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Home My WebLink About13365-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupnncy No. Zq 3559 Date June 25 85 .................................................. 19... THIS CERTIFIES that the building deck addi-~ion. Location of Property 255 ~red Stree~ l~ew Suffolk House No. Street Hem/et County Tax Map No. 1000 Section ....q.~? ..... Block .. & .Lot ~ 2 Subdivision ......... .x ..................... Fried Map No. x .Lot No. ~: conforms substantially to the Application for Building Permit heretofore filed in this office dated .... A. ?_~.~.~.~..I2 ...... ,19~.~. pursuant to which Building Permit No~ '13365Z dated ...... .~.~.~u. s..~..'1.7. ........... 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 ......... ...D..og.k' .~..d.d.i.~.5. 99..~.o...~.n..~.V.5_.~.~5:..~.~. one-family ~wellin~. The certificate is issued to .... F~_RGARET BROCK31ER ................. /o¥.'o;, ...................... of the aforesaid building. Suffolk County Department of Health Approval N/A UNDERWRITERS CERTIFICATE NO ................................................. Building Inspector Rev. 1/81 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) N? 13365 Z Permission is hereby grante~d to: ~ .... ~"~'-'~"~'"'~'"" ........ i ....................... .~..~......~J~/~ ....... .~...~, ................. ,o~:..~~~ ~~......~.....~.....~.....~......~..~~[.. d // I r,. I , ~,~,,~,~,,,~o,~o,....~.~ ....... ~....~: ............ ~.....~.~)J~ ....... ~.:..~... County Tax '--- I ........ ...... C~'~ ........ ........................ Q) [ ~ Map No. 1000 sect,o,F~j..J.....-/.~ Block '"~"*.~dL°t No pursuant to application doted ..... ~(.,l~9..~......~..~. ............ , 19.X.~.., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ,~outhold, N.Y. 11971 BLDG. DEPT. TOWN OF SOUTHOL~ APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitte~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 build[rigs, 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. C. Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling / [and 3. Copy of certificate of occupancy $1.00 u~ --Fre-Ex±sting C.Oo $15.00 Vacant land C.O. $ 5.00 Date ........ . .............. .. . New Building ........ Old or Pre-existing Building ............ Vacant Land ... Locat,on of Proper~. ~7..~..~,.../.~./.~... ~:.. ~.~-~ .... J.. ~ ~/.~... ~ '~ ~.. ~..,~.,..//..~.~.~/ House No, ~ Street / Ham/et Owner or Owners of Property ... V'~/~/~,,C~/] ~ ,~.c',/,-~,,. ,~, ,/~. o g~c; U ~ ~ County Tax Map No, 1000 Section .... ~.,~..7 ...... Block ....0...~. ....... Lot ..... ~.~,~ ...... Subdivision ................... .~. ........... Filed Map No .... ,~. ..... Lot No ..... ~,~ ....... '¢.. ~?.~'..~'Oate of Permit No./..~. . Permit .......... Applicant ................................. . Health Dept. Approval ....~. · · · Labor Dept Approval ~-- Underwriters Appr(~val .~/~/~.~. -- ................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ...... .~. .............. Construction on above described building and permit meets all applicable codes and regulatipns. Appl,cant ...... ~~ ~ ............. Rev, 10-10-78 ~E[~, INSi CPlON 1. FOUNDATION (1st) COMMENTS FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY Y o FINAL ~/6~v c ADDITIONAL COMMENTS: 'FORM NO. 1 ToWN OF soUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y- 11971 TEL.: 765-1802 L' · ~Acb?~. ~.?. , 19.~J. . xamlneu ......... \pproved ........... )?.., 19~q.. Permit No ............ )isapproved a/c ..................................... ................................ ...... (Building Inspector) APPLICATION FOR BUILDING PERIVIIT Received ........... ,19... Date...~( (' '~'/~'~' ........ 19.. iNSTRUCTIONS ·, .' ust be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 a. Xras aPphcat, m2_m, -lan to scale. Fee according to schedule.. -~,~tionship to adjoining premises or.pU~b.h,'c, stre_e,t..s sets of plans, accura[e p~ut? ....... nd of buildings on premises, ~a _, ~. ....... hich is Bart oI tms appu- 1, plr~t nlan showing loCal;IOn Ot ~u[ a · ~ ~ ..... ~*,~ must be drawn on me ttlag~,n- ,,.- ...... 5 .