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HomeMy WebLinkAbout11080-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Z10552 No .................. Date .... .~.u.n~. THIS CERTIFIES that the building ................................................ Location of Property .. . 125{)p Hain Road, ...... ~'.a:~?..;-.~3r.:L. qn.,..~q~4..'/.o.~.k. ..... Hot~sb '~lol .................. Street Ham/et County Tax Map No. 1000 Section .... 1~3.1 .....Block ...... 0.1.4 ......Lot ..... 00 .? ......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated March 16 19 .~.~. pursuant to which Building Permit No. 11080 g dated . . .~.a..e?.b...2.6 ................ 198. ?. , 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 ......... ............... .a.~.d.~. ~ .o.n..t..o.p.~.~.~.. ~j~..(p.e.e..k.) ................................. The certificate is issued to E. Xefos x x of the aforesaid building. Suffolk County Department of Health Approval ....... I~ / R ................................ UNDERWRITERS CERTIFICATE NO .... ~i/.1~ .......................................... Building Inspector Rev, 1/81 FOEM NO. 2 TOWN OF $OUTHOLD BUILDING DE~,ARTMEHT TOWN HALL SOUTHOLD, N. Y. BUILDING P. ERA~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ]N©. 11O80 7. Permission is hereby granted to: .... /~. . . ~;. .~. ~ zu. . . . .,r~ ~:. c. /~ ...... .../-:~c~./,~,z~..?...~..,....~........~ ................. , 6.~. ~.~ .,4~. ~z::...~.~c ,~ /~'~../~.= ~,f."~. ~....~..~..~z~ ....... ~zZzo~...... ~ ~. :.....~ ...... .~ .~.. . . . ~ ~ ..................... , ........................................ / County Tax Map No. 1000 Section ...~...~.~../. ......... Block .,~:...~.. ........ lot No ..... (2~.,7. ....... pursuant to application dated ........................................................ , 19.....;.., and approved by the Building Inspector. Fee $...~.~..~ ....... K,-,~,...............,~ Buj~ing Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" ~and 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. 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 $5.00 Date .......... New Building ............. Old or Pre-existing Building .... ~... Vacant Land ............. Location of Property ... Z'. ~...~.'-7 .~?..(~. ............. [~...~....l~".~; .~. ....... .~-iq~.~z..~., ~]! .o,.~',"0 House No. Street Hamlet Owner or Owners of Property ....//?.'~.-.~.;..~.J'..~.'X-J..'L..m~.,. ~.~. ~'~..~ .(}.-,-~ ....................... County Tax Map No. 1000 Section ....(?'..:.~. ~. .... Block ..... ~ .(.'( ...... Lot ..... '.~. ......... Subdivision ................................. Filed Map No.~-~, ......... Lot No.~ ............. / Permit No...~. [.~.5.~':.0 Date of Permit. ;-~//..~/Applicant., ~-;~,~, ,~,, ,~ ~-0.~-~.~. ~ ~'~ Health Dept. Approval ........................ Labor Dept. Approval ........................ / Underwriters Approval ........................ Planning Board Approval ...................... /~ ~,~ er e e Request for Temporary C tificat ..................... Final C rtificate ...... Construction on above described building and pc~--~'n~ets all ap,,lic~C_~de~nq~egulations. Applicant ~ Z " . .. .......... ~~; / FIELD INSPE NJ COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: ENVIRONMENT EAST c/o Peter R. Stourenbnqzh Indian Neck Lane Peconic, New York IIqS~ &I)PROVED AS 'NOTED 7651802 9 AM TO ~ ~M FOR THE ' - ~"~: t. ~..5T~ ~ ROUGH- FRA~..~,5'~ % PLUMBING 3. INSULAT~2~.: ~,~ .... MUST ALL CONSTRUcT~o?~ ~:-]AL~ MEET THE REQUIRgMENTS OF THE N.Y. ~ATE CONSTRUCTION & ENERgy C~ES. NOT RESPONSIBLE FOR ~I~N OR CONSTR~TiON FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved ?~ ~' ,19'! Permit No. J./..~.°~ ~'~5 Disapproved a/c ...... ~ ..................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No. ~ff.~. · .~.~. ........ 