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Home My WebLink About13139-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Zq 2692 198~' No .................. Date August 40 THIS CERTIFIES that the building addition Location of Property 260 l%ck l~lace Southold House No. Street Ham/et County Tax Map No. 1000 Section "....7.0. ...... Block ..... .~. ........ Lot Subdivision ........ x. ...................... Filed Map No .... .x....Lot No. conforms substantially to the Application for Building Permit heretofore flied in this office dated ...... .FI.ax.~. ~ ......... 19~./4.. pursuant to which Building Permit No. '1 3'139Z dated ....... .Fl.~2r...'J. ~ ..............19~.~., was issued, and conforms to ail of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ..... p~.C.:i,q. ~.d.d.i.~.i.o.n. to existin~ dwelling. The certificate is issued to ....... tfg. RD3 ....... ...................... of the aforesaid building. Suffolk County Department of Health Approval ............................ ..... .N/.A ........ UNDERWRITERS CERTIFICATE NO ................................................. R~v. 1/81 Building Inspector FOU'M' NO. 0 TO~N 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? 13139 Z Date ................... Permission is hereby granted to:..----~ . ........ .J~:~...~zc/...~5~....~ ................ ........ ~.~...... ..~.~.,~..~z,...~ ......... _~.w...z~..~=.~...~..~:../..~. ,o ............ .Q.d~./..z~,.~.~. ....... , ..z~..~...~./~,~....,z~ .~..~.~.~....,Z~...../ ............. ..~l~......~zl~,~..~~~' - ....... ~.,~,/~..~~..~..... .... at premises ,oc~ed at ...~...../....i.~.~'.--~.....~~./.... ...................................... .............................................................................................................. ./,...a~.~.~-~..~....-..~., ~, County Tax Map No. 1000 Section ..~).7..J~. ......... Block ....(~....~... ........... Lot No.....1~..../../.. ........... pursuant ,o application dated .... ~...~..~.....:~.~.'~..: ................. . ]~....~, and approved by the Building Inspector. ~e. ,.~.~.... Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ,~uthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted-~-~upllc;t= 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 insta[lation 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-existing" land uses: 1. Accurate survey of peoperty 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. Co Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling / 3. Copy of certificate of occupancy $1.00 landuse--Pre-Existing C.O, $15.00 Vacant land C.O. $ 5.00 New Building .... · .~..' .... Old or Pre-existing Building ............ Vacant Land ............. 260 Peck Place Southold Location of Property ................................................................... House No. Street Hamlet Karlo Le]~ich Owner or Owners of Property ............................................................ . County Tax Map No. 1000 Section ?0 Block .~ Lot... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No..~.~? ..... Date of Permit ~5/.~.8/.8~...Applicant . .R.o.~..N.o.~.~.s.s.o ...................... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $..a~-'..~... ~ .~..(~J.~. ........ Construction on above described builaing and p~mit meets all applicable codes and regulatio s. Applicant.. ,~,~ .... ~ ........................ Rev. 10-I0-78 FIELD IN~ECT~ON DATE COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & FLUMBING 3. INSULgTION PER N. Y. STATE ENERGY ADDITIONAL COMMENTS: APP,~OVED AS 'NOTED~ ~ NOTIFY BUILDING DEPARTMENT AT' 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: .!, FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH -- FRAMING & pLUMBING ;3. INSUI-A~ !~N 4. FIN/~'L - COk!c~-P'tJC-i ION MUST BE COMP! ~'~T[! FOR C, O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN, OR CoNSTRUCTtON ERRORS. ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL,: 765-180:3 F.., Disapproved ale ........... ~ ........ .,.. · ~ (Building Inspector) APPLICATION FOR BUILDING PER~iT INSTRUCTIONS a. Tkis 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 i~ctions. ,~ ''/~'//~ .............. ~' ~' t'~r"t'"'~'~/'~"/~7{'" ....... ~" (~l~a' i<~r~ .... (Signature of applicant, ~O~a .me, if a qo p t' ) /~M_ailing address of applicant) State whether applicant is owner, ~rchitect, engineer, general contractor, electrician, plumb~r or builder. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer)2 Builder's License No ...... .~. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ........................... .~ ..................... House Number Street Hamlet County Tax Map No. 1000 Section .... 7.0. ......... Block ~ Lot. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended tlse and occupancy of proposed construction: a. Existing use anarchy../.i .Z.~.~:. · i~. .................................... b. Intended use and occupa~y~. · . ~.p~ .... /~..~.~. ~..'~..t~.. ? ................... 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... Alteration .......... Repair .............. Rembval .............. Demolition .............. Other Work ............... "- (Desc t n) 4. Estimated Cost ......................... Fee ....................... *" (to be paid on filing this application) 5. If dwelling, number of dwellingiunits .............. 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 structur0s,, if any: Front ............... Rear .............. Depth ............... Iteight ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ..... ; ............. !.. Height ...................... Number of Stories .................... 8. Dimensions of entire new construction: Front .... ~ ....... Rear .. ~..~ ......... Depth . ~Q,~. ........ tteight ............... Numbar of Stories ........................................................ 9. Size of lot: Front .......... ~ ........... Rear ...................... Depth ...................... 10. Date of Purchase .......... i .................. Name of Former Owner ............................. 11. Zone or use district in which premises are situatgd ..................................................... 12. I)oes proposed construction vioiate any zoning law, ordinance or regulation: ................................ 13. Will at be regraded ..................... ~..,..t .... Will excess fill be removed from premises: Yes . No 14. Name of Owner of premises . ~.'.,~.~..~ ..t~..~.t~'./~dress ................... Phone No..2.~...~. '.'T '/~'~:~' '7 Name of Architect ......... 2 ................. Address ................... Phone No ................ Name of Contractor ........ i ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly alii 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, S.S COUNTY OF ................. ......... ~ ................... ~.' ................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ................ . ......~ ................................................................... i (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul~ 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 mannei set forth in the application filed therewith· Swam to before me this ............. .... day afl .... ........... 19 Notary Public ...... NOT^a¥~'~tE~ a ~[ ' '~'''v0[ PIJBLI§, State al New Yor~ ............................... No. 4707878. Sul[01k Ce~m~,.._ (Signature of applicant) 0