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Home My WebLink About12943-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...Z..1.2,3.9.9 ........ Date March 28 ............. 19 84 THIS CERTIFIES that the building --deck addi. tion Location of Property . .4.2. Q ............. Glen Road Southold ...................................... House No. Street County Tax Map No. 1000 Section 0 78 .Block 02 .... Lot ~ .0 2.2. Subdivision.. West Creek Estates .Filed Map No. .3.84.8. Lot No..~.. conforms substantially to the Application for Building Permit heretofore filed in this office dated March 26 1984 pursuant to which Building Permit No. 12943 g · dated ...... .M.a.r.c.t.~..2.7. ............ 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 addiLion to existing dwelling. The certificate is issued to RONALD & LUCILLE BACKHAUS .................. [owner, ~or-t'~r~) ...... of the aforesaid building. Suffolk County Department of tIealth Approval ,......N/A, .................................. N/A UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 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) 12943 Z Permission is hereby granted to: ~ . ~..~ .~ .~.~ G ~ ~ LoL ~o.. ....... ...... AL ,L,~ ~¢,J. ................................. ....,¢ ........ ,......~..--;TZ~;.; .................................................. ~, ¢,~,,, ,2,,ed ,, .....~.~.~.....~.~~ ............. .~.~ .......................... County Tax Map No. ]000 Section ....... .,~,.,.~.,..~. ..... Block ..... ,~,.,.~/. ........ Lot No ....... ,,'~, ..,~.,, ....... pursuant to application doted .......... .~.~) ........ .-')~...~ ........ , 19...~...., and approved by the Building Inspector. Fee $..~... .................. ~ ' Building Inspector Rev. 6/30/80 FORM NO, 6 TOWN OF SOUTHOLD 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 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. 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 topo§raphic 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 dwelting land use --~re ~E×±s t, ±rig C. 0, ~ 15 · 00 3. Copy of certificate of occupancy $1.00 / ~/acant, ].and C.O. $ 5 · 00 Date ... ~,to_~_~,/~ New Building ............. Old or Pre-existing Building ........... Vacant Land ............. Location of Property .. ,~, ...... ~, ~,~,0~!t... ,oT, ...................... ,~,~.~, ,o,~,c~, ..... House No. Street Ham/et Owner or Owners of Property ...~..~ ..~...L.;..~ .~'[¢,4-(~.~. ............................... County Tax Map No. 1000 Section '-) 'S¢ Block ~2__ Lot ................................. o - -. Subdivision bt~<~- ~ ~-~_/q ~'~:u-~S Filed Map No ..... ' .......o~ ~o .............. 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~-~mit meets all applicable codes and regulations., Apphcant . .(,,¢'.E,4¢~/. 27. ........................... /'. .... FIELD INSPECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ?DE FINAL ADDITIONAL COMMENTS: ' FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:3 Examined..'0 19 ?. ? Approved....~ 94-..~.,..~ .-/.., 19 ~ .~. Permit No..! ~ .q Cl. ~..~. Disapproved a/c ..................................... ................................ ..... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received .... - ... , Date March 26, 19 84 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 inspections .... (Signature of applicant, or name, if a corporation) 6 GLen Roacl, Southol~t, N.Y. 1 L97t (Mailing address of applicant) (Name and title of corporate officer) Builder's License No... Plumber's License No ......................... Electrician's License No ....................... Other ~rade's License No ...................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. owner ~2O~'['D Ag ~OTED N~e of owner of premises ~ ........................ . ..... ,',' '. ..... 4 FEE:'~E'; ' 7,'' eY':' ' ' B: G.'* .......... t~s on ~.~ tax ~o~ ~d+~fi~'¢ ~X~C~ If applicant is a corporation, signature of duly authorized officer. 765~1802 9 AM TO g PM FOR THE 1. FOUNdATiON - TWO REQUIRED FO~ POURED CONCRETE 2.ROUGH - FRAMING & PLUMBING 3.INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C. O. ALL CONSTRUCTION SHALL THE REQUIREMENTS OF TH~ STATE CONSTRUCTION 8. ~ .... CODES. NOT RESPOh'~ DESIGN OR CONSTRUCTM ..... 1. ~d on which proposed work will be done ....... 6 .Olen .~o~,gou~ho[4 ....................... ~. - .6 ........ 6hen .Roa~ .............. 8ou~ho~ ...................................... Street Hamlet County Tax Map No. 1000 Section ..... ?g ........... Block ..... 2 ....... ~ .... Lot ..... ~ ............ Subdivision West Oreek Estates . Filed Map No. Lot (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... 1..l~amil. y. [louse ................................................ b. Intended use and occupancy ...... DeRk...~Bl~l~. attachea, to. house ................................ 3. Nature of work (check which applicable): New Building .......... 'Addition..~ ....... Alteration .......... Repair .............. Removal ............ Demolition .............. Other Work ........... ~ ' (Description) 4 Estimated Cost I ' Fee (to be paid on filing this application) $. If dwelling, number of dwelling Units ............... Number of dwelling units on each floor ................ If garage, number of cars ' 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .................... 7. Dimensions of existing stmcture~, if any: Front ............... Rear .............. Depth .............. Height...............NumberofStories.. .................................................... .. Dimensions of same structure wi, th alterations or additions: Front ................. Rear ................. Depth .................... i. · Height ...................... Number .of Stories ..................... 8. Dimensions of entire new constrUction: Front ............... Rear ............... Depth .............. Height Number' of Stories ' 9. Size of lot: Front .. 4.00 ~ .... i ........... Rear ..... ).00 .............. Depth ...... 206.&.2t~ ....... 10. Date of Purchase .... ~.fl-~.6-68 ................. Name of Former Owner .... ~has,W,141elae~.. &.Wf. · ..... 11. Zone or use district Jn which pr~mases are s~tuated ..... A .resid. en~;i~4.-Ag ................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... no ......................... 13. Will lot be regraded ......... '...no .............. Will excess fill be removed from premises: Yes X No 14. Name of Owner of premises . .l~!,& .I,,B~ekhau~ .... Address ... 6.01e~ .I~¢, ...... Phone No... 76~1~0 ..... Name of Architect .......... ! ................. Address ................... Phone No ................ Name of Contractor ......... i ................. Address .................... Phone No ................ Locate dearly and distinctly all property lines. Give street and block interior or corner lot. STATE OF NEW YORK, COUNTY OF .................. '~'(Name of individual sig~ above named. PLOT DIAGRAM He is 'the ..................... 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 S.S .................... being duly sworn, deposes and says that he is the applicant lng contra~t) (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 cont'ained 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 Notmy Public, ....~ .... -i.. ....... '. ..... (Signatture of applicant) -