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Home My WebLink About12915-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z-15368 Date March 18, 1987 TH1S CERTIFIES that the building ADDITION TO EXISTING ONE FAMILY DWELLING Location of Property 1150 Pecouic Bay Blvd. Laurel, N.Y. House No. Street Ham/et County Tax Map No. 1000 Section 14 5 ...Block 2 .Lot I 1 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated March 5, 1984 12915 Z ' pursuant to which Building Permit No dated. .........................Ma r c h 6, 1984 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 ......... ADDITION TO EXISTING ONE FAMILY DWELLING MARTIN SIDOR, JR. The certificate is issued to ..................... id~,r;e'r,'i$~s~Y~ei~b~X .................... of the aforesaid building. Suffolk County Department of Health Approval N / A N701252 UNDERWRITERS CERTIFICATE NO ................................................. N/A PLUMBERS CERTIFICATION DATED: /f~ Buil~ii~'Ins~ictor ....... Rev. 1/81 FORM NO. 2 TOV~N OF 50~THOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12915 Z Permission is hereby granted to: ............ . .~...~.....~..~.~., .............. ,o..~ .................... ~...i..~~~.....,.. .................. '..~.~, .......... ~~.~. ~. ..... ~.~...~..~...q~,.~,. ................................. ..~. ................ !...,~ .......................... !. ...... ~-[/ ...... ~ ............ at premises located at ..... ]../...~..-.D.......~.~..~...C~...x~.......~..~(-.~.~.~.,..~.-. -.*..~../.~'~..~.- ............. County Tax Map No. 1000 Section ...................... Block ........ .~ ....... Lot No ......)..~ ............... pursuant to application dated ...... ..~..~.'~...~..~....~ .................... , 19~..L.~., and approved by the Building Inspector. Fee $..?;?- ..~...: ............. Buildin~ Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 Instructions This application must bo filled in typewriter OR ink, and submitted qa =ma=~=a 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 unu~al natural or topographic features. 2. Final approval of Heal.th Dept; of water supp!y an.d, se,w, er,age disposal-(S-9 form or equal), 3. Approval of electrical mstailaUon from Boaro of Fire unc~erwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Coda 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~perty 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 ~nspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: · ' ' l. Certificate of occupancy Neu Dwellzn.g.$25.00, Accessory :$10.00 tlua~ne,~.~ $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50. PO 3. Copy of certificate of occupancy $ 5.'00, over 5 yeare $10.00 4.Vacant Land C.O. $ 20.00 5.U~dated C.Oo $ 50.00 Date .......................... 6. Alteration $25.00 NewCons truc~ion ...... Old or Pre-existing Building ............ Vacant I-and ............. Location of Property ) I"cO ~ House ~Vo, Street Hamlc ~ O erorOwnersof,roper,y .'.' .... County Tax Map No. 1000 Section o. J ............ Block .......................... · · ' Filed Map No Lot No 8ubdwtsmn ......................................................... Permit No .... Date of Permit . . cant ................................. Health Dept. Approval ........................ Labor Depto Approval ....................... Underwriters Approval Planning Board Approval Request for Temporary Certificate ..................... Final Cortiflcatc ...................... Fee Submitted $ ..... , ........................ Construction on above described building and permit meets all applicable c~odes and regulations. Applicant ....................... ilar. 10'10 70 lO00~18 THE NEW YORK BOARD OF FIRE UNDERWRITERS: ~ D.,. July 23, 1958ss JOHN STREET, NEW YORK, NE)~V :YORK 100:)8 .,,~,,c.,,,,,,N..o,,.~,,. 262z~s/84 ~ N 701252 FIXTURE OUTLETS IECEPTACLE$ SWITCHES 6 FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS DRYERS IMECLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS OTHER APPARATUS: tl~htln~ 3' 0" 3 lites. S E R V I C OF CC, COND, 1 AW.G OF Hi-LEG NO, OF NEUTRALS 1 AW.G OF NEUTRAL Alexander O. Hubbard Box 222 Aquo~ogue, N.Y. 11931 Lio. 304 This certificate must not be aheted in ony manner; return to the office of the Board if incorrect. Inspectors co.~oR e~LD,~0 ~E.^.tM~N¥.*.,S co~¥ o~ may be identified by their credenhals ANY MANNER. FIELD INSPECTION FOUNDATION FOUNDATION 2. ROUGH FRAME & (~st) (2nd) PLUMBING INSULATION PER N. Y. STATE ENERGY C,ODE FINAL TOWN OF $OUTHOLD OFFICE OF BUILDING INSPECTOR ILO. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1gO2 This is to advi~e you that the job under building permit no. .12915Z issued to Martin'Sider. oa .~/84 .... for Addition is completed and a final inspection hms ( ) has not ( x ) been done. in order to complete this file, it is necessary that a L;ertiflcate of Occupancy be issued. Please fill out the enclosed form, return ~amc to the above office with a cheek for $25.00 payable to the Town of Sou(hold. Please indicate to Whom the Certificate of Occupancy is to be mailed, and arrange with this office for an inspection (late Occupancy or ut~e i.~ unlawfnl without a Certificate of Occ,pancy. l'lent~e help u.~ to clear t,p th~s matter so that legal action does not have to be taken. Thank you for yo,r prompt attention. Very truly _y~, Victor Lessard Executive Administrator VL:gar encl. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined...~%~.\..~ .... , 19~.bl Approved . .~'~-c~.. 9.~\..~. .....19~.tl. Permit No. ! .9'..~'./..~...-~. Received ........... ,19... Disapproved a/c ..................................... (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 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 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 iospections. ~ ._, /] ..... ......... (Signature of applican, t, or name, if'~(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 .... .Oq.. ~..~ ..t~. .....Sfl..~.. ~ .......... ~' ~ (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 .......................... Plumber's LicenseNo ......................... Electrician's License No ....................... Other Trade's License No ...................... I. Location of land on which proposed work will be done ................................ . ................. House Nmnber Street Hamlet ... "> County Tax Map No. 1000 Section .... [ t~ ........... 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 ..... .L.[.0. { ~..~. ..... ~..~..~--...f~. ......................................... b. Intended use and occupancy .... !w ! 3. Nature of work (check which applicable): New Building Repa/r .............. Remoyal .............. 4. Estimated Cost ........ ~ ..... 5. If dwelling, number of dwelling onits ............ Addition . : ...... · ~- . . Alteration ........ Demolition .............. Other Work ............... (Description) ....... (to be paid on filing this application) · Number of 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 structurel, if any: Front ............... Rear .............. Depth ............... Height Number of Stories. Dimensions of same structure wilh alterations or additions: Front .................. Rear ........ ; ......... Depth .................... :~.. Height ............ ~ ...... Number pf Stories .............. ~ ....... 8. Dimensions of entire new construction: Front ..... I.~o. ..... i 'l~ear ...]./'~...~. ~. t.... Depth .. ~ [. ....... Height ...... ./~' ...... Number o,f Stories ........... tt. ........................... .. ......o ......... 9. Size of lot: Front ........ ./. ~ ~ ......... Rear ....... /. ~.Q. ~. ........ DeEth ..... ~l~5.t~..: ........ 10. Date of Purchase ........... ~../. ~ .~..~. i ...... Name of Former Owner . .~.~.'~../.~..4LO.. · .~..~..~./..~.&'/../ .... 1 1. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violhte any ~oning law, ordinance or regulation: ...................... ~ .... .~ 13. Will lot be regraded ......... ! .... /..b/..~....;..,~... Will excess fill be removed fromm premises: ~ N~ 14. Name of Owner of remises °I~°,~-'FI~O ~,/t~o [~2 Address fi>..k~.¢ , ~.'/' t~.~.td/..)Phone No . .:~.~. ~e_e_~j. ~..~:> Name of Architect . .Z.-'~..~?... ~.'~,. ~'~._: ~.°....O~... Address .~.x~./.,~..~...t>,8~/../j.~--.. Phone No. . Name of Contractor .'~t~ .t~..k~..i. .6..~.o .~'.~..~..5'... Address . .[~.'.~?...~{4'. ,. ,~l~.-~7~,hone No. 15~ ~ ~q~.' ~/i PLOT DIAGRAM Locate clearly and distinctly all !buildings, whether existing or proposed, end, indicate all set-back dimensions from property lines. Give street and block ~tumber or'description according to deed, and show street names and indicate whether interior or cornerlot. /b¢.c c~ ~. Ot[;~.~=::~_._ [~ ~.V r~, STATE OF NEW YORK, COUNTY OF ,o-, ',dd,~,t~/~/,~,..... ,!S'S ~.. ~.)..,~? ~,. I ,5'j dO ~ being duly sworn, deposes and says that he is the applicant (Name of individual sign,ing contract) 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 i 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 applicatio.n filed therewith, Sworn to before me this ......... ......... day .......... 19 Notary Public, ~~.~A~' ~'. .... O~..~~. ~..~... ......... (Sigl~lture of applicant)