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Home My WebLink About11230-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..$.195.6.9 ......... Date ......... Jul}'..10, ............... 198.1. THIS CERTIFIES that the building ................................................ Location of Property ...R. ,. 0., .~.,.. l~../.e.n.d...R.u.~h...R.o.8.d. ~ ..... I![..a.~.~i..~.u.~.k.I..ND?...~ .o?.k. ..... House No. Street Hamlet County Tax Map No. 1000 Section .. 1.0.5 ...... Block ....... 02 ...... Lot .... .Q08 ......... Subdivision ............................... Filed Map NO ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated June 23 19 --81pursuant to which Building Permit No. 11230 g dated .. ?.u.l..y..1. ~. ................. 198,1.., 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 ......... Addition of Deck to P~,iva~e One-Family Dwelling The certificate is issued to ....... .L ,..arlft..C.,.. ~lD.s. ................................... of the aforesaid building. Suffolk County Department of Health Approval ........ ~I/It. .............................. UNDERWRITERS CERTIFICATE NO ..... N~.It ...................................... Building Inspector Rev. 1/81 ~o. 1]_~ 3 0 7. Permission is hereby granted to: SOUTH'OLD, BUILDING (THIS PEEMIT ~UST BE KEPT ON ~HE P~4'S~ S'UNTIL R~LL COMPLETION O~ THE WoRK AUTH6RIZEb~ ~ote to C(~r~ty TaX Map No. 1000 Building Iqspector, 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 ali burildings, 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 Architec( or Engineer responsible for the building. §. 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 · Id or Pre exlstln Bulldln ~ Date '~a~In~ :~'~' ~I~'~Z ...... New Building ............. O ~ - ' ' g ' ' g · ..~ ................... ,. Location of Property ~,~, ~ ~, .~.~C~ House No, Street Ham/et Owner or Owners of Property .g.-..~1--~ .... ~...~...~ .......................... CountyTax Map No. 1000 Sectiol~ ~ .... Block ... ~.Z ..... Lot...e,e.& .... Subdivision ................................. Filed Map No .......... .Lot No .............. Permit No./(.,'~.~..~... Date of Permit ?/I/~./...Applicant .~..~.~....~'2'.0~.. ~-?.~..~. ..... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ,, . ~,~/ ................. Request for Temporary Certificate ..................... Final Certificate .1~ ..................... Fee Submitted $., .,.~ ........................ Construction on above described building and permit meets all applicable codes a~ regula, ti~f~. Applicant..~..~....~.?..~....~...~..~-~¢... ~.~~'~ Rev, io-io-7e FIELD INSPECTION FOUNDATION (~st) FOUNDATION (2nd) COMMENTS ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined .~fl~.../ ....... ,19~./. Approved~.~. ~. ....... , 197./. Permit No. ~./. ~..~.~.. '-~ //,, Disapprovl~d a/c ..... .~:...' ......................... . 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 Buildi 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 stre~ or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this apg 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 peru 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 Occupan 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 t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Mailing address of aPplicant) /,/q ~r/ 7 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build~ ,, ?..c. ................................................ Nameo£ownerofpremises ~--' ,~Ze ' ~--'. /~tZ~..~.~' (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 .... ~.~ 2. ............... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ................................................ ......................... .............. ./.,i .... House Number Street Hamlet County Tax Map No. t000 Section . ]0..~,..~..~.. ...... Block .....~>..~.~. .......... Lot...t~X~ ....... Subdivision ..................................... Filed Map No ............... Lot .............. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b Intended use and occupancy ~.~ C,L~ ¢PYq~t ¢~7'(YV./7 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteratio~ .......... Repair ....... .~ ...... Removal .............. Demolition .............. Other Work..,t~-~(_.~ ..... /4~ t / _ ~-.~ ..~ (Description) Estimated Cost .~. ................................... Fee . .[ ................................. (to be paid on filing this application) ;. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars ........................................................................ i. If business, commercial or mixed occupancy, specify/~oture 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 ...................... ~. Dimensions of.entire new construction' F-alm~t ,"/tg~.'~. C) ~ '-~,~. 2,Q:.O Dmg~,h . Height /.b.../'~. e..SeT.~.~Number of Stories...( ..... i... i .......................................... L Sizeoflot: Front ...................... Rear .... ; ............ ' ..... Depth ...................... ). Date 6fPurchase ............................. Name of Former Owner . ............................ I. Zone or use district in which premises are situated ................................... : .................. L Does proposed construction violate any zoning law, ordinance or regulation: ................................ 3. Will lot be regraded ............... 2, .......... :. Will excess fill be removed from premises: YeA, No 1. Name of Owner of premises~., ~..2~.. f-7.: ./~..Le:.$.-. Address ................... Phone No. 02~'~';,~..'~.~./.. Name of Architect ............. Address ............... Name of Contractor 6).'?[-. .~..-:.Y~" '(-'"~'"[-" .... . Address ~.' P.- ..ff..e~./.0.o.?5..'" Phone No .... ............. ~:~j~,,.r lt ,.. Phone No. ~.~.~ .'-~ ?,~31 .~i PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from roperty lines. Give street and block number or description according to deed, and show street names and indicate whether ,terior or corner lot. TATE OF NEW YORK, ,, ~ ~ ........ ,,~-~.J':...~'7...~. o. ~..~--~.'egl ~ .......... being duly (Natne of lndiviffual signing contracf) )ove named. sworn, deposes and says that he is the applicant e is the .................... ~ /~ "~tract~,sagent, corporate officer, etc.) f said owner or oWners, and is duly authorizeff-to pen~rm or have performed the said work and to make and file this )plication; that all statements co~tained in this application are trua to the best of his knowledge and belief; and that the 'ork will be performed in the manner set forth in the application filed therewith. worn to before me this o_0J&ry Pu~blic, ....... ~ ........ ~County -- ./ /O ~' ' No. 52-8125850, Suffolk County . tSi'"'ature of a--licant~ Term ~xo[res March 30, 19~g".~~'''- - ; *, ~' FF ) ~TIFY P' ?L~NG DEPARTMENT AT -'~-1¢~ 9 AM TO 4 PM FOR THE D' ...... FOU~AT~O~ - ~/0 REQUIRED FO~ "mJqED CONCRETE 2 ROUG'~ ~ FRAMING & PLUMBIN~'~ 2 lh~CU' BE C-~ ~TE FOR C. O ...... ~.,LL CONFTR~:CT~ON SHALL MEET -HE RED~uRT,MTNTS OF TH~ cTATE CONSTRUCTIO~~/ CODES. NOT RESPONSIB~ DESIGN OR CONSTRUCTION E~O~S. [/ 2b." S :/ 140