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Home My WebLink About10686-z FORM NO.4 TOWN OF SOUTHOLD BUilDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy 29959 May 28 80 No..,..... . .. . ., .. Date , . . , , . . . . . . , . . . . . . . . . . . . . . . . . . . .. 19 . . . THIS CERTIFIES that the building . . . . . . . . . . . . . . . . , . . . . , . . , . . . . . . . . . . . , . . . . . . . . . . . . 12975 Main Bayview Rd. & Midland Pkwy. Southold. N.Y. LocatIOn of Property ............ , . . . . . , . . . . . . . . , . . , . . . . . , . ., ..........,......,.,.. House No. Street Hamlet ,088 02 013 County Tax Map No. 1000 SectIOn ........... .Block ........,..... .Lot . . . . . . . . . . . . . . . . . Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . , . . . . .Filed Map No. ,.,.... .Lot No. ............. conforms substantially to the Application for Building Permit heretofore filed in this office dated . ~~~. f.4. . . , . . . .. .. . . , 19~9. pursuant to which Building Permit No. .... .1~?86~.. . . ,.... dated ..... ~ay. .2~ . . . . . , . , , . , . . . . 19~q. , 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 ... . . . . . . . .. . , . .. P~c~. Addi.ti?n. ,~~ e?ti.~~~?& .1?~~.3:~~~. . . . . .. . . . . .. . . . . .. . . .. . ., .. . . . The certificate is Issued to ............. ~e ?r,~~ . ~'~~}~~aff . . . . . . . . . . . . . . . . . . . . . . (own,. ) of the aforesaid building. N/R Suffolk County Department of Health Approval ...........,.,..................,.,....... N/R UNDERWRITERS CERTIFICATE NO .....,., .. .. ,. . . .. . . . . . . . , . .. . .. . . . . .. . .. , ., . . ., . Rev 4/79 L r.1t,., , FORM NO. 2 TOWN OF SOUTHOLI> 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) Nt! 10686 Z H- ell n Date ....... ..~.y........................,..,........., 19..d:O Permission is hereby granted to: I ....:i;HIY.....~t9.k.I....t;t.t?/.L..IN~ . ..i.3.(;...~.I......I3.ox...,..r3.(.~..,..,....... , .....$.Q.QTH.QL.-k!.7:":"...AI...~y.,......."...... " to ....CQ.b!.;;../../.C.CI.C.T.......:uE.C5....Ae.P..'..I../.Q.Ak!...~.I.J:J.....;i;):<.1.~I.N.0......., ,. ~g:j/~"':1..........:6t.:".......G~aK.9~....~Lf..I..I,(c9.f.d..................................,..., at premises loc ed at-#..ldilS....H~/.tY.....i!(~/..;;:(!..).;:e....~....:............ ....... ......................................................ZQ...I1I.f!t.I1,v:P...... ...f!Y.5.:::.....::ib.9.T:tifQ/,f?.~ .;./'/ . ,..................................................................................,............................................................................. pursuant to application dated ./:1!.1.y.........t.s/......................, 1~r, and approved by the Building Inspector. Fee $..1.;;..=..... , , 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 to the Building Inspec- tor with the fallawing; for new buildings or new use: 1. Final survey af property with accurate location of all buildings, praperty lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage dispasal-(S-9 farm or equal). 3. Approval of electrical installation from Board af 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 Baard appraval af completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-confarming uses, ar 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 af owner or previous awner as to use, accupancy and condition af buildings. 3. Date of any housing code ar safety inspection of buildings or premises, or ather pertinent informa- tion requ ired to prepare a certificate. C. Fees: 1. Certificate af occupancy $5.00 2. Certificate of occupancy an pre-existing dwelling or land use $5.00 3. Copy of certificate af accupancy $1.00 Date. .1;t,4J. :?:?'