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Home My WebLink About13062-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Sou(hold, N.Y. Certificate Of Occupancy Z-15381 Date. March !8 1987 No... THIS CERTIFIES that the building . ALTERATION & ADDIT.I,O.N .T,O .EXI.ST, IN.G..O. NE '~A~z'z'~'~ ' b~'g~; L ~N'~ ................ Location of Property., , .t.2.,5: 0..0. ~a. i..n..Re a .d. .. .E.a s t Ma r i o. n..N ~.w..Y.o r.k . house (ye. Street Hamlet County Tax Map No. 1000 Section 3 I 14 7 ............ Block ............... Lot ................. Subdivision ............................... Flied Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated November 2. 1983 12723 Z April 4, 1984 , ...................... .. ~, pursuant to which Building Pennit No. 13062 Z November 2, 1983 dated . . .~.p.r. ~ .1_..2.6..:..I.9.8. 6, ........... 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 ......... ALTERATION S DORMER ADDITION TO EXISTING ONE FAMILY DWELLING EMMANUEL XEFO8 The certificate is issued to ...................................................... (owner, of the aforesaid building. N/A Suffolk County Department of Health Approval .......................................... N797155 UNDERWRITERS CERTIFICATE NO .................................................. N/A PLUMBERS CERTIFICATION DATED: ~uilding Inspector Rev. 1/81 TOWN OF Sou'rHOLD 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? 1306~ Z Permission is hereby granted to: ............. ........................ ........... /..~,.,~z...~.~/~.~.: .............................. ............ ~..~z....Z~.~.~.~.~.......~.~..~..-. .... ~o ...... ,:~..T~..~./..:...~,~..~-~.....~.....~ ~,~-.~ ....... ~.~,~.......,~......~.~.~ ........ ...~/. .~.~ ........ ..~..~./....~. ......,:. ............ ~. ~...~d~.....,~. .,~....~,.~....,~d.~..~..~.... at premises Iocfftted at ....~...~..~. ~. ........ ...~...~.~./~......~.~i~..~... .................................................. ....................................................................................................... ~.w.....~.....~.~~.......~.... ~ pursuant to application dated ..../~,~¥,.:~:m.........~... ................., 19~..:~.~ and approved by the Building Inspector. Fee $,.~...~.~ .......... :.. Rev. 6/30/80 FIELD INSPECT~iON FOUNDATION (ls FOUNDATION 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Exanfin ed,.~. ,/6~/~_ 7~ 19 Approved ................. 19... Permit No../. '~.~.'?.~. ~d~.4~- Disapproved a/c ....... -~.'7 ............... ~ .... , .......... ......... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 tins 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 throu~out 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 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 inspecfi6'~s. /7 " ~ ........ :./ ............. (SignatUre of applicant, or i~me, if 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 pre~nises .... (~,/~/~l~Zr~ . ~.~ x~7. ~:--~'._ .~ .......................................... (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 .... . .~.Q~ ................ Plumber's LicenseNo ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ................. '"_r ............................. ..... ............. ................... ................ House Number Street Hamlet County Tax Map No. i000 Section ..... -.~./ .......... 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 '.~..~.~'f./..~.-~. b. Intended use and occupancy .t~.fi~.. ?., ~' ..................... 10. 11. 12. 13. Will lot be regraded ........ ~ 14. Name of Owner of premises .. Name of Architect ........ Name of Contractor ......... 3, Nature of work (check which apphcable): New Building ..... , ..... Addition .......... Alteration . ~ Repair .............. RemOval .............. Demolition .............. Other Work ............... ,' (Description) 4. Estimated Cost ~'~ ~ o, t~o.: -2 ~ ............ , ......................... Fee ............ o ~2 ........................ (to be paid on filing this application) 5. If dwelling, number of dwelling )nits ............... Number o f dwelling units on each floor ................ 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 ........................................................ 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 ........................................................ Size of lot: Front r Rear Depth Date of Purchase ' Name of Former Owner Zone or use district in which pr~mises are situated ..................................................... Does proposed construction violate any zoning law, ordinance or regulation: ................................ ................... Will excess fill be removed from premises: Yes No ................. Address ................... Phone No ................ ................. Address ................... Phone No ................ ................. Address ................... Phone No ................ Locate clearly and distinctly alli property lines. Give street and block interior or corner lot. PLOT DIAGRAM buildings, whether existing or proposed, and, indicate all set~back dimensions from number or description according to deed, and show street names and indicate whether STATE OF NEW Y~)RIC IS S ..... i' ..... ~ .~.~..~ x 777....:'. ................... being duly sworn, deposes and says that he is the applicant (Name of ih~ividual sign lng contract) above named. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dui, authorized to perform or have performed the said work and to make and file this application; that all statements conl ~ined in this application are true to the best of his knowledge and belief; and that the work will be performed in the mm~n~r set forth in the application filed therewith. Sworn to before me this ~ .......... · ~.'~ ...... day o~ ...... .~. ...... la~/... .......... ....... i-" ~ ~'~1~' ~111~-~ ~ }~ ? ~ (S'g ature of applicant) ' ,i FOLLOW H']G INSPECTIONS: 2 ROIJGH FRAM]NG& PLUMBING 3 INqU[ ATr~N