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Home My WebLink About11309-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy Z10687 THIS CERTIFIES that the building ................................................ Location of ProperW 270 ,Ro.c, helle ~l&,c.e g&tt~.tuck,, ~9.w. ~9~k County Tax Map No. 1000 Section . .1..4.4 ....... Block .... 9.4 ......... Lot .0.1.9 ............. SubcUvi~on .L.t.d. 9..R.~y..t.l.e.y. ................ Fried M~.p No. %7.9 ..... Lot No ..... ~.~..-.~.3.... confor}ms substantially to the AppliCation for Buildin~ Permit heretofore fried in ~ offl~ dated Au~uat 4 .,19?.1. pursuant to which Building permit No. 1130~ Z dated ...... A.U..g.~.~.t...4 ............. I~?.. ,was i~ued, ~nd conforms to all of the requirements of the app~cable provisions of the hw. The occupancy for w~ch this certificate ~ issued h ......... Deck Addition to Dwelling The certificate is issued to ...R..o.b.~.~..I,.~.1.~ .h.~.o.n. ...................................... of the aforesaid building. Suffolk County Department of Health Approval ....... .N/.I~. ............................... UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector FOEM NO. ~ TOWN OF ~UTHOL~ BUILDING DI~PART~N'~ TOWN HALL SOUTH'OLD, N, Y. BUI[BING (THIS PERMIT MUST BE KEPT ON THE PRE/V11S~,S UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ii N°. 113 )9 Z Dete ...................... , ..... Permission is hereby granted to: ~.~/~.~..~.~. ....... i ..................... ..... ..C:~z'..~...~.~e.:.....;.~. ~.../..~.~.~..~...z~.:~.:.-....~;~......~.-~.~ ~.~.~. .............................. ~t premises ,ecote(~/at ....~.~.~.-.....~..~C~.~.~-~¢-~-..~7· ''''.' ...... ~..~, ~ ~.. z:..,~.~ ...... ~,~. : '~'~"::::':':'2~:::"~" ..... 5;:::-.':~ ............. .......................... . ~/w '~ ~ ' count,, Tax Mop No. ~0oo Sect, o~, ..../..~ ........ ~,o~ !..~,.~.... ...... ~_o, ~o..~z'..o ............ pursuant to application dated ....... ~,~,~ .......... i,...{~,......, ..~, and approved by~ 1 the / Building Inspector. / Building Inspector Re¥.r 6/30/80 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 Wpewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings or new use: I. 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. Approva~ of e~ectrica~ 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 featu res. 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 dwe~bng or ~and use $5.00 3. Copy of certificate of occupancy $1.00 Date .~../, .c~../.~.C/ ........ New Building ............. Old or Pre-existing Building .,~.. ........ Vacant Land ............. Location of Property/'...c~..7..0 1/~- C~ . .~..~ f'~-¢~ , .~.~..c~., House No. Street Hamlet Owner or Owners of Property '~ ° ¢~'~7~ '~ /-'- .~.. ~./~ ~'~ ~ County Tax Map No. 1000 Section ... ~ ..... Block ..... .~. ........ Lot.../..~.~ ......... Subd,v,sion..~./.~...~..(z'~. ................ Filed Map No. ,."~...-~..O..,LotNo. ~..~. Permit No. ,/,f ~ ,O. ~.. Date of Permit ~."~?.~ ~.~..Applicant....~'~..~..~ ('..~-~..J...J...f'~...~. -.~. ,~... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ................... Request for Temporary Certificate ..................... Final Certificate ..... Fee Submitted $....~...~-f .................. Construction on above described buirding and p~,~,t//n~eets all applicable codes and regulations. ................ Rev 10-I0-7a FIELD INSPECTION' FOUND%TiON (lst) COMMENTS FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: Rm$~/a~ory Affairs · Building 40, SUNY Stony Brook, NY 11794 (516) 751-7900 Rober= F. Flaeke~ A~ COPY OF, T.}I!S AUTH, ORI~.6T~N MUST BE AVA?T&BT.~. ON PROJECT SITE TIDAL I~gTLANDS NOTIFICA~iON :LETTER APPROVA~ Dear ~ L~._~_O~ ~ This is to info~ you that we have reviewed the not$~e~ion letter (or pe~it application) filed on ~o~V ~ 19~] ~h~ dete~ned that it will not be necessary to file~a permit appli~a~iom (~ secure a. tidal A~u~ng you hav~ ob~ain~ a~ o~h~r nec~ p~l~ you ~y pro~ with your project adhering to the special conditions (if any) found on this letter, c~: U.S. Army Corps of Engineers NYSDEC Law Enforcement ~ 'Region Regional Permit Administrator Date Issued '' ~piration D~te ,/ / i FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined~.~./~.. ~ ...... , 19 .~.