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Home My WebLink About13241-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate O[ Occupancy THIS CERTIFIES that the building ...d.e..c.k..a.d..d.i.t.i.q .n..t.q..e.x.i.s.t..i.n.cj..d..w.e.l.l.i..n.g.. .... 530 Stillwater Avenue Location of Property .... 2.4~5 ................ F.i..r.s.t..S..t.r.e.e.t. .............. .C.u.t..c.h.o.g.u..e House No, Strabt Hamlet County Tax Map No. 1000 Section .... .~.0.3. ....Block ........ 7. ...... Lot ....... 4. ......... X X X Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated June 19, 1984 13241Z ...................... pursuant to which Building Permit No ...................... dated June 20, 1987 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 ......... Deck addition to an existing, one-family dwelling. Th~ certificate is issued to PETER & THERESA BROPHY & MARY LOCINSKI of the aforesaid building. Suffolk County Department of Health Approval N/A UNDERWRITERS CERTIFICATE NO ............. N/A N/A PLUMBERS CERTIFICATION DATED: Rev. 1/81 FOB.M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 132tl Z Permission is hereby granted to: ........... ..... ,o ...,C..~~....~....~.~~....~....~.....~... ~......i.....~.~...~.......~. ~..~ ...... , ................................................... at premises ,i Lated at ..~...~..~.~......I..~.~..~.....~..[....~J., ~ ..~...~.~ ............................ County Tax Map No. 1000 Section~.....~..~...~ ....... Block ........ D .......... Lot No ....... '..~'.. ............. pursuant ,o application dated ....... ~..~...~. ........................, 19.~...~., and approved by the Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted m~ 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 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 safeW 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.Vacant Land C.O. $5.00 5 .Updated C.O. $15.00 Date ................... :~.~ .~{~ NewC°nstruction. ~... Old or Pre-existing Building ............ Vacant Land ............. · Location of Property ..................................... HouseNo.,-~ __ Str,'t Owner or Owners of Property .~.'-~..~.'~ .<J~/f~-~ ~..~..~..~.T~,~ .... CounW Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No, ~..'~.~ .~\ . . Date of Permit ~O,~-~,. ~.Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate. .... . v~.. . .............. Fee Subm,tted $. I ............ Construction on above described buildir~er~n~r~l~.pplicable codes and regulations. (~'~'~ ~L \5-~ c~ / Applicant .~-..~.. ~,¢~. ~. .......................... Rev. lO-la-78 FIELD INSPECTION DATE !1 COMMENTS FOUNDATION ('~st) FOUNDATION ( 2nd ) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ~ODE ADDITIONAL COMMENTS: r ~' ~FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined.. ~ W..v'~ .¢.9..., 19~. II. Approved . .~,~..~...&..~ .... , 19~.xl. Permit No.)..~..~..1~.]. ~ Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... INSTRUCTIONS 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 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 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 Departme~nt 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 ¢mla~Cfions. _ (Signature of applicant, or naffre~f'a corporation) ........... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . .'~....~.~?.: .~..~.~.~..~...~..~,~..k .~...~ .~.~.~..~..~.e} .................... (as on the tax roll of latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ........ 'N" ............ X Plumber's License No ........... N ..... l~hCili~Tn ' s, Lice n s e No ....................... ade s License No ...... I ............... 1. Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section .... 1..~..~ ........ Block ....... 7 ......... Lot .... .~. ............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and i~t~xded use and occupancy of proposed construction: a. Existing use and occupancy....]. ~ i .)..~.....C¢~c~ ........... ~ .......................... 6. 7. 8. 9 11, 12. 13. 14. Nature of work (check which applicable):' New B i Alteration .......... .............. bval ...... ...... ufldingDemolition. 'i;"~ ' '" ' '..XdditiRepair Rem . Ot~o'r Work ............. ~ ~ , Fee-~..~. ( (Description) Estimated Cost . .... .~,(~.t2~. J I~ ~" (to be paid on filing this applicaiion) If dwelling, number of dwellinglunits ..... ~ ..... Number of dwelling units on each floor ................ If garage, number of carsX'.,< . . i ............ ~ ................................................... If business, commercial or m'lxe~ occupancy, specify nature and extent of each type of use ..................... Dimensions of existing structure..s,X~ny~: Front ................ Rear .............. Depth ............... tteight .............. .. Num. b. er _o'_o~0 rio s ........................................................ Dimensions of same structure with alterat'~ or additions: Front ................. Rear .................. Depth ................... ......Heigh_t ....'~. ................ Number of Stories ...................... Dimensions of entire new construction: Front .. ~ .......... Rear ............... Depth ............... Height .. Number of Stories ..... .~. ........................ S~ze of lot: Front ...................... Rear.. ~ ............... Depth ...................... !)ate of Purchase ..... ~ ............ NameXo~f Former Owner ............................. Zone or use district in w~ated .......... ~ ....................................... Does proposed construction violate any zoning law, ordinance or re'~ag.'on: ................................ NWila~l le°tofb;regraded .......d~: .................. Will excess fill be removed ,from premises: Yes No. wner of premises .... e,g~..'~:~.~... Address . ~,~.~..~Bq~... Phone No..~.~.-.~"~.*~ .ch... Name of Architect ' Address · .O-A°..['g~C~OP--' Phone No Name of. Contractor. ......... ! ................. Address ................... Phone No ................ '> ~ ' i PLOT DIAGRAM Locate clearly and distinctly all] buildings, whether existing or proposed, and, indicate all set-bank 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, S.S COUNTY O.F-..~,.. t ..... ~ · . . ......... ,~..~-~...~...~?..~ ............. being duly sworn, deposes and says that he is' the applicant (Name of individual signing co'6Tl~ct) ' 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 contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the mannei set forth in the application filed therewith. Sworn to before me this ............. /. ~. ~ ..... day ofI. . ~.. ............. 19 Notary Public ......... 2~...~:. Z ~ . .~/..~-~. County NOTARY PUBLIC, State of Now York ...................................... N0. 4707878, Sollelk C,0,,t~ (~;~'nna~ur~;f applicant)