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Home My WebLink About11329-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate O{ Occupancy Z10734 No .................. Date October 21 ],,81~.. TIJI$ CERTIFIES that tile. bmldi~g ................................................ 'Location of Property '/45 Henrys Lane, Peconic, New York Hm~se ~V'o ................ Street Hamlet County 'Fax Map No. 1000 Section .... 0.7.4. ..... Block 01 .Lot 016 Subdivision Peconic Homes .Filed Map No~ 4181 . .LotNo. 7 confreres substantially to the Apphcatlon for Building Permit he/'etofore filed in Ibis office dated August 11 19 . ~8Jputsuant to which Building Permit No. 11329 Z dated . . .t. gg.u.s.%. I 1 .............. 198. !. , was issued, and conforms to all of the requirements of thc apphcable prm'~s~ons of the law. The occupancy for which this certificate is issued is ......... Deck Addition to Dwelling John J. Volosik & The certificate is ~ssued to ..................... io¥.'& igxa ..................... of the aforesakl building. Suffolk County Department of Health Approval N/R UNDERWRITERS CERTIFICATE NO N/R Rev 1/81 No. 11329 Z FOI~M ~NO. 2 TOW~ o~ TOWN HALL, SOUTH'O~D, N~ Y.~ BUILDISG P,E~!~ (THIS PERMIT MUST BE KEPT ON TH,~ COMPLETION OF THE WORK AOTHORIZ[~) Date .. Permission is hereby granted to: UNTIL ~ULL ................................................... · r · ? '"t~'""~' .......... at premises located a ............. ~:~~: ........ : .......................... , ~ ..., ..... , ...?.~,.., ................. ~ ......,...,..,.. .......... COu~ fox ~op ~o. 1000 S,ction ...... ~ . Block ...~.~ ......... ~kot ~o ..... ~.~.~. ....... opprov~ by Builglng Inspector. R?,v.. 6/3o/8o ~lnspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hail Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF Q~CUPANCY Instructions This apphcat~on must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor w~th the fo[lowing; for oew buildingsor 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 Planmng Board approval of completed s~te plan requirements where applicable. For existing buildings (prior to Aprd 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 topographtc 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 requwed to prepare a certificate, Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of ce~ tlficate of occupancy $1.00 $5.00 D ate. ~?~/~."~-,~.~...~..4 '~/. ,~. ,Z~ .... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of ProperW ...................... House No '/' ~tr~t Ham/et Owner or Owners of Property ... County Tax Map No. 1000 Section . .~.~ ....... Block . . .~./ ......... Lot. , ,~/.~ ....... Subd,vision...~]~Z~ ~/.~: ...... Filed Map No. ~/,~,~.. ,Lot No. ,.~. ........ Permit No. /[,~'~ato of Permit ¢¢~[.Applicant ......... {d?(: .... Health Dept. Approval ........................ Labor Dept. Approval ....................... Unde~riters Approval ....................... Planning Board Approval ............... tee buDmI~zeQ b ............................. Construction on above described budding and per~eets~l app~cable codes and regulations. ApoI cant ................... ~ .. Rev 10-10-78 FOUNDATION (~st) FOUNDATION (2nd) ROUGH ~'RAME & PLUMBING INSULATION PER N. STATE ENERGY C,ODE COMMENTS FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT ToWN HALL $OUTHOLD, N,Y. 11971 TEL.: 765-1802 Examined4V./{, ....... 19.~./. Approved~A~...dd. ....... 1 ~. me nnit No. t/Z~/51Z Disapproved a/c ....... ; .................. .-3 ......... (Building Inspector) APPLIC,~,TION FOR BUILDING PERMIT INSTRUCTIONS Application No ............ 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 giwng a detailed description of layout of property must be drawn on the dla~am which is part of this apr. cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon ap'pre, al of this application, the Budding Inspector will issue a Bmld~ng Permit to the applicant. Such porn shall be kept on the premises available for inspection throughout the work. e. No budding 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 1S HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to t Budding 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, buildi~ code, housing~code, and regulations, and admit authorized inspectors on premises and in buildings for necessary insp ct' s. (S3gnature c(,f applicant, or name, ifa corporation) (Mailing address of applicant) State whether applicant is oxw~er, lessee, agent, architect, engineer, general contract~dr electrician, plumber or build, Nmne of owner of premises ...... 