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Home My WebLink About11405-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildtn~ Impector Town Hall Southoid, N.Y. No..Z. ! ~{~.9.6. Date ...... .I,l.a?.c..h..a .................. 19 .~.~. THIS CERTIFIES that the building ................................................ LocationofProperty .2600 ~rath~ohl ,R.o. ad ..... New Suffolk Houm No. Street Harem County Tax Map No. 1000 S~ction . 1..1 ~ ........ Block ...0.2 ........... Lot...00.9.... Subdivision.. X. ............................ FII~I Map No. X. ....... Lot No. X conforms substantially to the Application for Buildin~ l~rmit her~tofor~ f~d in this Mlioe datM ~.e~.~n.~.~.~...La. ...... ,19a. !. pursuant to which Butldins l'm~it No. )).~.0..5..Z ............. clat~ . ~.e.P. ~..e r.n.b.o. ~...3.0. ............ 19.8..1, wU issu~t, ~nd c~nf,~,,i to ~11 o'~ the r~luir~m~ats of the applicable provisions of the hw. The oc~upsn~ for whioh this c~'tifl~ate is ism~d is ......... a private one-~amlly d~ellin~. The certif'a:at~ is issued to ..... F.~..a.n.k..~ :. ¢opius ~ Jr. ...... laii ;. ..................... of the aforesaid building. Suffolk County D~partmmt of H~alth Approval 1..l:..~.Qr~.%..~ff.1/./}2.,. l~o~ar~ /t..Villa P.E. UNDERWRITERS CERTIFICATE NO ..... l'.s.B ~ ;[~ .................................... Rw.l~l Building l~O]F,~g NO. ~ TO~N OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N~ Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 1141)5 Z Permission is hereby granted to: ...,,./~...~..~/.~.~..~..J. ....... . .~..~.,~...~ ...... .~. ..z~o~.....-...~.~:......,.:/..g~s ~o ..... .C~,c~.z.,~,..c~......~......'~..Z'~,~_.~......' ~.~,;z-/.z//.~...~. ..: ......................... '" . '1~ .......................... ......... ........................ ot premises ,ocoted a~....~..~.~...~.....~..~-~'~..~O~....~.~....Z~..~ .~ ............................................................................................................ :.~..~/...~.~. pursuant ,o opplicotion dated ..~~.~ ....... Z~., 1~., ond opprov, by the Building Inspector. Fe~ $..~...~......~.~.. Rev. 6/30/80 FQRM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southo[d, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY |nstructions A. This application must be filled in typewriter OR ink, and sub~itted 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 tho 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 $5.00 3. Copy of certificate of occupancy $1.00 Date .. New Building ............. Old or Pre-existing Building(X) ......... = fVacant Land ............ Location of Property .'Z(.~Cr-~) .......... House No, Street Ham/et Owner or Owners of Property . . / Z.. .... .......... Map No. 1000 Section /./- .'7 ......... Block ....~. ,.'~. ....... Lot.. ~..~..~. ....... County Tax Subdivision ..... ~ .......................... Filed Map No. Permit No. L,/.~.G,~, . ~ Date of Permit .C~. (-~ O.). ~,Applican, .... .~/...~......~-. ~...C_~?../~.. ,~ ........ Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. · .~ ........... Planning Board Approval .................. ~ ,.~ Underwriters Approval Request for Temporary Certificate ..................... Final Certificate ................. Fee Submitted $..~[~...~"~? .... ~ ............ Construction on above described building and permit'mee~ts all app[i,cable~codes and regulati~s, Rev, 10-10-78 FORM ~JO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL File No ................................ Date . .~../~.~/~/.~..~..~..~..~..~...~...-~.., 19 .................. .... PLEASE TAKE NOTICE that your application dated .. ~4... ~.%. .......... , for pemit to construct ..... ~(~.C~ .......... ~ ....... , ..................... at ~.~J~... County Tax Map No. 1000 Section ..... (L7. ....Block Lot Subdivision ................. Filed Ma o ................. Lot No ..... ~ ........... Building InsPecter RV 1/80 FIELD INSPECI~ION '~ COMMENTS FOUNDATION (1st) FOUNDATION (~nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ~ODE FINAL FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1801~ APPLICATION FOR BUILDING PERMIT Application No...~./..~...~.-. ...... 