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Home My WebLink About10747-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No. Z10111 Date AugUst 28~ 1980 19 THIS CERTIFIES that the building / , 4860 ~tocky Point Road East Ma~'ion, ~.Y. Location of Property/:/~s~ ~Jo. ' .................... ~'/e~t' ....................... County Tax Map No. 1000 Section 21 .Block 3 ..... Lot 23 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated 0'ulae 20 19 80 pursuant to which Building Permit No. 1 .0.7~7.~ dated ....ff..r~o.. ~..~ ................. 19.0.0. ,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 ......... ................. ~ .~.~.~..~.~. ~. ?.~.~.~..z. ?.~.o..<~.~.:. ~.h.o.d. ................................ The certificate is issued to Ke stutis Ka~oku$ ..................... ~o¥,,'o;,'i~,,*~;~;,r,~ ...................... of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE NO. Rev 4/79 FOI~M NO. ~ TOWN OF $OUTHOLD 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) N? 10747 Z Permission is hereby granted to: ...(:.~,~-2~ .:~.,....:~,~,. ~ ............ .... i ..,~...,¢_g:. ....... z.~..~....:~,. ........ to ...~.~.~.z.,~,:~ ~..-:......-~.~ ..¢_~ ~. ~ .... ~ ,..,,,,~.,.,~......"~. ~....~-~.~ ,~,,~ , ~ · ~.~.~ ....... ,,.,,,~...Tz,~....~,~ z~..~.. ~. ~,,, ~ ..~.... ~,~.,~: ~..... (~ z .... at premises located at ..~......~...~.dO.' ........ ,~C..f~Z ...... .,~T.~:~.*¢.,~..../~.~C-2/--.2. ........................ ........................................................................................... ~:~.....,...'~,~,'~,.o~. ...... ../v...:~. / ppi' ' d ..~..~ ~O 19~), d d by th pursuant to a ~cat~on date .......................... , an approve e Building Inspector. Fee $.../(~...~.., Inspector FORM NO. 6 TOWN OF $OUTHOLD 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 fo[iowing; 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 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. 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 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 3. Copy of certificate of occupancy $1.00 $5.00 New Building ... ~ ..... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ~.~. · .~..~. · .~. · .~.~. · · .~. · ,~. · · ~' ...................... Owner or Owners of Property ..... -: ................................. County Tax Map No. 1000 Section .....~%..( ....... BIock...~. ........ Lot...2~,~ ........ Subdivision ..................... ~ .......... Fded Map No ........... Lot No .............. Permit No./.~.7.~..~. Z~ate of Permit .......... ~,pp ' a t ...%~...% e~.~-../. ~ .-..: / .... Health Dept. Approval ........................ Labor Dept. Approval .............. / ......... Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate Fee Submitted $ ............................. Construction on above described building and p.er[pit meets all appllcaJ~le c~des and regulations. Applicant .............. COMMENTS FIEI~D I~ECTION FOUNDATION FOUNDATZON 2. ROUGH FRAME PLUMBING (and) INSULATION PER N.Y. STATE ENERGY cope FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971' TEL.: 765-1803 x m,d ....... Disapproved a/c ........ . .~..w-. ,~-~...''. ...... ../~ ..... ..y ~ :tor) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Th~s application must be completely filled in by typewriter or ~n ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according t6 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 Mb~DE 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 neces~ry inspections. __ .... ¢?.,... !,...5.o. t .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......................................... Name of owner of premises . .~.~.. ~.~,. ,~. 'tS., ~ .~.¢.~'~.~... q..~..~..~..~.~.....~...~.~ .~. ~..~..~..~ ........... (as on the tax roll or latdst deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No...~.. ). !.~ ................ Plumber's License No ......................... Electrician s License No ...................... Other Trade's License No ....... ~. .............. ~fi~/¢ ~ 1. Location of land on which proposed work will be done...~e~k~[.. ?.o;.h..~...~.,~ ..................... House'..~5~'.~.~ I~ ~.,..Number ~ ~ ........................ Street ......... Hamlet ............................ County Tax Map No. 1000 Section .. ~ .[...OO ........ Block . .~., ~O .......... Lot..Z. 3.-. ~ .~ ....... Subd~v]s~oq ....... , ............................. Filed Map No. Lot ............... 2. State exmt]n~g~ ag~,}c~pancy. ~prem*ses and intended use and occupancy of proposed construction: . . - W ~ a. Exlstlng use and occupancy .. ~~.~e .~ .......................................... b. Intended use and occupancy . .a ~'~"' c.~ t ~ ~t ~ J~ .~,~.~ .~. ~ {.x. ~,..,~ ~. ~ ~ .&... ~* ~,:, ...... 3. Nature of work (check which apblicable): New Building .......... Addition .......... Alteration .......... Repair .............. RemOVal ........ Demolition ............. Other Work... 4. Estimated Cost 0 .~. ~..~.9. (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... ~ .......... Number of dwelling units on each floor ..... l. .......... If garage number of cars ' "-' ...'.. 6. If business, commercial or mixe~ occupancy, specify nature and extent of each typ~ of use ............. . ........ 7. Dimensions of 0xisting structures, if any: Front...~. ~ .C} t. ..... Rear . ~ .(~' . Denth . .~.,~' iD Height ...}..On. ......... Number of Stories ........ I ................................................ Dimensions of same structure with alterations or additions: Front .... ~ ......... Rear ... ~ ............ Depth ......... .~. ......... '.. Height ......... ~ .......... Number 9f Stories .... ~ ....... ~ ......... 8. Dimension~ oflentire new construction: Front . . .~-~ C) ..... Rear .'2-, O: . Depth .'~-..~. ....... Height . .I..ac. .......... ~qumlber of Stories ....... I .......... ' ......................... , .............. 9. Size of lot: Front .. l ~.'-/ .... : ........... Rear ... l.fo .'"/ ............. Depth .~..~-~.q) ............... 10 Date of Purchase '~' .~ .................. Name of Former Owner 11. Zone or use district~in which pr~mises are situated ........ ~ ........................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: . .~ ~ .......................... 13. Will lot be regradeG .... ~[ ~' ~!"t:' "~' '-- ~ - k,~c~ · · Will er~es~ filljl~ r~,r0o_vei[_fram premises: Yes. No . .1_'-~ u.~; ~ ' ~,'~' ' 14. NameofOwnarofpremlses~.~.r.R.~l,.~nn~t~~. go,lq V'*.. ,e..m~-i -I~q ... Address .... ~ ......1~[~ ..... P~hone No.~ .~/.'/ ...... .3. Name of Architect ............................ Address .................... Phone No .... ~. ........... Name of Contractor C,~-~i.,~ .[.~ .~'~.~. ~1 ........ Address' .tAg.}h~'h~,~ P,~ ~lSPhone No.~/;~: ,~.q .'t.2,... PLOT DIAGRAM Locate clearly and distinctly all lbuildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block tumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW ~o,g.J~a//~ i~ ~ COUNTY .......... (Name of i~ividual signing contract) above named. ..... being duly sworn, deposes and says that he is the applicant He is the '~_~ ' ' ' (Contractor, ~,~-* - ^~ ,.e,~: .... ~ ~ , _,~ ..... ,or[' ............ , .... ~ of said owner or owners, and is duly 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 an&bvti~-g~ad that the Sworn to before m~isW°rk will be performed_ in the manne~i: set forth in the application filed therewith. ~'/, ' p.~tllti~t. ~Ot.~N''' ~, ,. ~' " ........ ~ ............ day of ......... 19 .~. #O~lft PUlIL~, ~m~ Itm V*n ·. County/~ . ~ (Sigrtfture of applicant) ,% 765-t80~ 9 AM TO 4 ~M -' -CTMNS, L R~U ...-, JN * TWO R[QUt F.~,t ~OU~ CONCR~T~ ~,.u~.~ ~ - & PLUM~ ...... -:-: C.O, ZLL COB~T~UCT~%N S~ALL M THE REqUIrEMENTS CF THE N ~OD~. NOT ~NSi~LE t D~IGN OR CON~U~iO~ ~ ': APt~ll~¥~l~ AS 'HOTEl) NO~rlFY BUINN6 '~pA~{~BNT 765-1802 9 AFA TO 4 PM FOR THE DESIGN OR ON: i~I