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Home My WebLink About13628-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No... Z.fl.~}.~.~ ........ Date June 25 19 85 THIS CERTIFIES that the building alt. o£ patio door. Location of Property flgO0 Hill Lane ~econic House No. Street Ham/et County Tax Map No. 1000 Section .... 6.7 ...... Block ....... 7 ....... Lot ...... '1. ~ ......... Subdivision .................. x. ............ Filed Map No...x. ..... Lot No .... .x. ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated December fi 0 19 .~.¢. pursuant to which Building Permit No. fl ~.6.28Z dated ...... .D.e.q .e .m.b.e.r...fl.~. ........ 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~L~.e.r..a .~.~.qn...5.n.~.~. a. ~.a.~. $9.n..o..& ~.a.~..~9..4o. 9.~..~.9..e.x.5. s..~.5.n.g..d.~.e.~.~..5.n~, ...... The certificate is issued to ................ ~Q .~.~..S. ?.E~I .............................. (owner,'P~&¢, ~. ,~f('.._.~.., of the aforesaid building. Suffolk County Department of Health Approval ............ ~./g. .......................... UNDERWRITERS CERTIFICATE NO .................... I~l~/g. .......................... Rev. 1/81 Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NM 13628 Z Permission is hereby granted to: ~ ....... ~~:.~......~;~.~.~.~....~.X~: ..... ~:....:..~.~....,,..~.¢,. ..................... .... 2~/~.....~:.~. .......................... ~o ..~..~~~.....z~~2~z.~.~...Z.~.~ ................... ....... ~.......~~ ....... ~m ............ ~o~ __~_. .............................. ~, ~,,~ ~=~ ~....z~a ....... ~r~.....~...~.....~~.c..~..~,.~.. County Tax Mop No. 1000 Section ...~..~.~.. ........ Block ....~...~... ......... Lot No..~.../....'~.... ........... Building Inspector. Building Inspector Rev. 6/30/80 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 H~alth 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 P~anning Board approval of completed site plan requirements where applicable. 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.. New Building ............. Old or Pre-existing Building(Z). ~x. ..... =/Vacant Land .......... Location of Property .... 1. 9,0-0, ...... ~j, 1..1. ~&Ae. ........................ ?¢ppp~c.. ,Aq. ¥ ........ House No. Street Ham/et Owner or Owners of Property ...S. qqj,&. Stein ' _._ . .......... County Tax Map No. 1000 Section .0,6.7. ........... Block . .0.7 ............ Lot... ,0.1,3 .......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. 1,3~. g... Date of Permit .l~/.lZt/.SA .Applicant ...G.e.o~'g.e. ~S... ]~izp~¥ ................. Health Dept. Approval ........................ Labor Dept. Approval .................. ,.. 'Underwriters Approval ........................ Planning Board Approval Request for Temporary Certificate ..................... Final Certificat~. Fee ~ubm'itted $ ~-~' Construction on above described building and permit'meets all app~cable~codes and regulations. Rev. 10-10-78 Applicant ...... .C,,e, o~ 8 A ~.~S... ,- ~.a ~e.,~ ~,//X. /). ,. ... ..~. ... .. .............. FIELD INSFECT.ION FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY QODE FINAL ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL .qOUTHOLD, N.Y. 11971 TEL.: 765-1803 ..... {Building Inspector) APPLICATION FOR BUILDING PERMIT Date .. P.e.c. Received ./..~./.? .... , 19~. INSTRUCTIONS a. Tins 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 this 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 wh61e 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, building.code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. .... Oeo.r~e, 8....]~m~-r ........................... (Signature of applicant, or name, if a corporation) (Mailing address of applicant~ 19 71 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............ ~.~ lde~ ............................................................................. Name of owner o f premises ... Son,~ a~.... 8.t~tn ........................................................ f (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.. ~.8 ..................... Plumber's License No. ' Electrician's License No. Doroaki ............... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ...... Peconie,. · ~It1.1. Lane ......................... ..... /..~..~..¢? ........... Mill. L~,ne ........................... Peeonie .... New. York; .............. House Number-- Street Hamlet County Tax Map No. 1000 Section .. ~...~.~. 7. .... Block ...~ ? ............. Lot .¢~..¢,~ ............. Subdivision ..................................... 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 .... 1. fmnily.., residence ............................................. b. Intended use and occupancy ............ sams... ~/. tMt ~!)ObA;.. ,~Z~./.=t~. tq'~.]...o";~M~... .............. 3. Nature ofwork (check which a~plicable): New Buflding ..... ' .....'Addition ., ........ __Al_t_e_ra_t_ion_ .~,d~... Repmr~ Removal ......... Demolition ....... Other W~ .~.... .......... ' i ' (Description) 4. Estimated Cost .3000.00 ~ ~.. .~.7~. . .... l~lUs ..................... Fee .......................... ,~ '~ (to be. paid on filing this application) 5, If dwelling, number of dwelhng iumts .............. Number of dwelling units on each flour .............. If garage, number of cars . , 6. If business, commercial or mixe~ occupancy, specify nat ..u.,r~e and extent of each type of use .................... 7. Dimensions of existing structures, if any: Front .... '~ ~ Rear Depth ....... Height ............... Number of Stories ............. -~.~.~ ........ Dimensions of same structure with alterations or additions: Front Rear Depth ' Height Number of Stories --8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............. Height ............... Number of Stories ......... ...... ;_ 9. Size of lot: Front ........... ! ........... Rear ..................... . O~g~t~7_....~ ..,. .......... 10. [)ate of Purchase ........... i ....... Name of Former Owner .t.'7~ .Z,~.. I 1. Zone or use district in which pr~mises are situated ................................................... 12. Does proposed .construction violate any zoning law, ordinance or regulation: ............................... 13. Will lot be regraded ......... i ................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises Soft, al.. 8~ein ....... Address ~8. longrttdge, ltd .... Phone No ................ Name of Architect ....... ' Address Pl.~m...do.me~ N.Y. Phone No ............. Name of Contractor George. S.[llauer ............ AddressP, 9,. ~.o~. ~.9.8¢. $g¢.~lao~llone No. 7~5.. 2722 ...... PLOT DIAGRAM Locate 91early and distinctly alll buildmgs, whether existing or proposed, and. indicate all set-back dimensions from property lines. G~ve street and block/~umber or descnptmn accordmg to deed, and show street names and indicate whether interior or corner lot. ltemove d!oor and windows, install 12' header with~ 1/4"x9" Steel beam~ Inst~&l 12' I Ande~een glase ~lider Permas~leld Insulated glase. Other repair ahd alteratlon work. N~p survey e~elosed. of said owner or owners, and is dui applic;ttion; that all statements cont~ work will be performed in the manne Sworn to before me this ......... 1''' ·/.0. ........ day ofi. Nota Publie, .... HELEN K. DE VOE ~^RY PUBLIC, State of New York 4707878, Sulfolk '~tm ~xt)lres Marl:ti 30, /gK~ ~ authorized to perform or have performed the said work and to make and file this ined in this application are true to the best of his knowledge and belief; and that the · set forth in the application filed therewith. STATE OF NEW YORK, S.S COUNTY OF ................. ............................. i .................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. I , He is the ' (Contractor, agent, corporate officer, etc.)