/ .If.f:..... New Building. .. . . . . . . . . . . Old ar Pre-existing Building .1. .\.. . . . .. Vacant Land ............. Loeatlan af Praperty ., t? 7??. . .$~A,J. ~tI~. .If'd. .j: 1!1.1~'~. .rLvv.y House No, Street Hamlet Owner or Owners of Property ... .MIt, . . .r;'?1itZj6. . $t:!1!r tlt?1~. . .. . . . . . . . .. . . . . . . . ., . . . County Tax Map Na. 1000 Section ............... Black .. . . . . . . . . . . . .. Lot................ Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. ......... .Lat No. .. ........... Permit No.1 0. ~2:~. . Date of Permit ;;j~~. .Applicant ::r;;/f;-!. ~tU/. PP'I !~^ ~ Health Dept. Approval. ..... . . H/Ift,.. ... . .. .. . Labor Dept. Appraval ......... !!/fl!. .. .... ... Underwriters Appraval . . .. ... tV/Pt.. ..... . .. . .Planning Board Approval. .. ...0... .. . .., . .. Request for Temporary Certificate. . . . . . . . . . . . . . . . . . . . .Final Certificate. . . ... .V. . .. . . . . . . . . . Fee Submitted $. . ;;:-;.VD. . . . . . . . . . . . . . . . . . . Construction on above described building a~eets all applicable codes and regulatians. Applicant... . . .fl.~~"'I4.Ma........... ... Rev.10-1Q.78 a ,CJ '~-:9 . 0NYO Lel.-~, /7'.31 ~e..e.-<.flf /c;,99j; , .,.. " . j ,.;1 , '" {; FIELp INSPECTION DATE COMMENTS - - ---..:..-,&-'+-.. ---t. 'D 1.. ~ (s HI ~ f-..__w - - ---_----..----~--- >-3 _FOUNDATION _ -11st) ~ . N -- - FOUNDATION (2nd) ~6~ '"1:\ "- . . - - <D<;, f' I 2. ~. ROUGH FRAME & ~~ PLUMBING . {)"-! ~, , ~ ~t- [fJ'~ ~ 3. c+~ ~ - 'i"'-t <D ~ INSULATION PER N.Y. - <D~, c+~ ~,I STATE ENERGY ~ '~ ~~ '\' COJ;m ~ :r: 4. ~/J.-.7 (iL-' - PJ l\ ~ o. - ) <D c+ FINAL / , - -- ~~ g0\ ADDITIONAL COMMENTS: 'i ~ . - ~ " ~------_._~. - ~ t - , ~, ~.-.::. ~ I\j c+" f-'. "" g~ - ; - ':r: , ~ j - t:1 ~ c+ . I i ~, *,_~j. ~ ji. ,'.!: """ ,..... , FORM NO.1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ,/!I:;c;j. d!. . . ., 19 fJ:; ~ Application No/Q(~. . . . , . . . . Approved .I.':k.y:. <it..., 19~. Pennit No.IC!.(!{ ~ APPLICATION FOR BUILDING PERMIT Date .t0~.!1......., I9<'!IR 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- f catIOn. c. The work covered by this applicatIOn may not be commenced before issuance of BuIlding Penn it. ! d. Upon approval of this application, the Building Inspector will issue a Bui1ding Pennlt to the applicant. Such pennit f 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 far the issuance of a Building Pennit pursuant to the Bui1ding 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. -- :r ' tI: /..J i3.tJ~-- B ' U':>tfI?- ..,.,Q. ....... /:411-<1... ........ h.-+J~""", (Signature of applicant, or name, if a corporatIOn) . . f!~ /. . ~>.<'. ::??~.c;... {. .~<!. ~~~, . . .. . .., . . (Mailing address of applIcant) State whether applicant is owner, lessee. agent, architect, engineer, general contractor, electrician, plumber or bui1der. . . . . . ~.l u:::,~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Nameofownerofpremises .,. /i!.q..,;;.iUf.'J.$...... ~C~.iI{ .. -?!<;!.(!~.~~......."..................,... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. . . . . . . .~ ,.f?. . .4?~~~~ ' . . . /Lt:::J, . . . . . (Name and title of corporate officer) Builder's License No. ..:1.6?8N. .(3.&f{~(. .~tcP~- ~"-' Plumber's License No. ...,............"".... Electrician's License No. ..... . ............. . Other Trade's License No. .....,..,...."...... I. Location ofland on which proposed work will be done. . .(t!'?'~~. .4"!7t.!I.~Y. .. t1?t? .j'. . . . . . . ., . . '. . . . . S~M.4.J. . . . . Pq.fv.E'(-, . =f. ~ .l.r.1:;; . . , . . . , . , , . . . . . , . . . . . . . . .S6.