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Home My WebLink About10566-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ...... .ZJ }.6.8.7 ..... Date .... July 50 ., 19 S5 THIS CERTIFIES that the building ...... addition & 81tera-hiom. Location of Pro eft 28¢0 Sigsbee t~d. Hatti~uck P Y h~&~hio~ ...................... 's'de~i ....................... h~r~iei County Tax Map No. 1000 Section .... J .2.6. .... Block ......... ~. .....Lot .... i..~ ........... Subdivision ................ x. .............. Filed Map No. :{ .Lot No. x conforms substantially to the Application for Building Permit heretofore filed in this office dated ....J. ai%t ~rS.'J J ....... 19.8.0. pursuant to which Building Permit No ..... .i.O.U.6..6.~ .......... dated February 25 19 80 , 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 ......... Second story addition e alteration to existing one-family dwelling. i~ASQUAL~. & LODA R0~LN~.LLI The certificate is issued to ........................................................... of the aforesaid building. N/~ Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO .............. N~-76108 Building Inspector Rev, 1/81 FOI~M NO. 2 TOWN OF SOUTHOLD BUiLDiNG DEI~ARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT OIq THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10566 Z Permiss~on is hereby granted t~ ~ ..... .~,~. ~,~z~...~. x.~../~... ..... .. ~4. ~ ~ ~ ~.....-~.... ~.~/.~.~.. z ~ ,~ ~....~- / ,. ........... ~z:..~zzz .......... pursuant to application dated ...~ff~.~...~ ............. , ]9.~,~and approved by Building Inspector. FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall ~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitteG,icmdup![catc 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, occupa, ncy 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, Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling/ land use 3. Copy of certificate of occupancy $1.00 --Pre-Existing C.O. $15.00 Vacanzt land C.O. $ 5.00 New Building ............. Old or Pre-existing Building . .'..~.. ...... Vacant Land ............. LocatioJ of Property..~..~. ~ .O...~~ ,/Cz3¢~, ~.c~..~ . . ............. ,'');r;;t ..... ............... b;/./e, Owner or Owners of Property .'~J..~.~. ~,..~d.._~. ?...c~..~..~ ..7~..% .~.... i ...... County Tax Map No. 1000 Section f~ (-~ Block '~---- Lot /~ ~-- Subdivision.., ........................ ; ..... Filed Map No ........... Lot No. ,~ ............ Permit No. ~..~'.%x~, .~..~.~ Date of Permit..~...-~.'S..~F.~pplicant . . .~, .~?~.~-../~.% .~.~, .' Health Dept. Approval ........................ Labor Dept, Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ........... 2j..~.. ,~.[C~.. ....... Construction on above described building and pej;~nit meets all ~pplicable cod~s and regulations. d4 \ pp ............ _-..... ....................... Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY m-~ pm I ~S JOHN STREET, NEW YORK, NEW YORK tOO3B ~ ~ril 28, 1980 ~o..~.o.~ 068893 N ' ~ 476 08 in the f~llo~tng ~c~t~on; :~ Basement ~ 1st FI. ~ 2~ FI. OU~S ida Secti~ Bi~k ~t w~ examined on Apr il 24, 1980 and fiou~ to be in ~mpliance with the requlremen~ of this Board. DISH WAS~S ! EXHAUST FANS o~ cc co~ ~ 1-Smoke Datector 1-G.F.I. Ail Ways Elec. Corp. 262 Orinoco Dr. Brightwaters, N.Y. 11718 GENERAL MAN~GE~, Lic.764 E x, ~! L '~ ~ Th~s cerhfi¢c~te must not bo attered in any ~onner, returp to the off~ce of the ~oord ff incorrect I~spectors may oe sdenhfted by fhetr credent~o~s COMMENTS~ FIELD INSPECT~0N , FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N.Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: SURVEY FOR PASQUALE ~ LLJDIVOIC~{ ROMANF'LL~ MATTITUCK TOWN ~ ~U THOL D SUFFOLK COUNTY~ N.Y. GUAR~NTEE~ TO: IN~R-~UNT~ TITLE ~U~NTY AND ~RT~E CO~AN~ NOTE: ; SCALE: l"=~O' NORTHFORKB~NKANO~STCO. · =MONUMENT LOT NUMBERS REFER ~ AMENDED MAP OF MATTI- 0CTI7,1966 ,~. ~ TUCK PARK PROPERTIES, FILED IN THE OFFICE OF THE ~ LAND SURVEYOR CLERK OFSUFFOLK CO~TYO~ JAN 12,19~ AS MAP ~ N.Y,8. LIC, ~. ~ ~0 80i _ I .... RIVEffHEAD~N.Y. FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined/~ f.~2."'...~.~..~:.., 19 . .~.. Approved ~.~. '/~.~....~.-..°c~...., 19~.. Permit No. zc?..am?.