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Home My WebLink About10748-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No .... .7.1.0.1.96 ....... Date ...... 0c.t. clbeT..l/3, .............. 19. (30 THIS CERTIFIES that the building ................................................ Location of Property ... 2.7.5. gl.oJ.s. 14$ne, ................ l~Ia.tt;it;ucR,. N...Y ......... House No, Street Ham/et County Tax Map No. 1000 Section ....1~.3 ..... Block ..... 6. ........ Lot ..... .~ ........... Su~J~smn jo.£. KJ.r. chgeJ~sr~er ............. Filed Map No... 1.19...Lot No ..... 1 ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ·.. May. 2.1 ........... ,19 .~0pursuant to which Building Permit No....10.7.68. Z ........... dated ... ,.Tzlne. 2..5. ................ 19 80, was ~ssued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ·.. Qn¢. Famll~..P. rivate. D.~ellgng ............................................ The certificate is issued to . . .~.d~.a.r.d.. DJ, e.g'qlCt~l~. ...................................... (owner~~.X of the aforesaid building. Suffolk County Department of Health Approval ...:l,O .-g.Q-~'59.. UNDERWRITERS CERTIFICATE NO ..... ~../495~3~3 ................... '/7 ............... / /./ Building Inspector Rev 4/79 l~Ol~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10748 Z Permission is hereby granted to: ..... _Z-~z:~./~........~(..~7... z.~ ~....... ....... ~.~....z..~...7.. ....................................... to...C~.~r~Z ........ C~.~.~......~.~.~.~.......J~.~Z.../Z~...~ ............................ ........... ..~ .......... _~.~,.~. ....... _:,..~.~.~..~.. ........... .L ............................... at premises located at .........~..-~....7~...~... ~ ...~',..~....g'~. ......... ~'/:~'"'v~"/k~")'""~'~/'/" "~'C'(~'''''''~' ' ........................................... .F.~.,.....zc~....o~...~...~.,~.....~...~ ............. ~urs~o~t to a~p,,cat,on d~ted ..... ~/~.7....~../. ...................... , ~2.0., °nd eppro~e~ b~ Building Inspector. Fee ~....~..z ............... ......... ~l~uilding inspector FORM NO. 6 TOWN OF SOUTHOLD 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 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 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 $I.00 $5.00 Date October 10, 1980 New Building ~ Old ~_p{~re-existing Building Vacant Land Location of Property ~..o.:b..~.~, ....~.~..o.i?.. ~.a~..e. ~...~.a.~.~.~..~?.~ !. ~...~.: ........................ House No, Street Hamlet Owner or Owners of Property . Edw.a~, .d Sieg~a~n -123-6-4 County Tax Map No. 1000 Section ............... Block ............... Lot ................ }~iinor 1 Subdiws.on..O..~..~,~..o.hge. ~. ~.e.::q... ~.~.~.9 ...... Fi~ed Map No ........... Lot No .............. .......... 6/25/80 Inl..a~.d H.omes, Inc, Permit No. 10748Z Date of Permit .......... Applicant ................................ Health Dept. Approval 10/3/8~ 10-S0-39 . .Labor Dept. Approval yes Underwriters Approval ........................ Planning Board Approval yes Nz~95938 10/6/80 ...................... Request for Temporary Certificate .......... .~.o ......... Final Certificate ... y~-s ................ Fee Submitted $ 5 o00 Construction on above described buildi~l~[cable~~ codes and regulations. Appl~ant .Robert 'E'.' 'Hilt~ '~z~'~an~' '~omes',- 'tho'. ......... Rev. 10-10-78 FIELD INSPECTION FOUNDATION FOUNDATION 2. ROUGH FRAME & PLUMBING INSULATION PER N.Y, STATE ENERGY COpE FINAL ADDITIONAL COMMENTS: TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN ~LERK'S OFFICE ~UTHOLD, N. Y. ......... , ......... ' ............................... Disapproved o/c ............... ~........,..,..,..~i..~.i~ ......................................................... APPLICATION FOR BUILDING PERMIT Date....~/!.~. ~.....~..]; ............................... 19.~?.Q ...... INSTRUCTIONS o. This application must be completely filled in by typewriter o¢ 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 oF areas, and giving o detailed description of layout ofproperty must be drawn on the diagram which is part of this application. c. Th,e work ~overed by this a~pplication may not be commenc, ed before issuance of Building Permit. d. Upon approval of this application, the Building Inspector wdl ~ssue~'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 Paws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, ar name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises If applicant is a corporate, 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 ............................................... Location of land on which proposed work will be done. Map ~'4o ......................................... Lot NO...x .................... Street and ' ' f ~,'' ~ -~+'","~ N ' ......................... NumberAA¢~.!..~; .. ,,~..~.~...L,~..,.~..c.¥.~,~.....,~.~ .......................................................... Municipality State existing use a uponcy of premises and intended use and occupancy bf proposed construction: a. Exisiting use and occupancy ~&cant b. Intended use and occupancy ..... ~:...l...~J~}~.~.~-.Z..?.~.~i.~?..g. .............................................................................. property lines. Give street and block whether interior or corner lot 3. Nature of work (check which applicable): New Building, .~DX~ ....... Addmon .................. Alteration ................ Repair ............. ' ..... Removal ................... Demolitmn .................... Other Work ................................................... ~ ~0,000.00 ,- ,e~/ "~- (Description) 4. Estimated aost ............................................................ tee ..... ~..~ ................................................................................. ~ (to be paid on filing this application) 5. if dwelling, number of dwell, ing units ............................ Number of dwelling umts on each floor ........................... If garage, number of cars ...., ......................................................................................................................................... 6. If business, commercial or j' 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 structu[e with alterations or additions: Front ....................................Rear ........................... Depth ................................ Height ............................ Number of Stories ................................ 26 8 Dimensions of entire new construction: Front ...... .~ ......................... Rear ......5...].. .................. Depth ........................ Height 26 Number of Stories I . ....................... .................... igs ............................................................. isa" 9. Size ,of lot: Front ............... i ........................................ Rear ........ ~..?..8. ........................... Depth ................................ 10. Date of Purchase ................ ] ........................................ Name of Former Owner ........................................................ 11. ZoRe or use district in whichi ',~,J t' premises are situated ..........~,..¢ .................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...g.O ................................................. 13. Will lot be regraded .........~.e.~ ............ Will excess fill be removed from premises: ( ) Yes (x) No 14. Name of Owner,,~ .... ~ ~dwar,d ~±agmann Address ................................ Phone No ....................... Name of Architect ............. ~ ................................................ Address ................................ Phone No ....................... , 298-9696 , PLOT DIAGRAM Locate clearly and distinctly fill buildings, whether existing or proposed, and indicate all set-back dimensions from number or description according to deed, and show street names and indicate / . / STATE OF NE~ COUNTY OF ?..¥.t.z...z..o...~.t..~ ............... , S.S Robe~l; P,. Hiltz ................ i .................................................................................. being duly sworn~ deposes a.d says that he is the opphcam (Name of individual si~ning contract) ~ above named. He is the . Cont~cto~ ...... (Contractor, agent, corporate,officer, eta ) of said owner or owners, and is d~ly authorized to perform or havb performed the said work and to make and file' this application; that ail statemeqts contained in this application are true to the'best of his knowledge and belief; and thaz the work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this j ..... .................. . N~a~ P%blic, ...... ~[~g.!}f...&.qy~ ................ C°~A ~ ~~:TZX .............................. '~' ~ ~/ d- ~" NOTARY PUB"' ~~ure o$~ant) .._, uc, 'J2 2 - ...... Qualified in Suffolk Co nty .. . ~ ~ COBra sslon Expires March 30, 19~ The water s~pply & sewage disposal sys- ~e~ls far ~h~ residence wdt conform to the standards of the Suffolk County ~prt- , merit of Hen~th Serwisaa, 315 Westphalia Rd ~ ~ ~ Box 117 + M~th~uc~ ~ N/OIF L4WRENCE REEVE N/O/F FRED E. PIVKO SUSA~ O.~SO~ SUFFOLK COUNTY DEPARTNENT OF HEALTH SERVICES ¥OR APPROVAL OF ¢ONSTRUCTION ONLY PPROVED sechon 7209 of the New York State Educ&tmn Law Copras of this survey map 'C~ot bearing the land surveyor's mk seal or embossed seal shall not be considered to be'a vahd cc Guarantees or cerhff~atlons in&cated hereon shall run only to ,erson ~or whom lhe survey is prepared, and on hm behalf to title company, governmental~agency and ~endmg mshtution lis~ed he~ ~n, and to the a?signee~ of the lendin~j inslitution. Guarantees or erhflcations am not transferable to additional Instituhons o NFO/F FRANK J. MURPHY $* 86°$4' 'O" E.' 19~,03' LOT ~ ,,~J~'E CO. TAX /VO. 1000-/23-6.4 SURVEY FOR EDWARD El JOHANNA SIEGMANN ~T MATTI TUCK TOWN OF SOUTHOLO SUFFOLK COUNTY~ SCALE : I"~ 40' NOV. 9, 1979 5,/980