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 Sou(hold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or de/molition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, burial, ling-co.,de, housin~ ~d re)~a,lations, and to admit authorized inspectors on premises and in buildings for necessaw~ihsp~ectionfl. I V/ / ........... ,- (S~gnature o'--~' ' f a , or name, if acor 'ration) cio l~ctcr R. Sroure-burba ~fa/pA*tfcant,~or name, if~ hM~an Ncck Lane Pcconic, New York 1195g (Mailing address of applicant) 5~ r~-734-? 474 ~on~ State whether applicant is owner, lessee, agent, architect, engineer ectrician, plumber or builder. Name of owner of premises ....... /../..c.~. ~.... ~...'x. ~xr.v¢~. ..................................... (as(.~ the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ~.:, ~ ~" ~-CJ ~- (Name and title of corporate officer) Builder's License No.. ~ / ~'- ~ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ...... .......... ........... .. ............... House Number Street Hamlet ~ ~ Block )<~ County Tax Map No. 1000 Section .... .~.-...~...1 ....................... Lot ................. Subdivision ..................................... Fried Map No ..... ~.~..~ ..... Lot ............... (Name) ~,~, ~ ~ State existing use and occupancy of premises and intended use and occupancy of proposeil construction: a. Existing use and occupancy .......... . .2~'.~.~e~. · .~. .................................... b. Intended use and occupancy ...... ./y.~,~-r.~....~-~-~-~. ...... ~ ....... 67.. -, ...... . ...... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteratio~ . ././~ ..... Repair .............. Removal ............ '.. Demolition ............. - Other Work..Q~LM-~4~-, .... ~ (Description) 4. Estimated Cost .................................................. (to be paid on filing this application) 5.l.f dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ I f garage, number of cars .... ~ ................................................................ - 6. If business, commercial or mixed ~ccupancy, specify nature and extent of each type of use .............. 7. l)~onsions of existing structures, ~f any: Front...: .~ ~ ...... Rear .... '~ .~ ..... Depth... ~.~.... Height ........ Number of Stories ................................................ Dimensions ofsam~mcture with alterations or additions: Front ...~.~ ......... Rear ...~ ....... l)ep~ .... ~. ~ ........... HeiSt ...... ~ .~ ........ Number p~St~es ...... ~..> ..... 8. Dimensions of entire new constrnction: Front .... ~ ..... Rear .... ~.~ ..... Depth . ~ .~ ..... llei~t .~,~Q ...... Number of Stories ........................................ ... 9."'--bize of lot: Front ....... ~..~,~ ....... Rear ...... ~-~. ~. ....... Depth ....... ~J~:'JJ 10. Date of Purchase .... ~ t .~%~ .... ~/ .... Name of Fo~gr O~er ............. 11. Zone or use district in which premises are situated ..... C.,~.g.(.~ ...... ".. 12. Does proposed construction violate any zoning law, ordinance or regulation: .... ~. ~. .......... 13. Will lot be regraded ........ ~ .................... Will excess fill be rewoved~ premises: Yes No 14. Nme of Owner of premises . .~ ~ .... Address , ,~ .... ~, 7~ .... Phone No ........... Nme of Architect ......... ' ................. Address ................... Phone No ............... Nme of Contractor ~~i~T. ~T... Address ................. Phone No... c/o Peter R. Stoutenburgh Indian Neck Lane Peconlc, New York 119~eT DIAG~M Locate clearly ~d di~-~ffd~gs, whether existing or proposed, and, indicate ~1 set-back d~ensions from property lines. Give street ~d block number or description according to deed, and show ~ n,mes and ~dicate whether interior or corner lot. ~ ~ ~ ~ : COUNTY OF..~.t{~.'~.' .~* ./..Ko. .... 2.2. ~ ' .../Z~..~,¢,~o,...~.,~ X~ .~./{ ......... bei~sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ................................... (Contractorl ~t', 'c~}~;a't~ 'o'f~i~;,'e't~.~ ............................ of said owner or owners, and is d¢ly authorized to perform or have performed the said work and to make and file this application; that all 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 ..... ./~..~.. · qua.ned ~ 0 ' ' /- [bi lure o oI appncan~/ , ' ,Commissio~ Exp,res, ~rch 3 198~a ~ ,g"~n~tlre t: