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Home My WebLink About16256-z J~Oll~ NO. I~ TOWN OF $OUTHOI.D BUILDING DEPARTMENT TOV4N HALl. SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NE 16256 Z Permission is here~y granted to: _ ,~ -- · tO.... 11~2... ..~..~&.., .... .~ ............ ~ ....................... ,o .~...~...~.~.....~.... .~....'t.,.....~..~ .... at preS,es ,d, ed o, .~......--g~..d~.a...~...Aff. ..~...~........~..~ti~A County Tax Map No. 1000 Section ...... ..~..~...~. ....... Block ...... .C)..~. ....... Lot No....~...~. .............. pursuont to application dated ..... ~.l...~. ....................... , 19~.~...., and approved by the Building Inspector. Fee $...~...:...~... Rev. 6/30/80 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 TOWN bf ~b'dT~OLD 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY ~,4~/x~ ,,~~~ ~ 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 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. B. 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 e certificate. C. Fees: Additions $25.00 1. Certificate of occupancy New Dwelling. S25.00, Accessory'i$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 $]0.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date ..~I.Q .o.~:-,;~.b..~.~..~J..~ J.M.~.'J NewConstruction ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ~0 ~:~ .c~,-~, .~..~ C~.c?~ [~-~. ~ ,--~'. ,C~. V. House No. Street Ham/et Owner or Owners of Property . ..~. j.c;..~.o~..~../....fiT., CO. r-,,S.-~.q~ .¢. o,~...~. 'c-. ~ ~E~A ~ ~ .... County Tax Map No. ~000 Section ... ~ .(~. ~c; ...... Block .... O .~'~. ...... Lot...~..~ ......... Subdivision ................................. Filed Map No ........... Lot No ............. ~ Date of Permit ~./.~ g-. l .~/TApp licant Permit No. ~' .......................................... 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 per, nit rr~et,~ all applicable codes and regulations. Applicant ~f.~ ......................... Rev. lO-lO.7a THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ B$ JOHN STREET, NEW YORK, NEW YORK 10038 in the followlng location; ~ Basement ~ Ist Fl. ~ 2nd FI. Section Blmrk Lot ~s examined on ~0~' ~ ~ ~7 attd found to be in compliance u. it h the requirements qf this Board. RANGES :OOKING DECKS OVENS DISH WASHERS EXHAUST FANS DRYERS S E R NO, OF CC, COND J A, W G, PER ,~ j OF CC. COND I C E ~c~thold, 11971 lie.. This certlficate must not be altered ~n any manner; return to the office of the Board if incorrect. Inspectors may be credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED N ANY MANNER. TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Permit No. Owner_~ '~ c,_~,~ o / ~ (pl~se print) W(please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this ~! ,~ayof 06f-o~'~ , Notary Public, ~FOI~ County ~plumber's signature) ~ N~o't s~r~p u~i c UNDATIO~ ~lst) UNDATION (2nd) UGH FRAME & PLUMBING SULATiON PER N. Y, STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION 2ND FRAMING ROUGH PLBG. INSULATION FINAL iNSPECTOR~~~ l 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [.] Fou~u~K~ATION~ 2ND [ ] INSULATION [/~ FRAMING [ ] FINAL REMARKS: DATE ~/~//~ ? ,NSPECTO"~,~ ]65-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST ~~OUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [ ] FINAL DATE INSPECTOR//~/,~~ Subdivision ~ "Caplain Kidd Estates" Lot t 19~ I Lol. 19.5 s. s.7" ~ ~' E. I ~54. '75 60' W. 91 NOTE~ a ~ MONUMENT SURVEY FOR MICHAEL R. ~ CONSTANCE MATTITUCK TOWN OF SOUTHOLD' SUFF. CO., N.Y. SCALE: I ," = 40' OCT. 2 ,' 1963 OCT. 26, 19(~5 -,. MAY 19, 1964 KRE~HON ' GUARANTEED TO-' SOUTHOLD SAVINGS BANK INTER 'COUNTY TITLE GUARANTY MORTGAGE CO* BOARD OF HEALTH ...~... 3 SETS OF PLANS I~..'''- 'FORM NO. 1 SURVEY -~- TOWN OF SOUTHOLD CHECK · BUILDING DEPARTMENT SEPT~IC F,ORM ............. TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved ..'~f~,,~..-~...., 19~.% Pe=,t No. ~.~ ;~.~/ Disapproved a/c .................... ~ .............. ¢I . (Building Inspector) APPLICATION FOR BUILDING PERMIT NOTIFY CALL ................ MAIL TO: IN STRUCTION S 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 inspecJions. ~ ~. · ........ ...... (Signature o~ applicant, or name, if a corpo t'on) ...~ .6.,.~.. b), .fG.,x~.,. I ..,.~.~.q,.c. ~ N.% .~.t?Y.~.... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Agent Name of owner of premises .... .M?.qh..~.e.l: .1~. :..&..q .o.n?.g.~..n.e.e..K..~.e.s.h.o..n .................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) 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 .................................................. .. ?. 9.o.~.~.o.y..9~...~.h...~.,~a...~...r,.v~..h.o?. ~o.~.a. ........... ~..~??.~.~.u..,.k.,.. ~...~: ................ House Number Street Hamlet County Tax Map No. 1000 Section...]~.(40. ......... Block .... ~. ........... Lot...~..~. ............ Subdivision ..................................... 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..F..a~i.],y. ~.e~%d~e~l~e ......... ~ ..... ' ...................... b. Intended use and occupancy ..... 1..P.. amzLly. Rosi~er~oo ......................................... 3." Nature of work (check which applicable): New Building ..... · ..... Addition .X ........ Alteration .......... Repair .............. Rem, }val .............. Demolition ........ 2 ..... Other Work ............... (Description) 4. Estimated Cost .... ~I,~.O.0.Q, ......................... Fee ...................................... ~ (to be paid on filing this application) 5. If dwelling, numberofdweiling'units..: ............ Number of dweiling 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. D~menslon[ofex~stm~$~ s, ffany: Front....6.~,1 ....... Rear .............. Depth :.24,.8.t ........ H~ight__~___~_w~~,'; $~;... ':-i*~ her of Stones ..... ~, ............................. . .................... Dlmensiog~.:Cff ~a~ll-e.~sI~cth*~[~ th alterations or additions: Front . .6..6.., .1.' .......... Rear...' ............... D~epth..- ' '" ~"'" ~'~.~:'i..2~. ~.lll~. ~q[~ .. ,Height ..... .2~.~ ....i ......... Number of Stories...2 .......... s ........ .... 8. D',imension~s~of entire ~ew ~ uctmn: Front .... 5.6. *..~. .....Rear ............... Depth . .2.~..,.~ ......... l~eighi .'~.i. ~ ~73,~ bet of Stories....2 ............. ~ ................................ 9. S~ze of lot. Fron*,,..,..~,~%9_~.*..0 ........... Rear...., ~.,.Tg. ....... Depth ~25 ......... 10. Date of Purchase ..... ~9.-q6-~ ................... Name of Former Owner .... ~19 cl.J.o.~k~ ................ 11. Zone or use district in which pl ~mises are situated...R.O..a .~ .............................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ..~IO ............................ 13. Will lot be regraded ..... .N.c. [ ................... Will excess fill be re.moved from premises: Yes x No, ........... ....... o . '__ 14. Name of Owner of premises ..I~.&..~..K.~.e..~.h.o.n.... Address Ruth Rd, Luthe~sph neNo . . Name of Architect ......... i ................. Address ................... Phone No ................ Name of Contractor . ....... i ................. Address .... : .............. Phone No ................ 15. Is this property locatedlwith~n 300 feet of a tidal wetland? *Yes ..... No ~... *If yes, Southold Town TrUstees Permit maybe ra~uirad. i PLOT DIAGKAM Locate clearly and distinctly ali 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 .... f..o ..... S.S Saul Millman being duly sworn, deposes and says that he is the applicant (Name of ~ndtv~dual mgmng contract) above named. He is the ................ ./t~o..n.~ ................................................................... (Contractor, agent, corporate officer, etc.) of said owner or ~owhers, 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 am 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 16th day o'f Notary Public,... ~-,~... ~. ~.~.../-'f~-~'... NOT/IRY PUBLIC, State of New No. 4707878 SuflQIk CeU~k'7,~ Term Expires Match 30 1~ ~ .... J~ne ............ 19/t7. .... County (Signature of applicant)