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Home My WebLink About13232-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z12743 Date Aug. 30 ................................................. , 19.84.. THIS CERTIFIES that the building ......... .O.n?...F.a.m. J:..1.y..D.w. ?.l.l,i.n. ~..w./.D. ??.k...A.d.d..., Location of Property 4600 Westphalia Rd. Matt. - h;~d,s'o ~o~ ...................... 'Siie~i ....................... County Tax Map No. 1000 Section . .1.1. 3. ....... Block . .0.9. ........... Lot..0.1.4. ............ Subdivision ................ X. .............. Filed Map No. X .Lot No. X conforms substantially to the Application for Building Permit heretofore filed in this office dated ·.. J.u.n.9 .....1.8. ....... 19 .8.4, pursuant to which Building Permit No. 132327. dated ....J.u.n.e. ...... 1..8 ............ 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 ......... One Family Dwellin9 w/~ Deck Addition The certificate is issued to ..... .~.O.N.E.S., .H.A.R.O..Lp..D. :..a...1~..R?.H.A., .A.. ...................... (owner, of the aforesaid building. Suffolk County Department of Health Approval ...N./..A .................................... UNDERWRITERS CERTIFICATE NO ........... ~/..A .................................... Building Inspector Rev. 1/81 lrOB~ bO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST I~E KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13232 Z Permission is hereby granted to: .................... ............ ~t premises located at ....~.~.~......~...,~~...~.~ ........ !.../...J.~ .................. County Tax Map No, 1000 Section, ........ .~....~ ....... Block ........ .~. ........... Lot No ..... ~ ............... tO application dated ....... ~....!...~. ....................... , 19.~.~.., and approved by the pursuant Building Inspector. ~ Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Tow~ Hall ,~;~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitte .'Ll-~t-~_~c~,l:.cctc 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 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, occupancv 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 land use --?re-E×±s t,±ng C. 0. $15.00 3. Copy of certificate of occupancy $1.00 Vac ant, 1anti C. 0. $ 5 · 00 Date.. ?./?o/.~. ~. ............ New Building .... .~/.. ..... Old or Pre-existing Building .... ' . .. Vacant Land .... ~ ..... p ' Location of Property. ~ .~.0.~. ..... .~,,~..~7-/~.~7/~..~./~... ~.: ............. ./~...~: House No. Street /Yam/et Owner or Owners of Property .. ~LJ,,~Q ~C/...~,...~?~ .... .//~. ~.../~i~~. .~.../."):....~.. ~.,4-.~?..-~.'. ....... Coonty Tax Map No. 1000 Section .... z'~/'.,~.. ...... Block ...... ~.. ....... Lot ..... .~. ~.. ...... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ~5~.~ ,~ ,~, Date of Permit .... Applicant ,~. ,~,. ~,,~, ,~, · ./--~. Health Dept. Approval ........................ Labor Dept. Approval ...................... Underwriters Approval ........................ Planning Board Approval .................... Request for Temporary Certificate ..................... Final Certificate ..................... Fee Submitted $ .'~"~ ...................... Construction on above described building and permit meets all applicable codes and regulations. (_O ~- ~'z-'q ~ Applicant... . ....................... Rev. 10-10-78 FIELD INS?ECTION FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & FLUMBING INSULATION PER N. STATE ENERGY qODE FINAL YJ ADDITIONAL COMMENTS: COMMENTS Approved .&.bC-'y~G.... [ ?~... .,p. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ., 19'~. Permit No Disapproved a/c .......................... ' ........... ................................ ....... (Building Inspector) APPLICATION FOR BUILDING PERI¥11T Application No .................. Date ................... 19... INSTRUCTIONS a. This application must bt completely filled in by typewriter or 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 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 issue 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 o"r used in whole or in part for any purpose whatever until a Certificate of Occupahcy 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 buildings for necessary inspections. :.: .................... · ' ' (Signature of applic~t, or name, if a corporation) ./. d. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nmne of owner of premises ..... /~ffZ?. i./O..../~....qT:..~?~.,q. IJ~.f). (-7 .... :~6.AJ.e-.3. ......................... (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...: ........... ........... Plmnber's License No ......................... Electrician's License No ....................... 'Other Trade's~se No ...................... Location of land on which proposed work will be done .................................................. ............... . /74 .................... ................... House Number Street Hamlet C;unty Tax Map No. 1000 Section ..... /./..~. ........ Block.... ~. ............ Lot.../...~. ........... ~, Subdivision ................ (iq'a~) ................ Filed Map No ............... Lot ....... . ........ State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... /OE/~$P.~..~.. ~.....~.~..~. *. ........................................... b. Intended use and occupancy ...... /~.~.7.,Of. ..................................................... 3. Nature of work (check which applicable): New Building .......... Addition ...... Alteration ........ ~ · 'R moval Demolition Other Work ............... Repair~ ................ * e ............................ .... (Description) 4. Estimated Cost .... ~-~.~.. ¢4. ........................ Fee ................................. ' .... " (to be paid on filing this application) ' Number of dwelling units on each floor 5. If dwelling, number of dwelling units ............... If garage, number of cars .......... ',' ............................................................., 6. If business, commer6ial or mixed occupan,c.y, specify natur, a, and extent of each typ,e of use .......... ; · · ./ ........ 7. Dimension~ o~f ~.xisting stmcture~, if any: '~rdn. t ....~..~. ........ Rear ...~."~.. ....... Depth..~..~. ......... Height: .. J.~;.'.i'. ....... Number of Stories '. .... /. ................ ..; > ................. ;~.~'; ~ ......... Dtmens~ons of same structure with alterattons or additions. Front .... ~/. ......... Rear ... ~',~.. · c~2.(e.~ ~ I · .J~. ............. Number of Stories ..... ,,~e.; f. ............. Depth ........ ; ........ Height ..... ' '~donstrC~fion: Front ' Rear Depth 8. Dimensions of entire new , ............................................ Height ............. -.. Number of Stories .......... ._. · ~. ~ · .:.2 ~ .~ .............. '~ '~z~ ;. ............ 9. Size of lot: Front .... ~ ¢~, ~. ~ .~>. ~ .... Rear .... ~;,~..~..o~, ~o4. ...... ~pth~.. ~. 9~.. 'O" ~; '~ Date of Purchase ~,. ~/~$~ Name of Eomer Owner ~T~..~..~-!J. 10 .......... ~ .... ~ ..... , ~ ' L t · · 11. Zone or use district in which premises are s~tuated ..... ~ ~. ~0 ................................ · ' ' g 1 di 1 rio 12. Does proposed construction molate any zomn aw, or naac~ or regu a n: ............... , ............ 13. Will lot be regraded ......... ~ ................. Will excess fill be re~oved f[o~ premises: ~ Yes No 14. Nme of Owner of premises . ~g~..~ ~.. Address ~/d.. ~fi~g(~ ~ Phone No...~~. Phone No Nme of Architect .......... 1 ................. Address ................................... Nme of Contractor ......... ~ ................. Address ................... Phone No ................ PLOT DIAG~ Locate 'clearly ~d distinctly MI~ bu~dMgs, whe~er existing or proposed, ~d. indicate ~1 set-back d~ensions from prope~ 5nes. Give street ~d block~number or description according to deed, and show street nines and indicate whether ~tefior or coruer lot. COU~Y OF..~4~. ....... .~7. /~. ~ t. ~. ~ .... being duly sworn, deposes ~d says that he is the applicant (Name of individual signing contract) above named. He is the ........................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is dhly authorized to perfom or have perfo~ed the said work and to m~e and file application; that ~1 statements cofltained N this application are true to the best of his knowledge and belief; and that the work will be perfo~ed in the m~Oer set forth ~ the application filed therewith. Sworn to before me this ....... ; ...... ~ ...... day ~f.. ~ N°taw P~blic' ' ....... ~~'~fi~N ~. ~[ vO['F/~J~C°unty ~~~~. ' NOIARY POBLIC, Stat~ et New Yorff .... ~ (Si~atum of applic~t~ No. 47~7878, Su~{0lk Count'L ~ le~m Ez?es Mamh 30, I9~