-, d Disapproved a/c ...__.. ;T'~ ........... : ........ / APPLICATION FOR BUILDING PERI, IT Applic ation No. t/c-) ~- ~'-~ 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 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 buildmgs for necessary inspections..~~ (~~j~j~cl . (S~licant, or name, if a co poration) (Mailing address of applicant) I i '7~-" State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. Name of owner of premises . .~..~.'.~..~.O. pi?..to: ~.'-'~...dT-.../ff..0..~..~. .... .~..0..~l...~../bf..~'..L' ~.1 ........................ (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.?.t?f..~-"../~./. (~.'.. ~'..L.°./~: .'~ Plumber's License No..~. 7/~q. l'~..TZct c. ~...~.~.~.~...- License No. ~..~.~ Electrician's Other Trade's License No ...................... 1. Location of land on which proposed work will be done...'~....~.~..0 .... ~.[ .(~.~...~..~...~.....~. ~.. ............... House Number Street Hamlet County Tax Map No. 1000 Section .... ! .~..~ ......... Block ..... ~ .......... Lot .... ]. ~ ........... Subdivision ~ h TI' I 1' P C)C- PA~z4~- ~ [~0 P~zJzD .~iled ~a,, No. ~.01 Lot ,].]J (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Ex~sting use and occupancy ..... b. Intended use and occupancy ..... I .... .~..~..P~..I.L.¥ ...... .}-{-.~ .td.,$...L~.. '.U//./~./.~.O/7~'O~d,~,..~..~. ....... -z ........... 3. Nature of work (check whmh aPplicable): New Building .......... Addition .......... Alteration Repair .............. Removal ......... : .... Demolition Other Work .... : (Description) 4. EstimatedCost...'~.:.~/ 009, 00 Fee .~. ~...~.~ ~ (to be paid on filing this application) 5. If dwelling, number of dwelling Units .[...~./.{ .~.! .L/.~... Number of dwelling units on each floor ................ ffgarage number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each t. yp%of use ....... -~-'~' ' · 't ........ 7. Dimensions of existing structurds, if any: Front..~* ~..t, Rear ~0 ' ~- Depth ~ ~ Height ............... Number of Stones.. !. ~- .................................................. Dimensions of s~ne structure with alterations or additions: Front .. ~ .0!..57..'~ ...... Rear . .? P.~..~.t. ......... Depth ... ,~-.?. ................ Height ...................... Number of Stories... ~ ................. 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Nun3ber of Stories ........................................................ 9. Size of lot: Front ' Rear ...................... Depth ...................... 10. Date of Purchase ' Name of Former Owner ~/~¥ 11. Zone or use d~strmt in which premises are mtuated ...................... 12.' Does prop0sed construction viollate any zoning law, ordinance or regulation: . 13. Will lot be regraded ............................ Will excess fill be removed from premises: , ..Y_es No 14. Name of Owner of premises l?:. ~. ¢l.0~t.~...L:q.I ..... Address . .~'..' Dp)-. CE- Phone No~.~~ '~.~.1~,~ Name of Architect . ~.t...~.~. T. ~ .............. Address . .C *..~..~.c..~ ......... Phone No~.~.~ .~.b. ~ .... Name of Contractor ' . .~ ................. Address ................. Phone No. 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 Ilumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, IS S COUNTY OF...~-~...Z~. ~..cJ.~. J/~ ........~..,~-~. ~ .W~~..~.J~d..~..~..~. ~../..~--'~ ~ '.. being duly sworn, deposes and says that he is the applicant (Nan~/6f individual sigmng contract) above named. ~ He is the .............. . ..................................................... (Contractor, agent, corporate officer, etc.) of said owaer or owners, and is dul~ 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 manner set forth m the application filed therewith. Sworn to before me thru ........... ,/../.~.p .day~~ .., 19 Notary Publi_~c _~-...~......... C (Signature of applicant) ,a t. .I .,. I::>ATEZ.~ ~:;~i~ ~'I~z, TT~.lC~ ~X( T.~ ~.~t~, AMP A5 ;j ,, , ~ M~ ~ F~ ~1 ~-~ / FOP, P'2'UP~D ~. ROUGH ~ FRP~MI[..[G ~ FINAL - CQ~[STP'JCTON rp, LL CONSTW, JCTION ~.. ¥. THE REQU~REbAEHTS OF ~ATE CONSTRUCTION & '~ODES. NOT REsPONSlB[~ ... - . .~~ ~ ' - .,> . .... ..; ., N'fAT1' 1 l'L nC t.<, Fr~Pt, J T ELL_F_.VATt -'1 ,/ 'N ,tr 516-249-0055 802-824-5057 ,/ 12- '3'/2 "k'_