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Home My WebLink About11155-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Z16960 June 6, 1988 Date ................................ THIS CERTIFIES that the building ....al. t..e.r.a.t.tqn..a., r. e.n. qya. t. z.' qn. ...................... Location of Property .. 605. Clark Road Southold House No. ' .................... 'S't/e~ .... Ham/et County Tax Map No. 1000 Sechon .... 5$ ...... Block ........ 3. ......Lot ...... .1.8 ......... X X X Subdivision .............................. Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated October i9, 1987 pursuant to which Building Pemnit No. 16550Z dated..........Oct°bet ....21. ....., 1987. ....... wasissned, andconformstoalloftherequirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Alteration'& renovation to existing one-family dwelling. The certificate is issued to Pd~RRY BAIS ..................... r'o¥,,'o;, ...................... of the aforesaid building. Suffolk County Department of Health Approval .......... N[A UNDERWRITERS CERTIFICATE NO .................... N007834 Innovations Plumbing Inc. 3/18/88 PLUMBERS CERTIFICATION DATED: Rev, 1/81 Building Inspector TOWN O~ S:,OUT,0[p BUILDING DI~PART/~EN'i{} TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISI[S UNTIL gULL CO~PLET'O~ O~ T.~ WO~ , ~/,r~, / ¢' ~..~/ N? 11155 Z Dote .~ ..................... Permission is horeb~ ~rontod to: ....... Z ............. ......... ~ ~ , . ...r ......................... ~ .............................. ,.., .................. . ................ ' , =~ prem~*~* Ioco~d o~ ........................................................... ?.-%. ................ ~ ........................................ County Tax Map No. 1000 Section .......... ..~,../: ...... Block 'dated ..... · · ..~,..~.. ......... ?' ;. J. pursuant to application Building Inspector. Fee $../ .................... Rev, 6130/80 : ~ ~Lot No. / ~ .....~ 19.....~ ond opprovod by the .......... , K...:~..:~ .............. Bui ding Inspector FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N,Y. Certificate Of Occupancy No 7..10852. ......... Date .... 4a. ~.l.u.a.e.y.J.4. ................. 198.'.2. THIS CERTIFIES that the, building ................................................ Location of Property . . 6.0.5 ............ 0,1..i~t?..k.s..l~qa..cl .......... $9.u.[h. 9 .i.d. ........... House No. Street Hamlet County Tax Map No 1000 Section . . . 10.5!. ..... Block . .03 ........... Lot ... D.l.~t .......... Subd~vzsion.. . × .......................... Filed M~ip No.. ~ ...... Lot No...1~ .......... conforms substantially to the Applicahon for Building Permit heretofore filed in this office dated · . l'lay..1.~ ......... , 1981 . pursuant to which Building Permit No.. Jfi. l. 5..5..g. ........... dated ... lqay..1.8 ................ 19 .~ ~, was issued, and conforms to all of the requirements of the apphcable provisions of the law. The occupancy for which this certificate is issued is ......... ·..~. d.e.c.k. ~.d.~ t,;[.o~..~.o..~, pr.t.v.a..~.e..o.n..e.-.f.a.m. $.Z7..d. ¥.e.Z.Z.~..n ¢., ................... The cert~ftcate is issued to ...... ge.z'~'.7.. ]~g~.,s . ~,..~.~.~ .e ................................. (owner, of the aforesmd braiding. Suffolk County Department of Ilealth Approval ...... I'1/, ]~ ................................. IJNDERWRITERS CERTIFICATE NO .............. ~/..R ................................. Rev. 1/81 t~mlding l~lSpector FORM NO~ 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N,Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY hlstructions A. This apphcadon mus[ be fdled in typewriter OR ink, and submitted in duplicate to the Building lnspec- tot w~th the following; for new buiidmgs or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Fmat 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 certdicate of, Code compliance from the Architect or Engineer responsible for the building. 5. Submit P~anning Board approva~ of completed site plan requirements where applicable, B. For existing buildings (prior to Aprd 1957), Non conforming uses, or buildings and 'pre-ex'sting" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topograph mc featu res. 2. Sworn statemen! of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or sa[ely inspection of buildings or premises, or other pertinent informa- tmon required to prepare a certificate. Fees' 1. Certificate o~ occupancy $5.00 2 Certlhcate of occupancy on pre existing dwelling or land use 3. Copy of cortihcate of occupancy $1.00 $5.00 Date. · ~..~ !.. / .~.../i ...... New 'Building ............. Old or Pre-existing Building .. /~ ........ Vacant Land ............. Location o[ Property Owner or Owners of Property County Tax Map No. 1000 Section . .S~./ ......... Block ..... ~ ........ Lot.../. ~ ........ Subdivision ......... '~ .......... Filed Map No .... ~ ...... Lot No, ./,~ ........ Perm,, No.I/,~ ~:~7.~ Date of Permit ¢~/~Xppl,cant..~..~~: ....... Health Dept. Approval ..... ~ ............... Labor Dept. Approval .... ~ .................. Unde~riters Approval ....................... Planning Board Approval . ,~ .................. Reques~ for Temporaw Certificate .... ~ ............. Fina~ Certificate . .~..~. Fee Submitted $.. , ~ .~ ................ / Construction on above described buddi~§ and per,it m~eets all ,app, ticable codes and regulations, zf; l/., ;> Apphcant.. ~..~ ........................ Rev. 10-10-78 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hail Southold, N.Y, 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ~ ~ to the Building Inspec- tor with the following; for new buildings or new use: 1. Fina[ survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographm 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 Reside~es 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 property 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 reqmred to prepare a certificate. Fees: Additions $25.00 ?OOLS $25.00 ALTERATTON $25.00 1. Certificate of occupancy New Dwelling $25.00, Accessory,S10.00 Business $50.00 2. Certificate of occupancy on pre-exist~ng dwelling $ 50.00 3. Copy of cert~ficate of occupancy $ 5.00, over 5 years $]0.00 4.Vacant Land C.O. $ 20.00 5.Upctated C.O. $ 50.00 Date. March 8, t988 NewCons tz~uct'~°n ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property 605 Clark Road Southold House No. Street Nam/et Owner or Owners of Property Harry Bais County Tax Map No. 1000 Section 051 03 18 ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. 