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Home My WebLink About13615-zFORM NO. 4 TOWN OF 5OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ...... Z13806 Date August 29 .,19.8.5. THIS CERTIFIES that the building a d d i t i o n. Location of Property ...2..g.0.0. Sound DP . '~ Greenport House No. Street Ham/et County Tax Map No. lO00 Section ...3..3 ....... Block ...... 1 .Lot 10 Subdivision...E.a..s.~.e?.n...S.h. qr.?.s ............ Filed Map No. 4586 .Lot No. 111&112 conforms substantially to the Application for Building Permit heretofore Cried in this office dated October' 30 19 84 pursuant to which Building Permit No. 13615Z dated ...... D.e.c..e.m.b.e.r...7 ...........19 .8.4., 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 an existing dw.el, ling.. ...................................... The certificate is issued to RICHARD & ELEONORA KOPEK (owner, I~.~YoX ~e~ of the aforesaid building. Suffolk County Department of Health Approval N //1 FENDING UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 FORM NO. ~ TOWN OF Sou'rHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NB 13615 Z Permission is hereby granted to:___ · ~,,~,~. ~... ...,~..Z,....~....~..g.i.~...~.r .......... ...Z2'.z.~,~~...,,...~..~. ........ zzgo/ ..... ~ .......... ~~.~.~~~.....m~x.~ ............. ~ ........ ~./ c~ r~ ~op ~o. ~oo0 s~o~ .... ~ ........ ~k ...~ ............ ~o~ ~o..0la ............. 8uild~n~ Building I~tor Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPA,N Instructions iV vow. or so'om, 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. 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. B. For existing buildings (prior to April 1957), Non-conforming-~es, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operty 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. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $15.0 0 3. Copy of certificate of occupancy $1.00 4.V, acan% Land C.O. $5.00 /~,D / ~'~/~/ ~ L~i,~,,a~ isting Bu ,id lng , Date .......................... Ne~'-~C'~fll~g ......................... Vacant Land ............. Location of Property c~?O~) Owner or Owners of Property . ~ ~,..C~.~ ?,¥ .f'.~ ·...~'.~..~.. ~-. =: .~.~....;..~..~'Y.... .~ ....... County Tax Map No. 1000 Section .... .~ .-~. ....... Block .............................. Permit No.l~.O./..~...Z... Date of Permit/.~./~/~/~..Applicant ~.c~.~.~..~{.d..~/ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval Planning Board Approval ~ Request for Temporary Certificate ..................... Final Certificate .. ~ ................. Fee Submitted $.. x~., .t.~..~'.....~..~...~. ~. ..... Construction on above described building and permit meets all applicable codes and regulations. e"~)'~-W/ZT:\~)~['¢~ Applicant ~ ..~.~ ................ Rev. 10-10-7S FIELD INS~PECT]ON FOUNDATION (1st) COMMENTS FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ?DE FINAL ADDITIONAL COMMENTS: ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved ~...~. .... 1 ermit Disapproved a/cb. .... .~.~.~_........ ....... (/~ ~ (B ilding Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BLDG. DEPT. TOWN OF SOUTHOLD Received ........... ,19... a. This application must be completely filled in by typewriter or in ink and submitted 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 tiffs application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued 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 buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, bu'fljt~g code, housing,~nd regu~t~ns, and to admit auth°rized inspect°rs °n premises and in building f°r neces:~.i~.....V/O.....~. ~h~ ....... ,/JI~ignature of applicant~,~e, if a corpo, ration) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises.. M.~../.~tS.. q/.~.~.~.4~..~. .......................................... (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.. ~.~.~.~... ~9'~..... ~.~$ 7~/~e~ t! t~ ~ tt Plumber's License No ................. ~ ....... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ... Eo. . .e. e ..... ao.o. . . . . .,. . . .c,.n .s. . .... /.1.9.9...'t ..... House Number Street Hamlet County Tax Map No. 1000 Section ..... ~. ~.~.. ...... Block .... C~.( ........... Lot. Subdivision..~..~.~.~.~....~..~. ~} ~.~'. ~. ......... Filed Map No ............... Lot. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of pr0Posed construction: a. Existing use and occupancy....~..~.A./..~.~...~'....~".?..,~, f ...... '~../~. ...... .~. ................... b. Intended use and occupancy . .--... · · · .-:..~ ..... .....~..¢~..t. , .~. ........................ . 3. Nature of work (check which applicable): New Building ..... ' .....'Addition . i ..... Alteration ....... pal al oliti ' Oth Wo Re r .............. Remov ............ Dcm on ...... ~ er rk . 4 ..... Estimated Cost ....... 3 ~)':-.~ .~..~)~ .......... ............Fee .................... "~ [to bei pa~d on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelhng units on each floor ....... . ....... If garage, number of cars .................................................. . ........ 6. If business, commercial or mixed occupancy, specify nature and extent of eachlv~e of use . 7. D~mens~onsofex~st~ngs~ructures,~fany Front ~0. ..... Rear ....~O Depth ~. Height &.J~APK..Z.'~ f...NumberofStories ......... ~ .............. ~.!iiii]ii ...... iii...iiii" Dimensions of Same structure with alterations or additions Front .... .~' ~ .. I ..... Rear ~,~ 5 .. ~. ' ' Depth.. ~.~ ....... Height ..... Z.~.t. ...... Number of Stories .... ii..i.i'" ... 8. Dimensions of entire new construction: Front .. ~5.~. Rear ~ ~5 t ....... Depth . ~) ! ..... Height .... ' - . . Number of Stories ....... I ...... ~ ......... i ' ' 9. Sizeoflot: Front ..... ~.~. Rear ....... ;* ...... ~ ...... ~ ........ ............ l~ ............. i Depth ..~J~l~ ............ 10. Date of Purchase .: ........................... Name of Former Owner ! .......................... 11. Zone or use district in which premises are situated ........................ ; ....... ' .. 12. Does proposed coi}gtruction violate any zonin~ law ordinance or regulation' ~l m 13. Will lot be regraded ....~. I[~,.z T.'; ::' 'v~ ..... ,... Will ex~cess fill be removed from premises. Yes 14. Name of Owner of p~.~[¢ .[ ly~. ~ ~¢.~K Address ~t~..~.u?..D.~.i .... Phone No. ~..? .~. ~ ~ Name of Architect .. ~....~...lt. ~.~r.~.~.C,~.~... Address /~..~. ~ .~.O..~..~.e,~..~r~$1$h~one No. ~..l~.. l.t... Name of Contractor .......................... Address .............. 2 .... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. i~dicate all set-back dimensions from property lines. Give street and block number or des. cripfion according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK S S COUNTY OF · ........ .... -.. ...... ...... .O'... ~..~. being duly sworn, depqses and says that he is the applicant (Name of individua'r~gning contract) above named. I : He is the .... ~ (Contractor, agent, corporate officer, etc.} of said owner or owners, and is duly authorized to perform or have performed the ~aid 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 ........... ...... ,'"--h " ' Notary Public ...... County ' ' No. 52-4640852~. '~. '~. ~'~ ........ Oualinecl in Suffolk Count'/ ~ (Signature of applicant) ~ ~oramiss on l~xpiro~ March 30 19~,,,~~ 0 o "0. :r~ 0 /0 /-'/'oi' /// -0