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Home My WebLink About13086-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z12880 ,,October 33 , 3984 ................. ~are ................................. 19... THIS CERTIFIES that the building ...[J..~ ~.~.~. ~. 7..s.h.e..d ............................... Lo cation of Prop erty h~tJ~ h/o' ~ .75.. ~ .P .5_ M.a. ~..e. ?.d.:..~ J .q. 9 .~f.. S. 9 :..H.a..~ .b.o.p...R .d.... S. ? .u.~.~ o. ?_ .d · Street Hamlet County Tax Map No. 1000 Section ... 9.8.~. ..... Block .... .0.0.~ ........ Lot0.q~ :,J..&... 9.0.3...2... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Pemfit heretofore filed in this office dated .... ~ p r ~-J,. ] 6 ......... 196 q. pursuant to which Building Permit No. ] .3.0.8.6. .Z .............. dated .. ~.a.y...3 .................... 195.4. . , 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 ......... .... [J I: j-.:l,~.~y. ~.2~ ~..a.~. ~..a.c.h.q O...~.o..d..~.e.l.l.~..nE ..................................... The certificate is issued to Kevin & Karen Boergesson (°wner, )~ez~/~ qlD{~t]~ X X X of the aforesaid building. Suffolk County Department of Health Approval ............... .ixl./.& ....................... N/A UNDERWRITERS CERTIFICATE NO .................... .............................. Rev. 1/81 Building Inspector IPORB~ NO. S "roxvN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, H. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 13086 Z Permission is hereby granted to: ....... ........ ...... .,_~ ~.~~.~.~. ...... ~z..~ Y ( ,o ..... ~. ~...:~. .~ ~.~...:...~.. Z~.~..~..~.~......,~:~.~_,/~........,~..~.. ~../..~./..c~,~.../~. ................. ........ ~"~:..~Z..~.,~.~~'~'~ ....... ~-/.~'~.~~' ' ' ................................................................................ at premises located ........ ~-~.......,Z~.....-..~..~.(~...~......~..C2.0. Z~.Q~-.:7.-./~.,,~,'~' County Tax Map No. 1000 Section .......(~......?...Z... B'ock .....(~../. ......... Lot No.C~...~....~......~...C-~....0'~'''~/ Building Inspector. ond approved by the .... .-T'.. ~- 'Bullalhg Inspector Rev. 6130/80 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=i~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. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and 'pre-ex'sting" land uses: 1. Accurate survey of peoperty showing all property 'lines, streets, buildings and unusual natural or topographic features. 2.Sworn statement of owner or previous owne~ as to use, occupancy and condition of bu ildings. 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: I. Certificate of occupancy $5.00 ~ 2. Certificate of occupancy on pre-existing dwelling / land use 3. Copy of certificate of occupancy $1.00 , --Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 ~ Date ...................... New Building ............. Old or Pre-existing Building ......... Vacant Land Location of PropertY.' .','~.7,~ ................ House No. Street Ham/et Owner or Owners of Property ........................................ County Tax Map No. 1000 Section ............... Block .... Lot Subdivision ................................. Filed Map No. . ......... Lot No .............. Permit No./.'.~,.~4~4-. Date of Permit ~--3-~j .Applicant z~<~?./~.. ~,~, ,~.~?,,S~j~,~, Health Dept. Approval ........................ Labor Dept, Approval ........................ Underwriters Appr~'val ........................ Planning Board Apprav~.,, ................... Request for Temporary Certificate Final Certificate~ Fee Submitted $ .... ~./. L~,, Construction on above described building and permit meets all applicable codes and regulations. Applicant . .)~<~.~(,.~/J..~qC~c~.~3~)v<L~ ............................. FIELD ~NS¥~CTION COMMENT~o FOUNDATION (1st) FOUNDATION 2. (2nd) BOUGH FRAME & FLUMBING INSULATION PER N, STATE ENERGY FINAL ADDITIONAL COMMENTS: FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL File No ................................ ...... ~z,~...~.~./....~... ~. ,~. ..... for pe~it to construct... ~ ~O.L~...~ .... ~~%..' ............ at Location of Property co.~tv ~a~ ~a~ ~o. ~000 S~tio. . .~ ..... ~o~ .. Sabdivision ................. Filed Map No ................. Lot No .................. ~~.::". :... ~.~...~.o.z... ~~z~a~ ..... , .............. .... RV 1180 · ~FoRM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N,Y. 11971 TEL.: 765-1803 · Examined...~.~..~. ~ .... 19 ~..~ Approved....~..~...~...~7 .... 19~...C~Pennit No./X~..~..'.~. Disapproved a/c ........ : .'~-.. · ................~ ......... (Building Inspector) APPL. ICA[ION 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 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 tliroughout 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) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..K~-.~.I'M '* .~I'~. (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 License No ......................... Electrician's License No ....................... Other ~rade's License No ...................... 1. Location of land on which proposed work will be done.~...~..~...~..~):..~D..~?. ~.~ ............................ .................... .... ................ House Number Street Hamlet County Tax Map No. 1000 Section .... .~..~..~. ........ Block ...(27.C~. i ........... Lot. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended use and occupancy ................... 3. Nature of work (check which applicable): New Buildin ..... ~Addition .... .~x,~.. Alteration .......... Repair .............. Removal .............. Demolition .... .,;6r ........ Other Work ............... ~t ' ~ __ -- (Description) imat' os ~d)O~l '700 4. Est cdc t ............ .......................... Fee.~...C>~ .,~..t.~.. ...................... I ~/ (to be paid on filing this appli.~cation) 5. If dwelhng, number of dwelhng units ............... Number o~ 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 structures, if any: Front ............... Rear .............. Depth... ' ...... Height ............... Nu ~mber of Stories'. ....................................................... Dimensions of same structure With alterations or additions: Front ................. Rear .................. Depth ................... i' ' ' Height .......... , ............ Number of Stories .................. :... ~8. Dimensions af entire new cons~ructinn Front. .?.O. ...... Rear . ,~: . . Depth Height ...~. ........... B!umber of Stories ...... ] ................................................. 9. Size of lot: Front ....... '.~'7 ............ Rear ..... .c'[.~'/ .............. Denth ~.?~)O_ ................ 10.. Date of Purchase .~[lf'l .~... i[.q~.. .............. Name of Former Owner . ['~.~.-~.....[~..~--..~.~.~Y:~ ~ .... 11. Zone or use d~strlct ~n which premises are situated.. ~. .............................................. '12. Does proposed construction vi61ate any zoning law, ordinance or regulation: . .~..O. ........................... 13. Will lot be regraded' .... ~., ........ ,~ .......... Will excess fill be removed from premises: &~,,Y~/ No 14. Name of Owner of premises .K~.'.~..'~...[(~L°°.....~.~.~.~.. Address ...~9 .~'9~J~9.. ~. ......... Phone No..?.,c-...-r2..~O .... ~ Address Phone No ;::~ [~ ~'.~ Name of Architect ......... ~ .............................................. Name of Contractor ' i;'. Address Phone No PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and bloc~ number or description according to deed, and show street names and indicate whether interior or corner lot. c y¥ >...: / .'(Nameaof individual signing contract) above named. being duly sworn, deposes and says that he is the applicant 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; 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 mannOr set forth in the application filed therewith. Sworu to before me this , ........ ~ .... da~fbf ............ 19 Notary Public ........... County ~,~,1,~ ~,,, ~,~ ~0. ~, ~°t~ (Signature of applicant)