16.550 Date of Perm,t .1.0./.2.1f.8.7.Applicant Ron Mori.z.zo Builder, Inc. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval .................. .. .. Request for Temporary Certificate ..................... Final Certificate ... on above described budding a~..per~t mee~cable codes and regulations. Construction FIELD INSPECTION FOUWD~T~O~ (~st) FOUNDATION (2nd) 2. COMMENTS ROUGH FRAME& PLUMBING INSULATION P~R N.Y. STATE ENERGY CO~E FINAL ADDITIONAL COMMENTS: o-1802 9 FOR POUp,.~/~ ~ ROUGH _ CONS'r~, uuDEs ~ ~IION & D~SIGN ~' ~ RESPONRm, ~ UONSTRuc~,X;~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'$ OFFICE SOUTHOLD, N. ¥, ............................. / 5& Disapproved ale ............................ ~ ...................................................... ~ (Building Inspector) APPLIGATION FOR BUILDING PERMIT ' ...................... Date INSTRUCTIONS a. This application must be completely filled in by typewriter off 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 m areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. 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 o 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 Deportment 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 buildings, additions or alterations, or for removal or demolition, as herein described. The apphcant 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 inspections. (Signature of app. licant, or name, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................................................. ........................................................................... Name of owner of premises ....L ~C~.~......~[~..~ ........ ~.~~ ......................................................... if applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ......... ~.../m....(~,. .......................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Locat on of and on wh chjcrol~osed work will b~ done. Mop No.: ..................................... ~.. Lot No ......................... Street and N. umbrm' ..... ~~.b ........ ~...E...-~..~. ............................. ~'-~'~"'-~'~'"'/i ~'~':';'~/';: ........... ~2 ~ /~unlclpallty State existing use and occupancy of premises and intended use and occupancy of proposed construction: o Exisiting use and occupancy ..... ~~.~-~....~'.~......~m ............................................................. b. Intended use and occupancy ....... .~......),:f,.,~.,~t,~.....C,.~..~. .... Repair .................. Remo<,a .................. Demolitic Estimated Cost...Z.~.~?. .............................. '. ....... ..... If dwelling,' number of dwelling units ............. ~. ...... Nature,of work (check whicl applicable): New Buii, hng,. ................. Addition .................. Alteration ............... : .................... Other Work ....~¢~'I/..-~...~,~.....'T ....... (Description) .Fee .......... /~....~2 .: ...~...-'k~.. .............................................................. (to be pa,d on filing this application) ..... Number of dwelling umts on each floor ........................... If garage, number of cars .... ..................................................................................................................... , .............. 6. If business, commercial or ! mixed occupancy, specify nature and extent of each type of use .....~. ...................... 7. Dimensions of existing structgres, if any: Front ..........~...~']. ........... Rear ......... ..~....~'].. ............ Depth ..~,..~. ........... Height ......~..! .......... Number of Storms ......... ~ ........................................................................................... D~mensions of same structur'e with alterations or addmons: Front ................. ~ .................. Rear ...... ~ .................. De th ................................ e~ t ............................ Number of Stories ................................ 8. Dimensions of entire new cqnstruction: Front ............... ~ .................. Rear ......... ~ ....... '. ....... Depth .....~ .................. Height ............ ~ .....Numbe'r of Stories .................................................................................................................... 9. Size of lot: Front ........ /..~ ..................................... Rear ....Z.~[ ............................ Depth ..~..~ ................... 10. Date of Purchase ............... ~ ........................................ Name of Former Owner ........................................................ 11. Zone or use district in which] premises are situated ..... I~.~....~ ....... .~ ............................................ 12. Do~s proposed construction ~iolate any zonmg law, ordinance or regulation: ........... ~...~ ................................. 13. Wilhlot be regraded ........ ~ ........... Will excess fill be removed from premises: ( ) Yes (~) No 14. Name of Owner of premises., Name of Architect ............. ~ ................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Loc~e ~leorly ~nd distincHy qll buddings, whether exmtin~ or proposed, qnd indi~qte qll set-~ck dimensions from property lines. Give stree~ ~nd block number or descr]pHon ~ccordin~ fo deed, and show streef names and whether in~erior or corner Io~. /.~ t STATE OF NEW_YORK ..... ~ c ~ COUNTY. OF ...~...~.~.-~r.~..6 ..~d. ........ ~' ........... .~r,~..¢,f'.'.~.~:..'~.. ...... ~..../.~.z.g.~...Z. ................................. being duly sworn, deposes and says that he is the appliconl .(Name of individual sioning contracf) above named. He is the ........................................................................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this applibation; that all statemenis contained in this application ore true to the best of his knowledge and belief; and that the V~ork will be performed in the manner set forth in the application/fi,~ed therewith. Sworn to befor~me this ; '/"-xx I I ,q ~ / ................ of ...... ............... :..., ( I [ ( J (/,, Noto Publ,c, ...... .......................................................... ~ ' (Signature of applicant) LINDA F. KOWALSKi NOTA~y PUBLIC, State o~ New York No. 52'452477! QU~ thec~ In Suff0Jl~ County