°./ ~ Application No../. (.~:.~.~...~. ....... Approve~?... ?. ...... , 1~.. Disapproved ate ..... / (Building Inspector) APPLICATION FOR BUILDING PERMIT Date~.~..~.( ....... 19(.~//. .. 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 braidings, 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 inspeqtig~. <-~ ... .............. (Signature of app~(n~/~ name, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· ....................... ....................................................... Name of owner o f"remises ~'~'~ ~ .?.~'~./'.~.~...7~.....~..."..: ......;..,., ........................ v ....................... ~(a~ o'n' the tax roll or rarest aeea) ' 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 ....................... Other Trade's License No ...................... 1. Locationoflandonwhichproposedworkwfllbedone .~./f~ I~OC/P~ [~' F/"qtCC' :- 3j'~Of ~004~/~ 42 ' ''/' ....................................... ~t~: · ............. .o.c ............... ................ House Number Street Hamlet County Tax Map No. lOOOSection ..... Block .............. Lot/.O.. ............... Subdivision..~.7 .~. ~.L.t.o.~.,..~../~.. ?.~.-.'.~... ...... F,led Map No. 7. ~..D.: ........ Lot ..2:?. 7..2~..~ ..... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... /...t~....~.. .... ~ ~'~--~( ~' .' b. Intended use and occupancy . .~?...&~..'~...~. i ............. ~ ........................... 3. Nature of work (check which applicable): New Building .......... Addition ......... Alteration .......... Repair .............. Rempval .............. Demolition .............. Other Work ............... ' ~1~ ~' (Description) ,,. Est ated Cost.. ..0. ..................... Fee .... J.? ............................. ~ (to be paid on filing this application) 5. If dwelling, number of dwelling Bnits ............. Number of dwelling units on each floor ................ It' garage, number of cars ..... : ................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. 1-)imensio~s of existing structures, if any Front..~ .AT. ......... Rear .... ~ .,~.~. ..... Depth . ~..o.. :~.. t~..O.,.. Height .0 ..... Number of Stories .../. ~ .......................................... -Dimensions of same structure with alterations or additions: Front .~..-?7 ............ Rear ¢.3'7 .............. Depth.../-/,~.~ .............. Height ...................... Number of Stories .......... :.,.... ,~ ...... 8.,, Dimensions of entire new construction: Front ............... Rear ..... ~..~. ..... ~. Depth /. ,~ .... .~.~ Height ............... Number of Stories ........................................................ 9. Sizeoflot: Front ........... . ........... Rear ...................... Depth ...................... 10. Date of Purchase ........... : .................. Name of Former Owner ............................. 11. Zone or use district in which pr~mises are situated ........................ ...,r. · i ....................... 12. Does proposed construction viohte any zoning law, ordinance or regulation: ..../'f..~ .......................... 13. Will lot be regraded ......... !../~..~ ................ Will excess fill be remove~l, from premises: .Yes Nok/ 14. Name of Owner of premises ~l~/)~/g.r....~7.tg. ~..>~o...~.. Address ~ Pti..~..e-..(.~:./~.. ~.-'/... Phone No. Z..~?... ~. ,,~. ~v~. · · Name of Architect ..... ~..~.~.., ............. Address ................... Phone No ................ Name of Contractor ~t~'9//9.4:q.. ~'~i c],~::-~X. Address ~e,,']~.~ $ .e~.. ..... £. Phone 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 YORK, . .~ ~ ..... · ~... ~..~ .................... being duly sworn, deposes and says that he is the applicant (Name o~ndivi~l sig~ing contract) above named. He is the ................ ~(.f~. ~.: ..................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is du~y authorized to perform or have perfomed the said work and to m~e ~d file this application; that all statements contained ~ this application are true to the best of his knowledge and belief; ~d that the work will be perfomed in the m~ner set forth in the application filed therewith. Sworn to before me this .............. ~~ ........ ~~..,19r/ ~ ~ ~ ~ .... :; :: :,. .... ~,,~lul~. ~..,~. ~.~ ~0, ~ (Signature of applic~t)