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Home My WebLink About11134-zFORM NO, 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall $outhold, N.Y. Certi{icate O{ Occupancy Z10694 THIS CERTIFIES that tile, buildtng ................................................ Location of Property .... .5 .9.5..~ 9g,e,~s...R.o.a.d. .......... S.o, .u .t.h.o. 1..d t..N.e..w..Y.o.l~..k .......... House No. Street Ham/et County Tax Map No. 1000 Section ..... 0.~.6 .... Block ...... 0.2 ....... Lot ..... q4. 3 ......... Subd;vis~on ................................ Filed Map No. - .Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated May 1 ,19.8.1. pursuant to which Building Permit No. 11134 Z dated ...~ .a.y..~. ................... 19..8.1, 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 to Existing Patio and Roof Mary June Kohut The certificate is issued to ......................................................... (o wne~r ~e~mr:~ 71~t:JX of the aforesaid bmlding. Suffolk County Department of Health Approval N/R UNDERWRITERS CERTIFICATE NO. N53 13 18 Budding Inspector Rev 1/81 ~0TM NO. ~ TOWN 01: ~ouTH~b~,D TOWN HALL SOUTHOLD, N. Y. BUILDING pERMIY (THIS PER/~IT MUST BE KEPT ON THE PgE/~I~S UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) , · 11134 Z Date ................................... Permission is hereby granted to: et premises located et ........... ,: ......................................... County Tax Mop No. 1000 Section ~6/0/ ,- Block ] ~ , ,Lot No. /~--/ ~ ~ 9 and approved by the pursuant to applicetionldated ................ f ............................ ?....., 1 .... ~... Building Inspector. Fee $ ........... ': .... ~ ' ~ Build~ Inspector ---.A-,,~o/,~u/~u ~ ~ _ ~ ~: . Rev. 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. Finai survey of property with accurate location of ail buildings, property tines, streets, and unusual natural or topographic featu res. 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. 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. 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..~..~.~....~...-7.../?..~..t~.... New Building ............. Old or Pre-existing Building ..., , ./'~...... Vacant Lan~... ........... Location of Property. ~-,~..-~4~'. ......... ~...~..0. ~ .~..~..~ ......... /~.,~,, ...... ... 'i~/~../.,~ House No. Street Ham/et Owner or Owners of ..................... County Tax Map No. 1000 Section .. ~. ~4~. ....... Block ...... ~ ~ ....Lot ..... .~. ~.3. .... S~;~d~y~ision~./..~. ,E-./.~.~r.-~..~.~).....~.~.~.~.)~'.~ ...... Filed Map No. ~, .~. ?...2~,..Lot No ............. Permit No./.~//.~-~... Date of Permit .~..~.~. J/~,~pplicant, ,~, .~.o..J~.. ,~..-..~...,., .~...~..o..~./.~ .... Health Dept. Approval ........................ Labor Dept. Approval ....................... ~ nderwriters Approval ........................ Planning Board Approval ..... r ,fl a e e ~ Hequest for Tempora y Cert' 'c t ..................... Final C rtificate ............. ~t~ .... ~ .~'~, · Fee Submitted $..~.., ...................... Construction on above described building and p(~mit meets all appli~ c,~and regulations. Rev, 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS 10~109 ~ E~UREAU OF ELECTRICITY,~ [~R 85 JOHN STREET, NEW YORK, NEW Y;ORK ]0038 THIS C~RTI~I~ THAT only t~ e~ctr~c~/eq~p~t as descried belo~ ~td i~uced by the applicant ~d on ~he able a~i~ation ~u ~er ~n the premises of in the followlng Iocatlo,~; ~ Basetnent ~ /st Fl. ~ and Ft. Section BIoch Lot was examined on /a:aggJs ~ 6, ',[98I and found to be ,n compliance w th the require,ne,,ts of th,s Board. FIXTURE OUTLETS DRYERS FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS FLUORESCENT MULTI-OUTLET SYSTEMS NO OF FEET E R V I C NO OF CC COND A W G NO OF HI LEG A W G NO OF NEUTRALS A W G PER ,~ OF CC COND OF HI-L~G OF NEUTRAL OTHER APPARATUS, Thru certificate must not be altered ~n any manner, return to the office of the Board if may be CoPlFOR BqltmN~ DEPAE~I'ME~T. rTH~S ~, IN ANY MANNER. FtEL~ 1. FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N. Y. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: CONSULT YOUR LAWYER BEFORE SIGNING THIS ~NSTRUMENT--THIS INSTRUMENT SHOULD B! USED BY LAWYERS ONLY. THL~ INDENT~RF~ ,,lade the 20th day of March BETWEEN GERTRUDE J. PETZ, residing at 87-23 Richmond Hill, New York ninelee'nhundredand SiXty-eight 134th Street, party of tbe first part, and MARY JUNE KOHUT, residing at 211 Roxbury Road, Garden City, New York party of the second part, wrrNF..~F. TH, that the party of the first part, in consideration of Ten Dollars and other valuable consideration paid by the party of the second part, does hereby grant and release unto the party of the second part, the heirs or successors and assigns of the party of the second part forever, ,,, ALL that certain plot, piece or parcel of land, with the buildings and improvements thereon erected, situate; lying and being in the Town of Southold, County of Suffolk, State of New York, shown and designated on a certain map entitled "Map of Beixedon Estates Town of Southold, Suffolk County, Iq.Y., Property of Grace R. Nicklfes, formerly Grace Rogers DeBeixedon", made by Otto W. Van Tuyl, Licensed Surveyor, and filed in the Suffolk County Clerk's Office om March 16, 1946, as Map No. 1472, as and bSz Lot numbered Ten in Block numbered Seven on said Map. TOGETHER with all right, title and interest, ii any, of the party of the first part in and~to any streets and_ roads abutting the above described premises to the center lin?s thereof; TOGETHER with the a'PPurtenanees and all the estate and rights of the party of the first part an an~ to mid premises; TO HAVE'AND TO HOLD the premises herein granted unto the party of the second ~l~t, the heirs or successors and e~signs of ' the party of tbe second part forever,~ FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ~xamined/.'