....~.l.ljil~.......... .Q.<,.~.:~J?..<1/E......Z5E/.tGj.c:;/.U....,..........."...............', at premises located at 7t!.:;?7s:......,..z:;..U,r_dj~.f.a:uj.....L~r'.................. ...........,................. .................... .... .................... ...,.. .., ..,........ ....Hc.9.f.././. .7(.1..cA;..~. ..r../... .~Y... ..y,6lt.?'L<...r;.7QOt:.c9.......73:v.ft.L. .7'fI.1...,.................LQT.....TI...7...,..,....... pursuant to application dated ..YAo/-.......,7,........... ........., 19JfJ. and approved by the Building Inspector. Fee $../~.:.~... , d . FORM NO.6 TOWN OF SOUTHOLD Building Department Town Hall Sauthold, N.Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate ta 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 tapographic features. 2. Final appraval of Health Dept. of water supply and sewerage disposal-(S.9 farm or equal). 3. Approval of electrical installatian 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. Far 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 af owner or previous owner as to use, occupancy and candition af buildings. 3. Date of any hausing code or safety inspection of buildings or premises, or other pertinent informa- tian 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 Date .. . ~.f /f. f!. . . . . . . . . . . . New BUilding. . . . . . . . . . . . . Old or Pre-existing Building ...~...... Vacant land ............. Lacation af Property . ~r4~.4w.:'(/~<f.'.. ~~.. . .. . ... . .. . . . ."fM-.14k 4'.Lr'~ House No. ~ ~ Hamlet JJ Owner or Owners of Property . ./' . . . '. .l~ . . . . . . . . . . . . . . . . .. ~...................... County Tax Map No. 1000 Section ../,;J.,.-?...... Block... p.~........ Lot... .f).c? .f(..... Subdivision. .r!I:;;rr.a.toOKa. .:P\3.;r'~. , . , . .. . . . .. .Filed Map No. . ~9. .. . .. .Lot No. ... 'J.. . . . . . . . Permit No/t??>.1J.l-... DateofPermit13I<r~.. .Applicant ~ t. .l1... ..L~=.... Health Dept. Approval . . . . . . . . . . . . . . . . . . . . . . . . Labor Dept. Approval ........................ Underwriters Approval. . . . . . . . . . . . . . , . . . . . . . . .Planning Baard Approval ........ . . . . . . . . . . . . . . Request for Temporary Certificate. . . . . . . . . . . . . . . . . . . . .Final Certificate . .~. . . . . . . . . . . . . . . . . . . . Fee Submitted $~. . . . . . . . . . . . . . . . . . , . . . Construction on above described building kmit meets all applica~le cades and regulations. Applicant..... .~. }{.9.(.M:<f.?~...$}. _............ Rev. 10-10-78 Receipt #17638 9/22/80 CO #Z10152 1 . ~,~ i ,J .,A_, j TEL. 765-1802 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN HALL SOUTHOLD, N. Y. 11971 ~ August 12, 1980 to' i ~ p' George G. LessarD Grand Avenue Mattituck, N.Y. Dear Mr. Lessard: . , This is to advise you that the job under Building Permit No. 106722 . issued to D. Bergen on May 1 3. 1980 for c;i!i'ck addl taon appears to be completed as of our last inspection. Before you can legally use or occupy this structure a Certificate of Occupancy must be issued. Please fill out the enclosed form and return same to the above office. There is a fee of $5.00 for a Certificate of Occupancy Thank you for your prompt attention, Very truly yours, ~N ~~V7 GEORGE H. FISHER Sr, Building Inspector encl. _'"' ,,,,J, "- ~ 4 J _,' .,_. I ~ - - F:l:C~:!J ~ i",k>: .r, tI~rt~ .. (' _'J~__~ II C()~\=. ~j-'-,:~'r.s . ==:=-:=' _ _ _ _:-:_;:__:::=:..-=---::-=--~:_--:;...-:. _:.-:l__ ._:_;:::-:-=..~-:::::::::=--=--:=-..::;::::=..:=-~:::::;:::_:::-..::::::::::-=-~-==-.::::=:::-=::::::==::-~-=~=.:....-::-....::::..::=-- --- c' I I -. .'-:"J- 1 ~'~ . " - ~ ~--~- ."-- ::;:' i ., 1-1{ .' .._'. .__ ____-.....------.--... .__.....______.__.