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Home My WebLink About16199-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certi[icate O[ Occupancy NoZI6000 Date July 28, 1987 THIS CERTIFIES that the building ..... .A.d.d.i.t..i .o.n. ................................. Location of Property 2650 Stars Road East Marion House NO. Street Ham/et County Tax Map No. 1000 Section .0. 2. .2 ........ Block 04 .Lot 25 . Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated June 30, 1987 ~ pursuant to which Building Permit No. 1619.9Z dated ..J.u.l.Y................I0, 1987 .... ... 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 ......... ~D.e.9.k~a.d..d.i~t.i.~..n~t.q..e.x~i~s.t..i.n~g.~..n~e~f.a..m.i~y.~.d.w.e.~.~..i~' as applied for. The certificate is issued to DOROTHY BROACH (owne'r,~rFt~XXXX . of the aforesaid building. Suffolk County Department of Health Approval ........ N./.A ............................... UNDERWRITERS CERTIFICATE NO ........ Iq /A PLUMBERS CERTIFICATION DATED: N/A .... ............. Rev. 1/81 IPOR~ NO. ~ TOWN OF SOUT~OLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 19..~.,.2 Dote Permission is hereby ~mr~o:.., . <~ ~ ................ .~.~.,~ ........... .~. .......... ~......~ ........ ~o.~~~.....~...~, ~.....~..~.~,.~ .... ~....~ ................. ~....~..~.~~...~...~..~ ............................... : .......................... ~, ~r.m,~, ,~,ed a,.~.~.~..L.~.~..~ ........ ~.~...~.~ ........................ County Tax Map No. 1000 Section .... ..~...~m...~'.. ...... Block ........ ~..,.~. ..... Lot No....."~..~. .............. pursuant to application dated .... ...~,~....~ .................... , 19.'~.....~., and approved by the Building inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted m~ 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-existing" land uses: 1. Accurate survev of p~opertv showing all property lines, streets, buildings and unusuat 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. C. Fees: ~ddit ions $25.~03 1. Certificate of occupancy New Dwelling 825.00, Accessory,.$10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 5.Updatecl C.O. $ 50.00 Date ........... NewConstruction ...... O~d or Pre-existing Building ............ Vacant Land ............. Location of Property ...~..~..~ .~. ........ . .~..'~../~..~ ......~.~....! ..... House No. Street Hamlet Owner or Owners of Property . ~.~.~,:, ."'~.O ~..'~..~....~.~.,'~...~-~. ...................... County Tax Map No. 1000 Section ....~.~-r. ~ ...... BPock ...... ~.. ...... Lot ........ ~ ~..... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./.4/.?.~. ?.. Date of Permit .~?'z//..~/4~.,~pplicant...~...~./¢~r.~.~. ............. ~.~,~-~, Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $....~. ~.~'.,. ~.~. Construction on above described building aj:LCLpermit meets all a~plicab.,le codes and regulations. Applicant Rev, 10-10-78 C,d. Zl4ao,o UNDATION (1st) UNDATION UGH FRAME & FLUMBING SULATION PER N. Y. STATE ENERGY CODE FINAL D · ADDITIONAL COMMENTS: J 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL COUTHOLD, N.Y. 11971 TEL.: 765-180;3 Examined...~..~..,.0..., 19~..7. Approved .1.0.., 19~.~. Permit No..[..~./.?..~. · . Disapproved a/c ................................... ~ ................................ .... APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... CHECK .......... SEPTIC FORM ............. NOTIFY CALL - INSTRUCTIONS a. Tiffs 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 throughtmt 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 necessarg inspections. ~., x. ............ (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. .13..o. ~b.~-r~. ' · ....................... Name of owner of premises ./~...~:~.:...~??-..~..w-&r..~t~ ....~...P~O. et~_~4~. ........................................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorize{officer. /// (Name and title of corporate offi~r) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED 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 .................................................. ~ 6 6-osw,~eq £~, .. ~-.,.. House Number Street Hamlet County Tax Map No. 1000 Section ..... 0.~ ...... Block ...... .~ ......... Lot ..... ~ .~ ~... Subdivision ..................................... Filed Map No ............... Lot . . ~ 0 .......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed constructi~: a. Existing use and occupancy ..... ~ ~ .~.~~~~. ~Z~.~) ............. b. Intended use and occupancy ........................................ . ............ ~ ........ 3. Nature of work (check which applibable): New Building ..... ' ..... Addition .......... Alteratic~ . ;. ....... Repair .............. Remorai .............. Demolition .............. Other Work..~.n'.~,~_~ .... ' ~rD ripJi ) 4. Estimated Cost ........................... Fee ...................................... ~ (to be paid on filing this application) 5. If dwelling, number of dwelling units... ~...AJ~... .... Number of dwelling units on each floor ................ If garage, number of cars ....... 1 ...................................... ; .......................... 6. If business, commercial or mixed o~cupancy, specify nature and extent of each type of use ~ ' 7. Dimensions of existing structures, i:f any: Front ..... ~, .~..t .... .. Rear .... &.6. t.. ~... 'l~;~ih" i.ii i :~.' ¢i ii i ii Height ..... 1o°~.t. ......Numbe~ of Stories ..... ~/~'. ~r' ............................................. Dimensionsof sal3¢ structure withlalterations or additions: Front ..... (~...r ........ Rear ..... ~.~ ./. ........ Depth ....... ~ ?.. ........ iHeight ....... /'o~../ ........... Number of Stories ..... ~.../~.~.. ......... ~ 8. Dimensions of entire new construction: Front ..... .~.Z ./' .....Rear ..... ~.~/. ..... Depth .../.-~./. ....... Hlght ............... Number of Stories ............................................... ...... /~.t~.../..I''' ~ ......... Rear'i ..... //..~../ . . Depth .... ~.~.~../ ........... 9. Size of lot: Front 10. Date of Purchase .. ~./..67../.d~. ~.... ............... Name of ............................. 1 1. Zone or use district in which premises are situated .... 12. Does proposed constructmn wolatq any zoning law, ordinance or regulation: .... ~ ........................ 13. Will lot be regraded ....' ......................... Will excess fill be removed from premises: Yes c-"'No 14. Name of Owner of premisest~ ~$,~)t~0.'tTq'. ~.~..,~e. AttAddress . .'~,.'r-~l~S..P-~,~ 6'~..Z~,one No...~.'~..'7...-7~...~.O. 7 ~ Name of Architect ......... : ·-- ~'. 1 ............... Address ...................t '~Phone No ............... . Name of Contractor I~Q~.tN~.{~.~.~5~,','~//~... Address 0~..5: ~t~0&~..-~.7~,~fPhone No..~..~.7.~/.~ 15. Is this property located wi~thin 300 feet of a tidal wetland? *Y~s ...'.. No ..... · If yes, Southold Town Trustees Permit may be required. i PLOT DIAGRAM Locate clearly and distinctly ali b~ildings, whether existing or proposed, and. indicate all set-back dimensions from i 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.~ EOUNTY OF ................. ............................... i .................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) lbove named. -Ie is the ........................ ! ................................................................. : (Contractor, agent, corporate officer, etc.) .)f smd owner or owners, and ~s duly 9uthonzed to perform or have performed the said work and to make and file this ~pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the ~,ork will be performed m the manner sgt forth in the application filed therewith. ~worn to before me this · ~ ........ day of. 'i .......... , 19 qotary Public, .... ~ ......... .~,.~-..~...~.....Countyi~ It~10t g l~ ~ , (Signature of applicant) NOTARY PUBLIC, State . No. 4707878,