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Home My WebLink About16650-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...Z. 1.6..5.7.6 ......... Date January 12, 1988 THIS CERTIFIES that the building Accessory Location of Property 16597 R.0.W. Main Road East Marion h3J~ ~iol ....................... 'S't/e31 ....................... h3r3ie~ CountyTax Map No. 1000 Section 023 . .Block 0 1 .Lot 14. 12 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated N o v. 24, I 987 pursuant to which Building Permit No. 16650 Z dated ...N py.....2 .5 .... ! .9 .8.7 ........... 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 ......... ..... A¢.c.e.s.s. pTy' .g .a.z.e.b.q..a.s..a. pp.l.~ed for. The certificate is issued to JEANNE C. THAYER ..................... / oYn'~, '?vi~ gvi~k4a~ ~ ...................... of the aforesaid building. Suffolk County Department of Health Approval ........ N../.A ............................... UNDERWRITERS CERTIFICATE NO ................ N. [.A ............................... PLUMBERS CERTIFICATION DATED: N/A ........ ' Building Inspector Rev. 1/81 FOB~ NO. B TO~N OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Yo BUILDING PERMIT fi.HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No_l 6650 z Permission is hereby granted tq: t'~ /~ ..~?...~.....~..~ ................................................ ....... . at premises located at ...L..~....~...~..~ ........ ..)~.........~...:...~.....,....~.~......~.. · ....... ....~...:...o...~.....~. County tax Mop No. 1000 Section ....... .~...~....~ .... Block ........ ..O....I ....... Lot No ..... I..t~.:../....~.. ..... pursuont to applicotion doted ...~.~....~.....~..~. ............. , 19..~...'~.., ond opproved by the Building Inspector. Building Inspector Rev. 6/30/80 FO. UNDAT~ON ( ls t) FOUNDATION (2nd) ROUGH FRAME & .PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: BLDG. DEFT. TOWN OF SOUTHOL~,, FORM NO. 6 TOWN OF 8OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted J ~ to the Building Inspec- tor witb 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, Mu[tiple 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, oc6upancy 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: Additions $25.00 POOLS $25.00 1. Certificate of occupancy New Dwell lng $2.~00, Accessory ~$ lO.O0 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copv of certificate of occupancv $ 5.00, over 5 years $]0.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date ~gA:.?? )~ New C on s t r u c t i on Old or Pre-existing Building Vacant Land Location of Property . .I ..................................................... House No. Street Ham/et Owner or Owners of Property ................................................ County Tax Map No. 1000 Section . .C). ?..~. ....... Block .... [. .......... Lot. l,~,'J~. .......... Subdivision .................................. Filed Map No ........... Lot No .............. Permit No..~,~,~ Q.7-.. Date of Permit l! g~5~ ~,~..Applicant .~. ~ ~.b.~. Health Dept Approval ' Labor Dept Approval Underwriters Approval Planning Board Approval Request for Temporary Certificate ..................... Final Certificate ..... ~ ................. Fee Submitted $ .).(~); ......................... Construction on above d scribed building an ets phcable codes and regulations, App,cant. ( /· ................... . ........... NOBL~ HO/~E CARE, INC, Rev. 10'10-78 ~ 3 8 F~/ ~ P,O. Box 758/35 Ma~on Sr. I--////~/F Greenport, NY ! ]944-0758 ~el, (516) 477-2200 ..~ 0 t.d ~' 0 '7' ,// Xq~. v' .... ' 'FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL.: 765-1802 Approved ZO m~..{~J~...*.~.'~., 19~.~.. Permit No.]. ¢.~..~.~...~.. BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... CHECK .......... SEPTIC FORM ............. NOTIFY MAIL TO: Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tins 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 constrt)ction of buildings, additions or alterations~or for rembval or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances,fiu)ilding ?/c~e, housing code, and regulations, and to admit authorized inspectors on premises and ha building for necess~ary4-t~qectioyf4// State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~J ...................................................................... (as on the tax roi1 or latest deed) If applic~o//n~nature of duly authorized officer. { (j~ame and/t~le of corporate officer) - ALL (~TRACTOR'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. .................................................. .../. ~ ~ .~..~ ........... .~./. ¢/..~...~.:... ~.....z-......~.. ~ ./?. ~ ..... //..f& 7. .......... House Number Street Hamlet County Tax Map No. 1000Section ....~...~. Block .../ .............. Lot../.~/P./..~. .......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .. <.~..,. ~.~: .~. · ........... ; .............. b. Intended use and occupancy..~.~ · .~. ~..~..?...~ · .~~'~ 9. 10. 11. 12. 13. 14. 3. Nature of work (check which applicable): New Building ..... ' ..... Addition . ......... Alterat~,, ~n~,~ ~.f,~. ..... Repair .............. Removal .............. Demolition ......... ; .... Other Work. ~..t~.. (Descriplio~t) o,'' 4. Estimated Cost ........................... Fee ...................................... ~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling ui~its on each floor ................ If garage, number of cars .......................................... : .............................. 6. If business, commercial or mixed occupancy, specify nature and extent of each [ype of use ..................... 7. Dimensions of existing structures, if any: Front .... .~. ... Rear .............. Depth Height ............... Number of Stories .... ,,.. Din~ensions of same structure with alterations or Depth ...................... Height .... Dimensions of entire new construction: Front Height ............... Number of Stori~'~.../~.,~ Size of lot: Front ................... .~,~/. Date of Purchase ........................ Zone or use district in which premises are situate~.(-t~,' Does proposed construction violate any zoning law, or'~ ........... ! ....... Rear .................. ~/~[qumber of Stories ...................... ' *l' ! ....................... ?l l frl ............................. ================================= Will lot be regraded ............................ ;. ~l~SVed from premises: Yes No Name of Owner of premises .................... Addrt ~...../~.~ .... Phone No ................ Name of Architect ........................... Address ........ ~-:?J~.... Phone No Name of Contractor .......................... Address .... : .............. ~' Phone No ................ 15. Is this property located within 300 feet of a tidal wetland? *~es ..... No ..... *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all 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 sliow street names and indicate whether interior or corner lot. /ol.-' ~. ,dlS. ------- ¥. v, '~ NOTIFY E~LIILDINC~ DEFARTM[-~T ~T 765.1802 9 A~ 'To ~ c~ ~R THE FOONDA'r~(J~v YWO ALL .CO~NT~() F~Ot~ ~A~,L ~ET 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 ........................................................... ~ ............................. (Contractor, agent, corporate officer, etC.) of said owner or owners, m~d is duly authorized to perform or have performed thel 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 manner set forth in the application filed therewith. Sworn to before me tliis ............ .~.~. ........ day of ...... ~ ........... 19 .~.~. m otaryPublic, ~ ~.,. bC/pe,.., /~~ ..~..... ............................. County HELEN & DE VOE .... NOT~Y PUBLIC, State ~f Ne~ ¥~ ....................... . N0._470787% Suffolk COUlflyo~ (Signature of applicant) ~erm tapir. M~rch