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Home My WebLink About10579-zFORM NO. 4 TOWN OF SOUTHO~.D BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y, Certificate Of Occupancy THIS CERTIFIES that the building ................................................ House No. Street Hamlet County Tax Map No. 1000 Section . 0'54 ....... Block ..... 04 ........ Lot .... 02~ .......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated ·. Ma,.ch. :~. ........... 19.80 pursuant to which Building Permit No ........ .1.0~5.7.. 9..g ...... dated ...... March. 7 .............. 19..8{)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 ......... The certificate is issued to ..... of the aforesaid building. Suffolk County Department of Health Approval .......... ~/.~ ............................ UNDERWRITERS CERTIFICATE NO ...... : t4~.R ........................................ Building Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDIHG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF q'HE WORK AU-['IJORIZED) N? 10579 Z Permission is hereby granted to: ...... ~o~ .... ~-..:.... ........ .... F~o ...................... at premises located a .... ~ ............. to application dated ..... ~./...~'.. .............................. , 19 '.~.~., and approved by the pursuant Building Inspector. Fee ...... / . 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 features. 2. F~nal approval of Health Dept. of water supply and sewerage disposal-(S-9 fo'tm 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 buddings (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 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 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 ............. Property83Z~0 Horton Lane, southotd, New York Location of House No. Street Hamlet Frank W. Wagenbrenner Owner or Owners of Property ............................ ................................ County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. PermitNo. ,Z,0.5.~).Z,.. Date of Permit 3/7/80 .Applicant Health Dept. Approval ........................ Labor Dept, Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ..... ~ ......... Fee Submitted $ ..... .5., .0.0. ................... Construction on above described building and permit meets all. applicable codes and regulations. Rev. 10-10-78 FIELD iNS?EC'~"~N , '~ DATE CO~N~S FOUNDATION (~st) _ ~ FOUNDATION (2nd) ~ ROUGH FRAME& PLUMBING INSULATION PER N.Y. STATE ENERGY CODE " FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined. ./? ......... Application 7. ..... Approved..' .(?. ........ , Permit No.. / (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .................. , ]~... INST RUCTIONS 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 buddings 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 ~nay 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 preinises available for inspection throughout the work. e. No building shall be occupied or used m 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 heroin 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. , (Signature of~}pplicant, 9r~ame, if a co]poration) ~ ~ . ('Mailing address of applicant) ~ . State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .F..r.a.n.k...~:..~.a.g.e.n.b.r..e.n.n.e.r. ................................................ (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. ~-~ ~ Plumber's License No .......................~~ Electrician's License No.. t. .................... Other Trade's License No .................... 1. Location of land on which proposed work will be done .................................................. 8340 Horton Lane Southold House Number Street Hamlet County Tax Map No. 1000 Section . . .90 ............. Block .................. Lot...0.2. .............. 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 ...... Roof..Ov¢~c..ex~.t;~rtg..p.~:~..o ................................... b. Intended use and occupancy ..... Oul:s.ide. gatio ................................................ 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ~t~. ....... Repair .............. Removal .............. Demolition .............. Other Work ............... , e .~.~..~....~,,~, ~ (Description) 4, Estimated Cost...~50D.,.O0 ............... Fe ............................ (to be paid on filing this application) 5. If dwelling, number of dwelling pnits ............... 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 ...(}~It .................................................. Dimensions of same structure wlth alterations or additions: Front ................. Rear .................. Depth ................... ~.. Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height . ~1. t~t: ......... Number of Stories ........................................................ 9. Size of lot: Front .120..:~;,. ! ........... Rear ...],20..~.~, ........... Depth 31/* .~ .............. 10. Date of Purchase I~eell~a~. 1~,. 19.~.0 ......... Name of Former Owner .~ .lllld..~.J, IIIOll~' .......... 11. Zone or use district in which pr~mises are situated.., g.Ql~gh.O.~t$ ...... ~ .......................... 12. I)oes proposed construction violate any zoning law, ordinance or regulatio~k..~:w~4. .......................... 13. Will lot be regraded ...l~.O.... i ......... ,. ......... Will excess fill be re-"~-8~d from premises: Yes XllIo 14. Name of Owner ofpremise~.~.8~.l~...~.llg.~.~..b.r~.t~..~.~Address ..8..O~/.~.hO..]..d ........ PhoneNo~7~f-.~21l ...... Name of Architect ... l~one, i ................. Address ................... Phone No ................ Name of Contractor .. OMnori ................. Address8.$$0..I~O.1~{)1~ .~!II1.~. Phone No ................ , ! PLOT DIAGRAM Locate clearly and distinctly alt 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. i Hee aeeaclmd sheee Roof materials All 216' ~/8" Plywood 1 coarse 55 weight ~ele 1 coarse 90 weight mineral - whi~e All edges' T STATE OF NEW ~. R.I~ j., COUNTY O~- S.S ............................ I ..................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dhly authorized to perform or have ' ' performed the smd work and to make and file this application; that all statements conlained in this application are true to the best of his knowledge and belief; and that the work will be performed in the mm~n~r set forth in the application filed therewith. Sworn to before me this/ ............. /'~ ......... day of .... (.~..c~. fC?/-~. ..... ,19 .~.q JUDWH T. TERRY ........ Notary P~tblic, State of NeW YorR /~ (Signature of applicant) Commission Exp,r~e March 30~ 0 1. FOU~'~' ' ' '~ FOR ~ .~'z'~ ~ PLUM~ANG 3. IN_U-A ~ ..... ~ ~uST A, FINAL - FOR C.O. BE C~MpLE~E cHALL ~EET ALL cONS ' :~ OF N.Y. T~E REQUIREMEFETS THE ~TA~ CONSTRUCTION & ENERGY ~T RESPONSIBLE FOR ~ ~ coNSTRUCTION ERROR~ I $3~ E" -, t