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Home My WebLink About11400-zFORM NO. 4 TOWN OF 5OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y, Certificate Of Occupancy No. Z10723 :~Date October 9, 981 TI-HS CERTIFIES that the. building ................................................. ~m - 1355 Tuckers Lane~ Southold, New York .fLotation opt ropcrry .......................... , ....................................... ' House No. 'Street Hamlet County Tax Map 'No..1000 Section 05 9 ·Block 10 ..... Lot 01 0 Subdivision ........................ [. ...... Filed Map No ...... :..Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated · .S..~P.~.e~.b.~Y..?.~ ..... ,19..8.1pursuant to which Building Permit No ...... ! 3P.99z. ......... dated .... .~.8.e.p..g .e.m.b.e.P....2.9. ....... 19 . .8.1, was issued, and conforms to all of the requirements of thc applicable provisions of the law. The occupancy for which this certificate is issued is ......... Deck Addition to Dwelling The certificate is issued to A1 Falkowski ..................... ?o¥;~;, ~;~/~it ~g, tkk k .................... of the aforesakl building. Suffolk County Department of Health Approval N/R UNDERWRITERS CERTIFICATE NO. N/R Rev. 1/81 TOW~ O~ SOU ~, UILDiN~ TOWN~'H~L sOUYH,O~=~ ~:~ (THIS PE~IT MUST BE KEPT ON ~HE PRE~!S iS COMPL~ION OF THE WORK AUTHORIZED) U Nil L' F~U LL N9 ~1400 Z Vote Per~nission is hereby granted ~ ,~.~.~..~.., ........ at premise~s located at /..~...~...~.~ ....... ~[~./~ County TaX Map No. 1000 Sect,on ,..~.~,~,..~,.......,. Block ~ ~t~.~......... iLot No. ;..C,~/..~. ......... ,. and ; roved b the~ r ' ' ~ } pursuant fo applicot,on dated ~~~ .:..~,...., .... ~.., pp y ~u~l~ng Ifispector. Fee ',; ............... ~:, Re~. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N,¥. 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. 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 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 New Building ............. Old or Pre-existing Building $5.00 ate / ?>.1 ...... ..... x~ ..... Vacant Land ............. r % Location of Property ,., /~. ~.0~.~.~-. .............. :~../t/~--/~--~ ........ ,~.~..~. · · . House No. Street Ham/et Owner or Owners of Property ...../~..~,.~ .... ~-~....~'~-~'~¥g--/~. .................. County Tax Map No. 1000 Section .., '.(~. ,5.~. ....... B~ock ..... ,/.~. ....... Lot .... ~./'. ,~. ....... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No, ///~.~..~.. 'Date of Permit ~...~'¢-~'.~Y..Applicant ..b~..~ .~//~.-.~.~ Health Dept. Approval ....... /~J/]~ .............. Labor Dept. Approval....~_.~.~ ............... Underwriters Approval ....... /~/~ .............. Planning Board Approval..../~.~ ...... Request for Temporary Certificate ..................... Final Certificate ................ ,~. · .~.q~ Fee Submitted $.. ~. ,.<~. ...................... Construction on above described building and per it meets all applicable codes and regulations. ~ )~ Applicant ..... Rev, 10-10-78 FIELD INSPECTION COMMENTS 1. FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY FINAL ADDITIONAL COMMENTS 4,' ............ -~: MUST STATE CO>~ L:.~-~ CODES. NOT I ...... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examine~=~....~..?. .... 19 .~.? - - c~ .~. Approved ~.~.'(... [ ..... , 1~. ee~it No. ~PPLIG~TION FOR BOILDI~G Application No.. d/..r~.~. ·0 ........ Date... ~.~./.~ ........... 197./ 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 dia~am 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 purpos~ 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. Th~ 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. . .~7~./~...~.~.~q.~...~..~t..~-. -- ~ (Signature of applicant, or name, if a corporation) .~..~../. ~ ~.~.o.~. ...... £~.~ ........ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. &,..~..*.0. ............................................................................ Name of owner of premises . j~t.~.~. ,d~Ag,~'... ~ .... .~.~.,,~k~'~./~'~)/~d, ff'~;'/. ............................... (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... 4~ ................... Electrician's License No.. 9/~t .................. Other Trade s License No ................... 1. Location of land on which proposed work will be done .................................................. ... l. ~. .~Tff. . ................. ~ c/cr-~. . h~. .e. .................. ~. o. ~ -~-x>. . ........... House Number Street Hamlet County Tax Map No. 1000 Section ....t~. "~'7 ........ 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 ... 0~..~-/~-t~'~'F'.. ~/,~ b. Intended use and occupancy . ~./¢~. t~-~gg4~..~nr/~,t~.. ~.~../~. ;.~f~.~...~;~,~./J./.~'.~.~. ............ 3. Nature of work (check which applicabi~lh~ding .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work.. ~1~ ..... (Description) 4. Estimated Cost '~3~O° Fee/~-..~ .................. , .......... (to be paid on fding th/s application) $. If dwelling~ number of dwelling units ............... 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 ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ......... · ............ Number_of Stories ............ · ......... 8. Dimensions of entire new construction: Front., .~.. !i ...... Roar ...~..~.: ........ Depth ~) ............ Height ............. ;. Number of Stories ....................................................... 9. Sizeoflot: Front .... ~ ............. Rear ...... ~ .......... Depth . .'~f~.' ............... 10. Date of Purchase ............................. Name of Former Owner ............................. 11. Zone or use district jn which premises are situated ..................................................... 12. Does proposed construct/on viohte any zoning hw, ordinance or regulation: ................................ 13. Will lot be regraded ............................ Will excessfjll be removed from premises: Yes No Name of Architect ........................... Address .. --~-- , Phone No ..... ~. .......... Name of Contracto W- .. iiii Phone No. .... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give st~et and block number or des~i~tion according to deed, and show street names and indicate whether interior or comer lot. I STATE OF NEW YJ~,~ · · · · - · .x~-~. · ..................~../..~'~-~. ................... being duly ~wom, d~poses and ~ys that he is the applicant "~ (Name of individual signing contract) · above named. He is the.. l~ .... i~.~c_.~-~ ..................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and fde this application; that all statements contained in tl~ epplication are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application fried therewith. Sworn to before me this · ' · ............... ..day of. ff~~~, Notary Public, N0ta'13" Public, State of New 'yoe~ ... ~ 52-0344963 Suffolk Count~..~ ...... Oon~cd~on Expires March aO, ~ (Signature of applicant)