The URL can be used to link to this page

Home My WebLink About12981-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z125A.R ........ Date June 11 19~3 THIS CERTIFIES that the building .-:-.c~G.k..a.d...d.i.t.~.o..n .............................. Location of Property 1625 ............ .S .h.i~. ~z .a .r .d..h..a .n?. ..... East Marion h36do }~d ' Street ................. h3t~l'o't County Tax Map No. 1000 Section ... 9 3.8. ..... Block 01 . .Lot 017 Subdivision ..... .X ......................... Filed Map No...X. ..... Lot No..X ............ conforms substantially to the Application for Building Permit heretofore ~ed in this office dated ....... Ma:r:ch. 3.0. .... ,19 .B. 4. pursuant to which Building Permit No .... .3_.2.9. .B.1..Z. ......... dated ........ Ap~i 1..6 ............ 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 ......... a deck addition to existing one-family dwelling. The certificate is issued to CONRAD C. VOLINSKI of the aforesaid building. Suffolk'County Department of Health Approval ....... Iq../..A ................................ UNDERWRITERS CERTIFICATE NO ............... I~./..A ................................ Rev, 1/81 FOR~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPART/vlENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.° 12981 Z Dote ...~......~ ......................... , ,,.~.~ Permission is hereby grante..cl~to: .L ~.._....~.L..~.........u....~ ½ ............... · ......... .~......~.~ ....... ~..:~.., ............. ot premises Iocoted ot ./..~....~...~.....~.~f~.~...~.........~...~ ........ County Tax Map No. 1000 Section ......C~....~....~.. ....... Block ...... .0....1 .......... Lot No ....... t...--/. ............ pursuant to application doted ..... ...~...~ .................... , 19.~.....~., and approved by the Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall ,~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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 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 / land use 3. Copy of certificate of occupancy $1.00 ~ --Pre-Existing C.O. Vacant land C.O. $ 5.00 New Building ........ Old or Pre-existing Building ............ Vacant Land ............. Location of Property ........................................ House No. -- (~ Street , Ham/et Owner or Owners of Property .......... ~?.Q-~...~.;...~.~~,4~ .................. County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No,..~ .~, ,(~, ,~ ~,~ate of Permit ~J~ [.,~..Appticant..,d(¢~,~.....~.;.., Approval - Health Dept. Approval ........................ Labor Dept ......................... Underwriters Approval .... '.~. ~ .............. Planning Board Approval . . ...~. ............... Request for Temporary Certificate.....................FinalCertificate .... .'¢. ............... .. .. Fee Submitted $ . .~..." .O. P..(~...~...~/lz~ Construction on ~~ ~" "~'~'~' '~" ' ' '~' '~' above described building and ermit meets all apphcable codes .and regulations. Applicant . . .-~...~' ...... .~0 FIELD I~SP~TION FOUNDATION (lst) COMMENTS FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N. STATE ENERGY QODE FINAL ADDITIONAL N 'FORNI NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1803 ~xamined i~ [o , 19~q . Approved ] .~. i i ], 19iil Permit No. / ·~. t) . .~.1. .~'. . )isapproved a/c ..................................... Received ........... ,19., (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................... 19.. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot ahd of buildings on premises, relationship to adjoining premises or public streets ,r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- etlon. 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 kall 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 hall 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 luilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or [egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. 'he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to dmit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) itate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Oco~ qameofownerofpremises......~e"v"'~g...........~...~O.Z/~..~,.~.&, ' ....................................... (as on the tax roll or latest deed) ~f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ....... ~...~..~.~ ............ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... ~. Location of land on which proposed work will be done .................................................. ........... 1. .3. .o. ........ d . . . o, ............. Itouse Number ' Street Hamlet County Tax Map No. 1000 Section .... (~ ~.~..~ ....... Block ..... .~..I .......... Lot .... ]..~. ............ Subdivision ...... .~. ............................. Filed Map No .... ~ ......... Lot . . .~. ........... (Name) 2. State exist~ng use and ~ccupancy ~f premises and intended use and ~ccupancy ~f pr~p~sed c~nstructi~n: a. Existing use and occupancy ..... ,,.~.t./~.~' .&.... .~..~.&/0.i¢..d(g).~./. [/./f(~~ ' ' ~ ........................... b. Intended use and occupancy ...,,~..d/..g)~..... ~....df~,O~.. ~ i .~.d~74.~ ...................... Repair .............. Removal .. Estimated Cost....~. ~.~..: ~ ..... 5. If dwelling, number of dwelling units. ( ' ppl' bl )' N Additi . Alt Nature of work checkwhlch a ica e . ew Building .......... on ........ eration .......... .......... Demolition ........... :... Other Work ............... . ~ (Description) **' (to be paid on filing this application) .......... un er o we ng un on cae oor ................ If garage, number of cars .......................................... I ............................ 6. if business, commercial or mixed occupancy, specify nature and extent of each type of use .................... 7. Dimensions of existing structures, if any: Front ............... Rear ....... : ....... Depth .............. Height ............... Number of Stories ............................ i ........................... Dimensions of same structure with alterations or additions: Front ............ i ..... Rear ................. ~ Depth ...................... ,Height .......... , ./ .......... Number of.S~ories ..................... l~g;~sions o~ entire nTw co~nr;;tri;?:stF:~;ts .... ~ !: :: ..... Rear ..... .~..~. ...... Depth../~../ ......... ~ Size of lot: Front ... Y~. ................ Rear .... ~ ............... ]Depth ....~..a: .~. ............. I 0. Date of Purchase ............................. Name of Former Owner .' ............................ I 1. Zone or use district in which premises are situated ..... '~ [. · .~ .............. i ............................ Does proposed construction violate any zoning law, ordinance or regulation: ...K2.O. .......................... Will lot be regraded ......... .,gP.., ... :. ~.: .: .,... Will excess ~ill be rgmoveld from premises: Yes ~ (~ Name of Owner of premises ~..~.n..r?.d:..c..~.'/t,'t ~,g!:. Address ~7~..g.~/g~,~. A,~4.... Phone No.."/.7. 7..'-..~..~. Name of Architect .......................... Address ................... Phone Np ................ Nine of Contractor ......................... Address .................. Phone No ................ Locate clearly and distinctly all buildings, whether existing or proposed, and, if ~dicate all set-back dixnensions from ~roperty lines. Give street and block number or description according to deed, and sho~ street names and indicate whether qlerior or corner lot. -/6~ _,% /~c~ ~ ,f ~TATE OF NEW YORK, S.S 2OUNTY OF..~..~ D~..~.g. ~ .~. ·. . ................... (Name of individual signing contract) ~bove named. -te is the ............................................................ ~ ............................. (Con(rector, agent, corporate officer, et~.) ff said owner or owners, and is duly authorized to perform or have performed thelsaid work and to make and file this ~pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the york will be perfohned in the manner set forth in the application filed therewith. ;worn to before me this ..... ~. ~.. 7. ............ day of ............... 19 qotary Public, .... LINDA F. KOWALSKI I .', NOTARY PUBLIC, State of New York ..~ ...... ..-' · · .,, .............. No. 52'4520,771 (Signature of applicant) Qualified in Suffolk County ,/ Commlaslor~ Expires March 30~ being duly sworn, deposes and says that he is the applicant i'