-. ~ a~tailed description of layom ot or areas, ann giving a u~ menced before issuance of Building Permit. cation. _ ....... d hv this ap lication may not b_e com. :- :~qned a Building Permit to the applicant. Such permit -' f his a hcauon, tu~ d. Upon approval o .t P.P, -,~ ~- inspection throughout the work. shall be kept on the premises avanam¢ -,,- r whatever until a Certificate of Occupancy e. No building shall be occupied or used in whole or in part for any purpose shall have been granted by the Building Inspector. E to the Building Department for the issuance of a Building Permit pursuant to the other applicable Laws, Ordinances or PLICATION.. IS HErE.BY MAD old Suffolk County, New york, and as-herein described. BuilTig Zone Ordinance ot the Town of South , or alterations, or for removal dr demolition, Regulations, for the construction of buildings, additions building code, housing code, and regulations, and to The apphcant agrees to comply with all apphcable laws, ordinances, necessary inspections. ~ ~? ' ~ -eft :.: .... '.' .. '-" 7> ...... (Mailing address 6f applicant) or builder. State whether applicant is/owner/lessee, agent, architect, engineer, general contractor, electrician, plumber ...................... ,/. ................. Name of owner o f premises ....... L. '../~.Z~.-'.~.Zv..c~.~. ..... ia~'o'n' th~{ax rob or latest deed) If applicant is a corporation, signature of duly authorized officer. ........ '(iqame and title of corporate officer) Builder's License No .......................... . _. ·Plumber's License No ......................... i~Electrician's License No ....................... ' ' de's ' ' Other Tra License No ................... 1. Location of land on which proposed work will be done ............... JN~ ..................... · ' = Hamlet .......... Street House Number i .~..~.. .... ~. ,[..~...5... .it71 County Tax Map No. 1000 Section .............. Block ..... · ...... Lot Filed Map No. }Q .......... Lot . · }C,. .......... Subdivision ........ .}5. ...... (}q'a'~;)' ........ . of premises and intended use and occupancy of proposed construction: 2. State existing use and occupancy .'~Xl~ ~ ~ L~..O~. ~... ~_Oef'.0~ ·. · .. -' a. Existing use and occupancy ............. ~ ~ _ ~ b. Intended use and occupancy ...... ~..[~. .... ~..0klM?.-lg~ 7. [~;k/(. ~ ......... 3. Nature of wot check which a ~cable: New Buildmg .......... Add~tmn ........ Alteratmn .......... pal Re r .............. Removal .............. Demolition .............. Other Work ............... I (Description) 4 stimated cost, , ,0. 9, eoFee ,:,,S",, O0 ................... : 4, (to be paid on filing this application) 5.If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage number of cars , 6. If business, c ' ' qd ' ommermal or m~x occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ' Nurpber of Stories Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth . Height Number of Stories ~- 8. Dimensions of entire new construction: Front ..... '2..~. ...... Rear .... ~ ....... Depth .[."2.. ........... · Height . ." ............. Number of Stones ....- .................................................... 9. Size of lot: Front ....... I,¢.O. ........... Rear .................. · .... 10. Date of Purchase .... .~.-~.-. ~. :."J.'l ............. Name of Former Owner ..... .~.t .m:~. ~..'~. ~h;v~t.~ ...... 11. Zone or use d~stnct ~n winch premmes are situated . 12. Does proposed construction vi61ate any zoning law, ordinance or regulation . 13. Will lot be regraded .... v3~Q. j .................... Will excess fill be removed from premises: Yes 14. Name of Owner of premises : ......... Address ................... Phone No ................ Name of Ar h~tect .,~,~).~ ..... ~ ................... Address .................. Phone No. . PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ................. S.S ............................ ~ .................... being duly sworn, deposes and says that he is the applicant (Name of individual sigfiing contract) 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 .application; that all statements conti'alned in this application are true to the I/est of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworu to before me this 1 7, . ,~, ..... dayoi .... ~. ,, ............. · .~.'..~..j~..~...~r ........... , 19.~ .... HELEN K. DE V~E ' NOIARY PUBUC, State of New Yodl ...... , .... . ./'~.~'~....Lz?--~-'~... i. ''t'' , , No. 4707~78, Suflol~ 12ountJ/...._ ~/' ,,~ t .,;':. (Signature of applicant) : lern~ E;~plres Ma, feb