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Home My WebLink About12897-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Zfi..3.2.9.7. .......... Date ...... ?.~.~ .~ .L..1 ................... 19 8.5. THIS CERTIFIES that the building ....A.D.D.I..T.I.O.~ ................................... Location of Property . .3.9.0...L.~.K.E...D.~.~.V.E. ............. .S.O.~ ?.H.O.L.I? ...................... House No. Street Hamlet County Tax Map No. 1000 Section . .0.8.0. ....... Block ....0.4. ......... Lot .... 0.0.z}. .......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 17 , 19S. .4. pursuant to which Bnilding Permit No. 12897Z dated .. ?.$. B..~ .U.~.~ ¥..2.4. ............ 198. 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 ......... FOR ADDITION & ALTERATION TO EXISTING DWELLING The certificate is issued to . GUS L MUELLER ................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. ~./.A. .................................... UNDERWRITERS CERTIFICATE NO ..... .N.6.7. 9 9~.~ .................................... Rev. Building Inspector FORM NO. 9 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? 1289~ Z Permission is hereby granted to: .......... ~-~......~.:.......~.~..~c~ ......... ....... .~.....~...~...../....o....= ....... ~ ............. ...~~.,.,,.).~..c~.~.......~.,...~.:~_,'~v--~ ,o_~ - ........ .(~z~.~ .7. '/~.... ~m.. ~ _- .../.~.~..,,./... ..~..~...~-~.~,c~.~z~........Z..a.. .................. .... .~/.~ .7.~,.....~.~.~..~..~: ................................................................................... ~ ......... ..... ............ ~ ..................... ~ .................................................................................... .~z..o.~..<o.. ~ ...... ..................................... .......................... County Tax Map No. 1000 Section ...4~...C~.~) ........ Block .....~.....~.. ....... Lot No..~,~.~....~..~... ..... pursuant to application doted ...~'.Z..~- .......... /.~.. .................... , 19.~L..~, and Building Inspector. Fee $ · · · .~.Q.. ~.~... · ..~.~..~ approved by the Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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. 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 featu res. 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 $15.0 0 3. Copy of certificate of occupancy $ 1.00 4.Vacant Land C.O. $5.00 Date ...~... ~' .~.'~-. ~- °~ J- New Building ~--.i.~.~... Old or Pre-existing Building ............ Vacant Land ............. Location of Property .............. .~..'~,I~ .... ~..0 ~ r/,./o~.d .3 ?o ................... , .......................... House No. Street /Yam/et Owner or Owners of Property .. ~--~. ~. ¢.. ,~./~.~,.,'4~.~(-.4F~ ............................... County Tax Map No. 1000 Section · ..d~. ~ ..0. ...... Block ...0, ,4/. ......... Lot...0..o. ~ ........ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./.~ ~?.~.. ~. 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 p~/c,m., eet~a~b~ ~s y regulations. AppJicant ,'..~..¢%¢¢ ¢;~.. ;[.. ,< .~ .~, ,~..'%-~,. .................. Rev. 10-10~78 FIELD INSPECTION COMMENTS FOUNDATION. (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY FINAL ADDITIONAL COMMENTS: 765,1802 BUILDING DEPT. INSPEI TION [ ]FOUNDATION '~ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [~NSULATi0N [ ] FRAMING [ ] FINAL REMARKS: DATE INSPECTOR List of upgraded changes to approved plans for propesed addition of Gus Mueller located at Lake brive~ Southotd 6xlO B.U. girder instead of 6x8 in new s~ructure~, span of lolly columas to be approximately ?.0 under 6xlO girdSr proVide for 12" overhang at both eaves wall thickness on 1st floor to be 6" throughout wall thickness on 2nd floor to be 6" on north wa~l only provide for 8" concrete block wall at end of exiWting structure FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL,: 765-1802 Examined .~.~...~. ~7. .... , 197..5z5 Approved..~.~.~.~.. ?.~, .... ,1 ~¢Pe~it No .... ~7~ Disapproved a/c ...... 77~ ~--T .... ~/,.. .... ........ ~ (Building Inspector) ~P~LIC~TIO~ FO~ BHIkOI~G ~E~I Received.. /.7-//. 7... , ~ 9~ Date .. d .T ./.7 .......... 19 .~.~. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Buliding 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 Buliding 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 Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southotd, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of bulidings, additions or aiterations, 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 in tions, e . ~ (Signature of applicant, or name, if a corporation) .... ./.K~,~..r../,:?m'?..w. .'~/. -.f-..~.-..,~.../.<g:/. 4 ....... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . .~?.~.~ 4..~../.~.w.~..c~./.~'4: ................................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duty 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 ...................... 1. Location of land on which.p_.roposed work will be don~..../?.,,.~..o.w:~..~?.°.¢~.sI .,..~.~.5'.~: .r-.r.v'5~ .z'.)' ............... House Num her Street Hamlet co,,ty Map So. 1000 Sec .... ....... Block ....... ...... Lot.. .......... ...... - ....... iled Ma,,o ............... ........ (Nmne) 2, State existing use and occupancy of premises and intended nse and occupancy of proposed construction: a. Existing use and occupancy ...t,(..~..'.c: g.~../"~'f':~, t .~.~',.. ,/d.-~./..".~bC~,%~.~...,: ................................ - /~ (.., -" _ . ~--,. :~m';~ ~:; ~ ,, / ~ (~ _ ~, b. Intended use and occupancy .~.z.~c Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Remqval 4. Estimated Cost .... 5. If dwelling, number of dwelhng ~umts ............. Demolition .............. Other Work ............... . ~..X...~7 ~ (Description) ..................... Fee ¢.. ............................ (rot'be paid on filing this application) / Number of dwelling units on each floor·../. ........... If garage number of cars ~ ......................... 6. If busihess, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structur~s, ifany: Front ..... ,~.<~/ .. Rear . .,3. .......... Depth..e~a~./. ........ Height... 02-.0 ......... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front .... ,.,,~....~..' ....... Rear ...,-5'] 9e....... / ...... Depth ...... c~./. .......... i.. Height ...................... Number of Stories... ~ ................. 8. Dimensions of entire new construction: Front ...?-~. ~ ........ Rear ... e%/. ( ....... Depth . .o<7. ,7...~ ......... · o Iteight . 5~ ........... 'Number of Stories ..... ~ ................................................. 9. Size of lot: Front .......... i ........... Rear ...................... Depth ...................... 10. Date of Purchase . . a'~.~ ./.,~../.~..7.~ ........... Name of Former Owner .~ ~ ~ ....................... 11. Zone' or use d~stnct' ' in which .... premises are s~tuated.../Q~qc~.o-,~ r~.<; ................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...~.t? ........................... 13. Will lot be regraded ........ ~ ................... Will excess fill be removed from premises: G No 14. Name of Owner of premises (--wl~ ~..d, .,(?/..q.~.t;45~,~. Address ,~t~.?.+-.r.,.ae~ r~.,t~.~/?'Phone No. ,~..~x ,/."..c? ¢.~¢ .-% Name of Architect . .x,(~. ~..~¢'.q ~ ............. Address 0'~ ~,:r.o'.o.~-. ~ ........ Phone No. ?.a. 4':..~f. L67¢... ) Name of Contractor . ~/_~ .~.r; .,~. ............... Address ................... Phorte No ............... ./ .. i PLOT DIAGRAM · Locate :clearly and distinctly al! 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_/YO~RIC/;/ ........ ~/'erg'" ' ~'-/~' i(Name of individ~tract)~ ........... being duly sworn, deposes and says that he is the applicant above named· He is the ...................................................... ~ ......... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d~ly 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 manner set forth in the application filed therewith. Sworn to before me this ! . 52.0344eea Suffoltt ~,~,/r-.~--~ (Signature of applicant) ,.,mam,ssion Expires Maroh