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 buildings for necessary iqsp_~ti,gns. __ .. ......... (Signature of appliOtnt, c~%fiame, if a corporation) . ....... ~,~d,~,),,M ailing~add re s s. o f ap pJ,i cyp t) State whether applicant is owner, lessee, agegI~ architect, engineer, general contractor, electrician, plumber or builder. .................................. ..... , ................................... Name ofownerofpremises '.~.'~...~.]~ .~.' COP/us (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....--7~./~.. Electrician's License No. t t tt ~, Other Trade's License No ...................... " 1..,~ation of land on which proposed work will be done ...~//g... ~~...~....Cr~..~zf..O?.~ '~-'-flouse Number Street Hamlet County Tax Map No. 1000 Section .-.'.! !..~. .......... Block ~..~. / ............ Lot..~.~. ~. :./~.... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and,,h~tended use a~nd' ocbupancy of proposed constructioh: a. Existing use and occupancy ........................... ' .... ~ ..................................... b Intended use and occupancy / Fd ~.f / l' ~4J-~~2~'/'2-~ ' ,' ' 3. Nature of work (check which applicable): New Building .......... ~" Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... 4. Estimated Cost '~.-- c~' -'-~--~ Fee .--~. 55- (Description) (to be paid on filing this application) 5. 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: FrontHeight..J~..t ....... ~_Number of Stories i i¢i~.' R.~ar . ~xi~.. ........ Depth .~.': ~.../.'..~.... 9. Size of lot Front.,,[..~>. ............... Rear../,7..3~-. ...... iiiiiiiii b~ ~.'~ '~-.' ~.~.'~.' .~.". 10. Date of Purchase ............................. Name of Forn~r Owner ............................. 1 1. Zone or use district in which premises are situated .......... z~..: ./..Z~./.~9...~-~X~7....~. ..................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ Will lot be regraded ...................... t~' '~ ' Will excess fill be removed from premises: Yes ~ 13. 14. Name of Owner of premises .~.~../<..P,. ~. ?{.~ddress .~tr .~f.~. ~ .~e.. Phone No ............... Name of Architect ........................... Address ................... Phone No ................ Name of Contractor (,g~.,. ~ t. 0 t°t-(-~O~'-2 .J; ..... Address {~)~..~.?~..~.c~... Phone No..7.~ .~.7.~.-~.../.J--. 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 number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW.:gDRK.. -- S S COUNTY · ..... .... (Name of individual signing contract) above named. being duly sworn, deposes and says tha~a~e is the applicant He is the .......... ~ ~.:: .~../g'.~ ................................................... Oe ~(Contracto~, agent, corporate officer, etc.) of said owner or owners, and is duly ailtho~erform or have performed the said work and to make and ~e this application; that ail 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 in the application filed therewith. Sworn to before me this ............. ~ ~ .... day of..~.. ~ O(~t~.~.g4e'..., 1~/.. BOTARY PUBLf Stat~ ef Nek~ York tJO. 52-8125850, Suffolk Cou T~rm Expires March 30, I SUFFOLK CO. HEALTH DEPT. APPROVAL : H.S. NO. //- ~- Z~ q ............................. THE WATER SUPPLY AND SEWAGE DIS~SAL : SYSTEMS FOR THIS RESIDENCE WILL ~ CONFORM TO THE STANDARDS Of THE SUFFOLK CO. DEPT. OF HEALTH SERVICES. , ~ APPLICANT i ~ SUFFOLK COUNTY DEPT. OF H~ALTH , CONSTRUCTION ONLY ] DATE: I! ~ F[OO~ ~ ~---~ J h~ APPROVED: i ~ DIST. SECT. BLOCK PCL I, OWNERS ADDR~S: T~ HOLE ~AMP SEAh ~u~eo~ ~a. ~0. LICENSED LAND SURV~ORS GREENPORT NEW YORK + ~ .... ~ ~ ~ ~ ~ .~ ~ , ":~,, - ' ~ ~ : ' , : ':~, ' ' .' ",.': ']4 . ' . : t ; ' ". ',:,-, ' , ' ' f :, -. , r' ' .: g~ ,~ ~:1 ~u,t~,. ~ " ~ ' ~ ' ., , ,- : :' : L CEN ND F . ~' :. : .GREE~RT ' ' NEW. Y~K. , : , RODE,RICK VAN !_UYL, P.C. LICENSED LAND SURVEYORS GREENPORT NEW YORK STATEMENT OF INTENT THE WATER SUPPLY ANDSt~'V/AGE DISPOSAL SYSTEI¥tS FOR THIS RESIDENCE WILL CONFORM TO TH~ SIANOA~D$ OF THE SUFFOLK CO. DEPT.-OF HEALTH SERVICES. A'PPLIC~NT SUFFOLK COUNTY D~f. OF. HEAL.T-H SERVICES -- FOR APPROVAL' . OF CONSTRUCT tON ONLY DATE: ................... H. S. REF: APPROVED: ~AL JOB No. ,j NO~'~ m ~dNG ~EP.ART~.~NT AT ~ .~M ?~ 4 pM FOR THE 4. F'"'' ,: MUS,, ] ] SHALL MEET THE pFr':':F'- ~ZNTS ~F STATE CONSR'EUC'[i(a]~ &' ENERGY CODES, NOT R~SPONSIBLE DESIGN OR CONSTRUCTION