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Home My WebLink About10720-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No...Z,10.1B6 ........ Date .. Dctobar .?,. 1980 ............. t9 ... THIS CERTIFIES that the braiding ............................................... Location of Property ....2.!5.0..4°.c..k.e7 .Cr.e.e.k...Dr.,..a...27.5.0...0..~.1..a.wn.. A¥.e.,.,..S.o.u.~n..o~d,N, ¥, House No. Street Hamlet Cmmty Tax Map No. 1000 Section ... 7.0. ...... Block ..... 5. ........ Lot .2. !, .~ ............ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·. ff.q~O../I.. ............ 1~0. pursuant to which Building Permit No .... ].0'~20. Z ......... dated .... ~..tlzle. 21.0~ .............. 19..~10was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ...... ,..~.~.~.~.~. 9.n..o.~...~o...~.,×~...t.o. ~.y.~.n.g..R9.o~ ................................ The certificate is issued to . . .~'.O.~...H.: .~.q .~..b.e.~.g ..................................... (owner, of the aforesaid building. Suffolk County Department of Health Approval ...... ~/.R. ................................ UNDERWRITERS CERTIFICATE NO. Building Inspector Rev 4/79 TOWN OF SOUTHOLD 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) N? 10720 z Permtssion ts hereby granted to: ........ .(..~z....~.~.~ Af .... /.:~:~.~.......r.. .... ..>..~ ........ , ....... .... d'Jzc~:~. ~.~.~.. ~,...y. ·. , ,o ~/~Z~ .:~ ~.~..~..~r~ ~l~..~..~~ z~.:::f~...z~-.:.~:¢.~ ...... ~.......'~.:..~.~ at premises ~cated a~,..~~..~~/~,.,.~ ............................................ ................... ::~.~~. :~ ....... :~:~.~..:. ~. :~ pursuant to application dated ...................... ]~0., and approved by the Building Inspector. Fee $.....~... .............. FOl~ NO. ~ TOWN OF SOUTHOLD , Building Depmtment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions A. This apphcation must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector 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 installations, 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 opphcable. l~. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses' 1. Accurate survey of property 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 in- formation 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 ................ Addition .......~,~', ....... Old or Pre-existing Building ................ Vacant Land Location Of Property ..... ............. Owner Or ~ners Of Prope~y .~....b~.z~~ ................................................................ Subdivision ................................................................ Lot No ............. Bilk No ............. House No ............ Permit No. Z~..~.~.~..~ate Of Permi~.,.-,~../.~,~plicant ~.~..~ Underwriters Approval ...... z. ..................................... Planning Bo<3rd Approval ...... ~ ................................. Request For Temporary Certificate ...... ~.L ............................ Fincd Certificate Fee Submitted $..: ~-. ~..~ ..~........~ ~fq~....~ ,~--~, J~_¢,~,~.~,~C~ '"~'""~' .................... Construction on above described building and permit meets all Opl~cabJe codes and regulations. App,,cont ....................................... Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) FIELD INSpECTiON ........ FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY C0 E FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c . ...~__~.---~._.. i' ' i .................... ,;/:7 . Y APPLICATION FOR BUILDING PERMIT ~//~/~) Date ~vi.~Y..~.~. ............ i9 8.0. 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. APPLICATION IS HEREBY MADE to the Building Department for fl~e 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, 1}ousing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary ~nspect~ons.~^ ~ n I , [ (Signatt/re of applicant, or nakfie, if p ' ) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises , l,~a,~,ga, r, gg. , ,~,', )~,qh, l.b,e,r,g, , ,ap, d, ,4qr,,n,, ~, .., y~.o,hl, b,e,r,,rg ........................... (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 L~cense No.. 2..~..~. ............... Plumber's License No...~.. 3.7 ''~)' ........... Electrician's License No...7.56.E ............... Other Trade's License No ...................... Location of land on which proposed wqrk will be done .................................................. · ~...t3~k~ ...... aouttio3..c[r . .i~.. 'f.. ................................................. House Number Street Hamlet County Tax Map No. 1000 Section ?0. · .5 · .~.1.~- ...... Block .................. Lot ................... Subdivision ..................................... Filed Map No ............... Lot .............. ~Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a, Existing use and occupancy . . . '.R.e.s.i.a.e.n.c..e ........................................................ b. Intended use and occupancy .. Rea&al. once..~. ·..~.'~~. ~~ ............. 3. Nature of work (check which applicable): New.Building .......... Addition .......... Alteration '~hlgl2[l~' ' ' Repair, .............. RemOval .............. Demolition .............. Other Work ............... r~2 ! 7~ (Description) 4. Estimated Cost ...o ~. .......... Fee...~ .... ~ .,~..' .............. (to be paid on filing this application) 5. If dwelling, number of dwelling ~nits ............... 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 .. t~ ..................................................... Dimensions of same structure with alterations or additions: Front ........ .- ........ Rear ...Y .............. Depth.. ........ .~. ........ :.. Height ........ ~. ............. Number of Stories .. '2 .................. 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ................ tteight ............... Number of Stories ........................................................ 9. Sizeoflot: Front .......... i ........... Rear ...................... Depth ...................... 10. I)ate of Purchase .,Jaga.:l.4,~£~79 .............. NameofFormerOwner~r,.dolm.&.Oathr~e.ltro'qJm 11. Zone or use district in which prgmises are situated ................ : .................................... 12; I)oes proposed construction violate any zoning law, ordinance or regulation: ....... ~'O ...................... 13. Will lot be regraded ........ i ................... Will excess fill be removed from premises: Yes No 14. Name bf Owner of premises l~a~garet;. ~,' .&' Jolm' ~g~el]Pr' $~?~0 · .Oakl, a~a. ~.~,hone No.. r/~ '~9~½ ..... Name 'of Architect Oo~a~.a .G}. l~ela~.;~,~ ......... Address l~Ol~ol~..~6~i .l$~ebos~al~aone No.7~..~j~ ....... Name of Con(fac'tot Gh.~a~;~' i Or].o~, ........ Address {lat~hol~ ......... Phone No. y.~l, .6&9] ...... 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 YORK, COUNTY OF..., .............. ' ........~J~;tM ~..'2' ......... I~ ~'/// ;.'//~ ........ .~,.~7. ~c7~---..0., .~.~.b..~. ~ .JQbeing duly sworn, deposes and says that he is the applicant (Name of individual signing contract) abow, named. H is th - · . (Contractor, agent, corporate officer, etc.) . of said owner or owners, and is dqly authorized to perform 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 of his knowledge and belief; and that the work will be performed in the manffer set forth in the application filed therewith.~ Sworn to before me this ' ........ , .... ~ .......... day ~f.. ~ ........... ' 19 '~' '~ , , . , Notary Public, . ............... ' ........... ~ ...... County