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Home My WebLink About13354-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-14712 Date JULY 25, 1986 THIS CERTIFIES that the building~ Location of Property 2820 MAIN ROAD House No. County Tax Map No. 1000 Section 125 Subdivision ONE F~4ILY DWELLING Street Block 3 Filed Map No. LAUREL~ NEW YORK Hamlet Lot 6.2 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 15~ 1984 pursuant to which Building Permit No. i3354-Z dated AUGUST 15~ 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 ONE FAMILY DWELLING WITH ATTACHED GARAGE & TWO DECKS UNDERWRITERS CERTIFICATE NO, PLUMBERS CERTIFICATION DATED The c~rtificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N-728501 JUNE 3, 1986 MITCHELL M. WILCENSKI i4-SO-141 Rev. 1/81 FOBM NO, ~ TOWN OF SOUTHOLD BUILDING DI:PAI~TMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 13354 Z Oot~. .,....~. .................... , Permission is hereby granted to: , , , ......... ....... ...~,7..o..o. ....... .~.~.....e....d. ........................... at premis*s located ot ............................................................................................................................ County Tax Map No. 1000 Section ...L~...~.. ........ Block ........ ~ .........Lot No ....... .~.:.~ ..... ~q pursuant to application dated '"'~"~"'~"~'~"X' ................................ , 10......., Building Inspector. and approved by the Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Bu ilding Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUP~ Instructions A. This application must be filled in typewriter OR ink, and submitted I~ to the Building Inspec- tor with the following; for new buildings or new use: I. 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 sifnilar 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 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 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. Updated C.O. $15.00 New Building ............. Old or Pre-existing Building $15.00 Date..~....~',.~..:...~..~ ......... ............ Vacant Land ............. Location of Property .................................................... House No, Street Hamlet Owner or Owners of Property ..... /~. ~,/~..~.~?./ .... .~..,....~.~ ~..~.~..~..1'..~/ .................. County Tax Map No. I000 Section .../.~..~.'~, ..... Block ..... .~,. ....... Lot.,. ~ - )*~'..'.. Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. ~ .~?.~.~. ,.~-:. Date of Permit ~.~/.~.i .... pplicant . ~,/.~..~/(..~.~.. Health Dept. Approval / ,Labor Dept. Approval Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate...; ~r ............... Final Certificate ....................... Fee Submitted $ ...... ~ ,%,0 ...... Construction on above described building and permit meets all appli~/le c~/~e.~/~~s. Rev. 10-10-78 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No. (please print) Plumber ~ /;'////~j~ -(please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn Notary Public, to before me this day of County (plumber's sign~e) WILLIAM L. ,SCHUMANN ~l'grm ~xpiros March 80, 19 ~ ? F1EL~ II~'ECTiON DATE COMMENTS FOUNDATION (1st) FOUNDATION ( 2nd ) PLUMBING 3. STATE ENERGY C~DE ADDITIONAL ,( 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION ZND [ ] INsULATiON [ ] FRAMING ['~ FINAL REMARKS~~ DATE ~?~ INSPECTO..~ BUILDING DEPT. INSPECTION FOUNDATION ZST ~ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION · ,JO ~ ~o o'$ ,~ 3 PRO?£'RTY 70 ~' COWI/E~y'ED ?0 WIL CZ:X/SKI By' TIlE ~7~ "DETAIL RO4D 6~4~.1Z!~0''E OF PROPERTY Surveyed b~ SMITH ~ dUN8 'FORM NO. 1 ToWN OF sOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL.: 765-1802 9isapproved a]c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completelY filled in by typewriter or in ink and submitted to the Building Inspector, with 3 scale. Fee according to schedule. . streets , s accurate plot plan to .... = ~,.,,A;.,,~ n nremises relationship sets of P~on~ 'plan showing location oI to~ anu ut uu,,~,~v o = · to adjoining premises or public ; or *br~as, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ' re issuance of Building. Permit. . cation ..... :~ ~nllcation may not be commence, d..befo~ ~..aA;,. Pormit to the applicant. Such permit c. The work covereo oy tm~ ~c~i~n, the Building Inspector wm ~ssuea a ~ ..... is a d Upon approval of th P.P. - ~-; .... ction throughout the work. ~ .....