~7~.~...~ ..... , 19~.~. Application No .................. kpproved ~...~ ....... 1~. Pe~it No )isapproved a/c ..... : ............................. :: ....... ...ff~ ~ (Building Inspector) / INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building ~nspector, 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 )r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :ation. c. The work covered by this application may not be commenced before issuance of Building Pe~rmit. d. Upon approval of this apphcation, the Building Inspector will issue a Building Permit to the applicant. Such permit ;hall 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 ,hall 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 3uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or t~,egulations, for the constrnction of buildings, additions or alterations, or for removal or demolition, as herein described. ['he applicant agrees to comply with all applicable laws, ordinances, bui,lqling code, housing code, and regulations, and to ~dmit authorized inspectors on premises and in buildings for necessa~:ctions. :~~_...-~. ~.~..~ ................... ~ (Signq~re of applicant, or name, if a corporation) :;tale whether applicant is owner, lessee, agent, architect, engineer,c~e'n'~ral--~, electrician, plumber or builder. ....... .... ................................................. .qmne of owner of premises /~, .~, ¢...~.. O. ~. ~,../~.J.O, ~. O' .~... ........................................ (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..~...~..~.O~'C...~ .~..~.~?.. Plumber's LicenseNo ......................... Electrician's License No ...................... Other Trade's License No ...................... a. Existing use and occupancy b. Intended use and occupancy Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section ~ff .... Block ...~.~ ..... Lot... ~..~.~r~ . . . ; .... .... Sub~ision ..... ~Z ~.~,p.&~, .,. ~/~. Filed Map No. Z~.Z.~ Lot .... (.~ ........ (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: ......... Nature of work (check which applicable): New Building .......... Addition ...... Alteration .......... Repair .............. Removal ............. Demolition ............. Other Work ............... i. If dwelling, number of dwelling units.. _~ :~. ~ (Description) ...... Fee ....................... .t ........... (to be paid on filing this application) Number of dwelling units on each floor ................ It' garage number of cars It business commercml or mixed occupancy specify nature and extent of each type of se .......... ....... :g 2, ~ ~ .~." Rear ~-:.~. ~ ~." Depth Dimensions of existing structures, if any: Front.. ~ ................................ Height ............... Number of Stories ..... ~ ............................................... Dimensions of same structure with alterations or additions: Front ................. Rear ................. Depth .................... '.. Height ...................... Number of Stories .................... Dimensions of entire new construction: Front ............... Rear ............... Depth ............. Height ............... ~,cN~umber of Stories ...................................................../~'~ ~ Size of lot: Front ....~-- ................ Rear .....~.'~.. ............ Depth .................... Date of Purchase ............................. Name of Former Owner ........................... Zone or use district in which pr~nises are situated ................................................... Does proposed construction violate any zoning law, ordinance or regulation: .............................. Will lot be regraded ............................ Will excess fill be removedfrom premises: , Yes No Name of Owner of premi~es//].//~..~., .,3..0/~..k-'./~q.~.a..~. Address ... ~.~./.~'.R'-,0e.~.... Phone No..,~..~ .-~.. 7T/.~./. ~-,~. Name of Architect ........................... Address .................. Phone No ...... ,L ......... PLOT DIAGRAM Locate clearly and distinctly all, buildings, whether existing or proposed, and, indicate all set-back dimensions from -operty lines. Give street and block number or description according to deed, and show street names and indicate whether terior or corner lot. rATE OF NEW YORK .... OUNTY CffO./- . ..... , · ... ~. ¢.0. t~; ~.~,..O.. ,..~.~..t( ?../~. ................. being duly sworn, deposes and says that he is the applicant (i'~'ame of individual signing contract) oove named. .e is the ......................................................................................... (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this pplication,; that all statements contained iff 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 kefore me this !otaryPublicf~.~.~.~~ ..... ~ // // /~" NOTARy PUBLIC, Stata ~, t'~°' se:?n~' ' /" , (Signature of applic~t) ~ ~ mea m ~uftolk Coun~ Commission Expires OCClP HCY BR' ir wee~w. LL. N.y. ! IlM ~OLLowING iNspr:CTioNs ~1' FOUNDATION . ~0 ~ CONCR~E ~, ROUGH . F~MiNG 3, INSULATION & PLU~iN~ 4, FINAL BE ' CON~qTRUCTIoN THE REQUIREA~,~ ' DESIGN OR CON~RU~i~