__ '-oJ '-I YOUNDA'E,Iqt! _ -i1s..iJ - 13 ~ l" !.I..j.):, FOUNDATION (2nd) ~ ~ I~ 2. ROUGH FRAME & i'f ~ PLUMBING · ~ . CI.1~ 3. q ~ _ m~ INSULATION PER N.Y. ~ ~ STATE ENERGY ~ ~ ~ ~. !IJ 4. s - 17/'3t' -:J- A_~~I fJ /// ,/ ~~ '7 ~ FINAL ~-/ /. 'A ' . " .4. . ~ fA P' l \ --:7 / )" D ~. ::s . m~ ADDITIONAL COM!V1ENTS: ,Ii ~1 '?i' -.--..--- ~ 1t1 ( t~ ~'-0 !IJ r1~ g~ -1- ~ , . ~l ~ IT !' . ,__ ! j, ^~. '.h_ ; f:':t; -.' K .~. (.. L :, ." ~ ~. , ,,' .I t.4. , " ~ ~.. / . OCCUPANCynR I . , ) ~"-. .tf7\>T I USE IS UNLAWfUl , , "'>.. .. I I WI1KOU1 CER1\f\CA tE , I , I I I "') bt i,t '...,.' f"D ,- r' (JJ [; c " G'J t :v 1;1 =f. ' 1"1 J> " X t> l' - '7~ t/! ~ { -I 0 , . ~ " :171 - 1\J~ ( . Ie p....>rs. <i i ..-0 b . " ~",,- I ( -. )J f b.t:!~~ . -_.~ I JK.~-() ;( )f./-vT.. :r 't z: Q "I j) ~ G If' " '" ,':=> , 271 !::::J ) ~ ' ::D '; ~ 9 .~.\ ~-fj ~(J \_' -, ,-. :-r !c' YI2.~j'''~oJ i(' 1-ov...;Q. ~ I :r , 1<;0""',* i , !f:(o! J< I~'.,,~ I I l I I I I-'Pf"~tJ1< lZ" t-I (: (\) ! r ' IN"" i , 1\ 1{ , e ". ~- . :::\ ~ I , ..- t () i a l"- . I{",~ JJ O' ,~, I _,_, ",,,,,,_"1 ~ .-/ (- - \1.,.' ~ IL o b , IXi ~ _,_ _~_ p tJ ! ~. ~ ~-"-, .....~t:- fJJ . t;'- - -- "-' - ,. -f) -t - ,.. .... i" "= ' IL. -" . tII I ,.... -. ') . .i'G 0 . I' "".'- '" . ~ /~-' - \'1 I ., , ,< ...., ~ -" lJ : ,~S~ ":;::~'~:~:~~~~ ~ ; "~~":~ .::-~~T';'-,~' ~ "",~r~:~~;~ ~~ '~::: ~,:.\~~" i """'''''':';-''''- !. . , ,,~, h~' }',.1( '" , - t. .' G, (, 1<"'-'''- , fORM NO.1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOlD, N.Y. 11971 TEL.: 765.1802 Examined HAy./..3...., 199..J Application No. rQ{lc2. . . . . . . . ApprovedH0I'I J?..,., 1Jb. Permit No.1067.lZ -- (Building Inspector) APPLICATION FOR BUILDING PERMIT Date. . m A ~. ..1. .. ., 19.~.0 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. APPLlCA TJON IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southo1d, 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~and regulations, and to admit authorized inspectors on premises and in buildings for necessaG~.f~ G GtoLJ. j.......... .. .. ..~ r... G.. . .., p,{). .... ~j.... .. . (Signatur af applicant, or name, if a corporation) G(-~d.. Q~.,., Yn 0~.~............ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . .C::-.9.~I.~.":I.":--"t"?~.,.........................,,.........................,..,.,................. Name of owner of premises ... .1::?A.l.,..f;..~ ~.~.G.I:2. N.........................,.,................... (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. -#.4-: %. .. . , . . . .. . . . . . Plumber's License No. .............. ., ,-..... Electrician's Lieense No. ........... . ,........ Other Trade's License No. ...,..........,...... 1. Location of land on which proposed work will be done. .......................,......................... . . .5.7 :J: ..,...,..~ ,V.!J ,G.J.~ .~.o.~... ..~~r.v,~......... .M.t:<: n;.t'y.c.)r.,......."......,.. House Number Street Hamlet County Tax Map No, 1000 Section ... / v? $, . . . . . . .. Block ....9.;5;.......... Lot.. Q9.?, . . . . . . . . . . Subdivision . . ' . . , . . . . . . , . . . . . . . . . . , . . . . . . . . . . . . . Filed Map No. .............. Lot............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed constructian: a. Existing use and occupancy. . .q(~li. r.A~!''-:7' .~D:( I.I./Y.~. .'. .... . . . . . .. .. ... .., .. ... . ... .. . b. Intended use and occupancy .~-:<?~.c.:.. .Wql'(. . iJ~. ~f:~~ ~;;~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . j j ~. {j, ' ~ '- .> ,.' \ ... ~ , ), 3. Nature of work (check whicp applicable): New Building . '. . . . . . . . . Addition ?,<;:=: /~.. Alteration .......... ,Repair .... . . . . . . . . . . Remqval . . . . . . . . . . . . .. Demolition .............. Other Work. . . . . . . . . . . . . . . (Description) ... -=<>. 4. EftdCt~O"'>h:> ; vF I:) ,s Ima, e os... . . . . . . . . .:. . . . . . . . . . . . . . . . . . . . . . . .. ee..............................,....... I (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 .....1,..........................,...............,....................... 6. If business, commercial or mixed occupancy, speeify nature and extent of each type of use . . . . . . . . . . . . . . . . . . . . . , 7. Dimensions of existing structur~s, if any: Front. . . . . . . . , . . . . , . Rear .............. Depth. . . . . . . . . . . . . . . Height ..........,.... Nunjber of Stories. . . . . . , . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimen~ions of same structure with alterations or additions: Front ................. Rear . . . . . . . . . . . . . . . . . . Depth . . . , . . . . . . . . . . . . , . . .1 . . Height . . . . . . . . . . . . . . . . . . . . . . Number of Stories . . . . . , . . . . . . . . . . , , . . . . 8. Dimensions of entire new consttuction: Front. . . . . . . . . . . . . .. Rear . . . . . . . . . , . . . . , Depth .. . . , . . . . . . . . . . Height ............... Nun\ber of Stories. . . . . . . . . . . . . . . . . . . . '. . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . , . . . 9. Size of lot: Front . . . , . . . . . . : . . . . . . . . . .. Rear...,.........,........ Depth ...........,.......... 10. Date of Purchase .........:.'.................. Name of Former Owner ............................. 11. Z d' t . t' h' h '. 't t d "f.\ \. . "one or use IS TIC III W IC pr~mlses are Sl ua e ......,.. .... ',' . . . , . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . , 12. Does proposed eonstruction violate any zoning law, ordinance or regulation: ...............,............G> 13. Will lot be regraded . :t':-l ~. ; . . . . . . . . . . . . . . . . . . . Will excess fill be removed from premises: Yes N 14, Name of Owner of premises. . ' . . . . , . . . . . , . . . . . . Address. . . . . . . . . . . . . . . . . . . Phone No. ......... . . . . . . Name of Architect .. . . . . . . . . . . . . . . . . . . , . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . Name pf Contractor. . . . . . . . . . . . . . . . . . . . . . . . . Address .. . . . . . . , . . . . . . . . . . Phone No. ...... . . . , . . . . . PLOT DIAGRAM Locate clearly and distinctly alJ buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and blockinumber or description according to deed, and show street names and indieate whether interior or corner lot. I , ; I ~lic t[,-Q/J eN t::.tcE I).; t ~ t-+-. I I STATEOFNE~ SS COUNTY OF . . . . . . . . . ,. .. . . t/t.y~.1?-. ..~ . .J.;?;i.~ It~. .. .. . ,. . . .. .. being duly sworn, deposes and says that he is the applicant (Name of individual sig~ing contract) above named. i i He is the ... Q..~ (\!/of.f>.c,T:"....... .'........ ..'...........................,.............................. , (Contractor, agent, corporate offieer, etc.) , , of said owner or owners, and is d41y authorized to perfarm or have performed the said work and to make and file this application; that all statements contained in this application are true to the best afhis knowledge and belief; and that the work wi1l be performed in the manner set forth in the application filed therewith. Sworn to before me this : M ' .............. .7...... .day ~f..... .7:n.o:;....,.., 19~ ~~7(~' NotaryPublie, . ':f:;. , .; .............., Cuuuly y ~ LN ' \ NOTARY P~~l~ ~~t~~';eK' ) . . . . . . . .. ;,~. (!;, .'. . . . . . .M.L. . . . . . . . . . Q No. 52,4524771 w prk (Signature of applicant) uallfled 10 Sf i CommJssJOn E lJ folk COunty ! xprres March JOt 1Q~