<-)~t) , . . . , , , . . . .., " House Number Street Hamlet County Tax Map No. 1000 Section ". .Q..? fr. . . . . , ,. Block ...Q Pl.. . . . . . . . . . ., Lot.. <;:?/.';;' . . . . . . . . . ' , 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 . . . . .l).w.rs;e,!j ~. . . . . ./. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , b. Intended use and occupancy.. .'P-w'~4f"'~" ~.;::... AP.P.(/'rQ.~....,............. , 3. Nature of work (check whicl1 applicable): New Building. . . . . . . . . . Addition. . . . . . . . ., Alteration .......... Repair.............. Remo~al .............. Demolition.............. Other Work .. .l?~~..... , ,1$ , . (Description) 4. Estimated Cost. . .~. . . . . . .!. . . . . . . . . . . . . . . . . . . . . . . . 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 ..... i . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. If business, commercial or mixed, oecupancy, 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 .' . . . . . . . . . . . . . . . . . . . : . Height . . . . . . . . . . . . i . . . . . . . . . Number of ~tories . . . . . . . . . . . . . ,,' . . . . . . . 8. Dimensions of entire new const~ction: Front. . . . . :2:1. . . . . . . Rear . . . . ~:I: . . . . . . . Depth . . . /oJ:' . . . . . . . . . Height' . . . . . . . . . . . . . . . Number of Stories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size oflot: Front .. . . . . . . . . . '. . . . . . . . . .. Rear...................... Depth ...................... 10. Date of Purchase ........... '. . . . . . . . . . . . . . . . . . Name of Former Owner ............................. II. Zone or use district in which prelnises are situated. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. D~es proposed construction violfte a~Joning law, ordina~ce or reg~lation: .......... .H..O. . . . . . . . . . . . . .. . . 13. WIll lot be regraded .........~................... Wtll excess fIll be removed from premIses: Yes ~ No 14. NameofOwnerofpremiseslfl<tl?i';'~. .~6.~dress.................. . Phone No. ............... " 1 Name of ArchItect ., . . . . . . . .1,' . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . 'f?' . . . Name of Contractor .:J'PrtP-. . ~',~A21'41-1. .~r~. Address. . . .., ... .. . .. .. . . . Phone No. . '~-:I..r:f!' ..... PLOT DIAGRAM Locate clearly IS mc Y ! Ul mg, ether existing or proposed, and, indicate all set-back dimensions from property lines. Giv street and block pumber or d scription according to deed, and show street names and indicate whether interior or corner I 7AI/..II..)6} ~UI /ZE,P "'F ,,;Ie.... ( .~(..e 'Et<C&t::>II-.JCj 18<< /1) ~~ (j..oyS6 -- -;r;!fftG) Ef I -. , I 1-11 ;J , 'f ;A FOc:JTIIU'7$ 5-<' 73z.( J?U 9K,C/.>2;' e,/l.b~ 1>''''1 II \1 \ , 4 ~iMf6 STATEOFNEW~ 's.s cou~... ., ~....i ....... .. . ':.J2.. ~~ . . . . . . . . . . . . . . . . .. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. ' He is the. . . . . . . ~e!\..-~ . . ~r~~t;r: ~~~~t', 'c~~~~;;t~ ~'fi:i~~;, 'e't~.')' . . . . . . . . . . . . . . . . . . . . . . . . . . . of said owner or owners, and is dlfly authorized to perform or have performed the said work and to make and file this applicatiOlj; that all statements conrained in this application are true to the best of his knowledge and belief; and that the wark will be performed in the manner set forth in the application filed therewith. SWOI11 to before me this , .... ...... ... ./.+.... ..day9f.... ..lM.~....... .., 19W . ~ ..,.4-' ~ Notary Pubhc,. . ~UD;:~r;R~' count.y. .~ .~.!dut-~... . .. . ....... Nntary Public, Sta\c of New vortr.rrj (Signature of applicant] 'No. 52.0344963 Suffolk Coun~ Commission Expires, March aO,19.