0.3. ~ (~ ~ ~h .~.~).].127~ ........................ (as on the tax roll or latest deed) If applicant is a corporatmn, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No... ~/d" Pluiuber's License No ......................... Electzician's License No ....................... Other Trade s License No ..................... 1. Location of land on which proposed work will be done ................................................ ..... .7..4. ....................... ..... ................. House Number Street Hamlet County Tax MaEA.No. 1000 Section .... Q. 7. ~ ........ Block ....O./. ............ Lot...~. ?'.4.' ......... S~bdiv,sion .... ~-'..~ .O,/~,-/'.( . .~./~.Z"~'.: ........... Filed Map No..,..~../~./. ..... Lot... ~. ......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .. ~)/2,b'~?~ c2/o'9Cd///t) gi .................................. - b. Intended use and occupancy ... ~.~. ,.[/..4.~.~.....C(~..e?-///./.~?..~.. d~///.~.ff~. ....... Nature of work (check which applicable): New ). 1. 2. Building Addition ........ ~ Alteration Repair .............. Rem6val ............. Demolition .............. Other Work ............... (Description) Estimated Cost ................................... Fee ..................... ~- ........... (to be paid on filing this application) Ii' dwelling, number of dwelling hnits ............... Number of dwelling units on each floor ................ If garage, number of cars ........................................................................ It' business, commercial or mixed occupancy, specify nature and extent of each ,type of use ..................... Dimensions of ex~stmg stn~cturels, if any: Front ............ Rear ........... De ........... Height ............... Nomber of Stories .. ~. .................................................. Dimensions of same structure with alterations or additions' Front ~,..~. k Rear ~.(P '~ ......... '.. Height ........... ) .......... Number of Stories .,~'. .... Dimensions of entire new constr.uctmn: Front . .I~. ~. . Rear .~-~ ........ Depth ......... Height ............... Number of Stories ........................................ ,, ............... Size oflot: Front ...;a~...'.. ,' ............ Rear . ./~-~. / .............. De~th ~.~.~ ........... ' ..... Date 6f Purchase .... .] ~.~. .................. Name of Former Owner ./.'~./t,?~. 7' ~7....~./.~O. ~..~.~.,~. Zone or use district in which pre, raises are situated· )~.~ ./(~,~.'.7-7]..(~..L-v ............. '. ................ Does proposed construction viol.ate any zoning law ordinance or regulation: . ,,~. ~... 2 ....................... W I1 lot be reeraded~ .......~..~..,. ..... ..... ._.. . . ... Will exce~ fill be removed from premises'. Yes Name of Owner of premises ~.c).L.O.~ t.].~...~...~.~). Address . [.~.~..~. ~ .,~.. !.~-~..... Phone No.~.&'. q~. e/oc~.~ .-..~-~. · Name of Architect .......... ' ................. Address ................... Phone No ................ Name of Contractor ....... ~ .' ................. Address ................... Phone No ................ PLOT DIAG RAM Locate clearly and distinctly allI buildings, whether existing or proposed, and~indicate all set-back dimensions from roperty lides~ Give street and block number or description according to deed, and show street names and indicato whether terior or corner lot. rATE OF NEW YORK, OUNTY OP...~5'~... ,a.a ........... ~ .~......~.C..~...?'-~. · · ............. being duly sworn, deposes and says that he is the applicant (Nra'me of individual sign;ing contract) )ove named. e is the ~ ; (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duiy authorized to perform or have performed the said work and to make and file this )ptication; that all statements contained in this application are true 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 lne this ........... ./<9.,~. ..... day of... ~ ......... 19 ~/. /-*o ) ........... ' ............ ! ,,- ff ' (Signature of applicant)