~ nntil a Certificate of Occupancy - "[~ ~-~t on the premises availabl~ fu .... v.~. '-~ or in ,,art for any purpose wnat~ e. No building shall be occupied 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 constntction of buildings, additions or alterations, or for removal or demolition, as-herein described. applicable laws, ordinances, bulldh~g code, housing code, and regulations, and to The applicant agrees to comply with' all admit anthorized inspectors on Premises and in building f°r necessary insp~ecti°x~)-27]'/~ ~ QA" /' ~m~e. ~ '" [g~i;~tuee of applicant, or nam , a'tid~) .... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............. ..... .......... ........... a'x' ;dl{ ;; i t; t' l;dd) ......................... Name of owner oI prem' · ........... (as on the If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... 's License No ............. Plumber ............ Other Trade's License No ...................... b. Intended use and occupancy ........ Location of land on which proposed work will be done .... Street Hamlet House Number Lot · · · ~ ....... ,-'' } o~,.~. , Block .. ' pN ..... County Tax Ma o. 1000 Section .... Lot ........... ........... Filed Map No ............... Subdivision ................ (iq'a'~)' , 2. State existing use and occupancy of premises and intended use and occupancy Of proposed construction: a. Existing use and occupancy ......... ~' . ................. 3. Nature of work (check which at~plicable): New Building .... ".~,~.... 'Addition .......... Alteration .......... Removal .............. Demolition~ .. ~. .......... Other Work ............... Repair .. ~..~ ...... l 4. Estimated Cost . .7. ~. ...... ' .................... ..... Fee : ............................ i ~ (to be paid on filing this application) ? 5. If dwelilng, number of dwelling units ............... Number of dwelling units on each floor .............. l'f garage number of cars i ..~. 6. If business, commercial or mixe'd 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 const[uction: Front... ~.~. ........ Rear .... ........... Depth if?. ......... i' : Height ............... Number of Stones ..... /.'~..: ........................................... 9 Size of lot: Front . Rear Depth 10 Date of Purchase . , Name of Former Owner 11. Zone or use district in which pr~mises are situated ..................................................... 12. Does proposed construction vie!ate any zoning law, ordinance or regulation: ................................ 13. Will 10t be regraded ........ ! ................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .. ~ ................. Address ................... Phone No ................ Name of Architect ......... ; ..... Address Phone No. Name of Contractor ........ ! ................. Address ................... Phone No ................ ~ ! PLOT DIAGRAM Locate clearly and distinctly al1 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 YORK, COUNTY OF ......... ,,..... S.S (Name of individual sigfiing contract) above named. .... being duly sworn, deposes and says that he is the applicant He is the.. ................... , ................................................................... ,,~ (Contractor , agent , corporate officer , ere . ) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this applleat~on, 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 ' ........... ./.. ~ ...... day or ..... ~ ...... , 19~.~. ~ ' Nora, Public .......... .'rY--Tr 'm , 1) : NOIARY PUULIC, Stale of ~W Yoi~* ' '" 'f .......................................... RE?, OatJ/ : /000- Ig~~Od-O06.1 ~ ~/o007 ~EG,,$ilP JOB,YOOZ,fl -"o~ ~ ~ / ~' : ~<<m~ ~J ~ ~ J' ~ B "~T~IL la [ : ~ ~j,, ,, ,,, is71-09-t~" ~ C~ ,.. iii ouKVEY OF PROPERT 8/tuqi'~d at Surveyed by 'j~ j L A U R E L SMITH ~ __~~~ ----~ taO MeOFOnO AV~. Il I , ' Phone 47.-~192 . ~rvc9 CCH/f/ed to' " ' ' J~ I CHIC~O TITLE IN~OR~NOE CO. ' ~o~ru FOR~ ~ ~ r~u~r CO. t?EF, O/V/F: ]vt lA I [4 S/iD.dOB f{O~o SUFFOLK COUNTY HEAl,TH DEPARTMENT SINGLE lNG ONLY H,D. REF, U THE . AND WATER SUPr'L¥ FACILITIE$ FO~ THIS ~e{ ~anage~en se~on ~ SurveYe# by ~5 UR VEY OF' PROPERTY $ituqtcd of TO OF ,$ o ~/ I'N O L D ~ SUFFOLK COUNTY NEW YORK SCA LE: I" ~ 5o ,.,Survcg C¢~t iflccl.To: ~I/ FC~iELL I/VILCE/dSKI cg/c4 60' FIFLE I~/~q: ¢0. /VOR /-H FO/?/C Z~/ix/td,5 ~/F~/~¢£ CO. ~0 /, ,3 4 5 ? /-)ceF-~ ~o~.$71°-,0q: /E, /5,$7', OF ,4LE,,~ IA/ILCF_N,,SKI SURVEYED