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Home My WebLink About15643-zFORM NO 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No .Z15fiS. 9 .... Date April 20, 1987 THIS CERTIFIES that the budding . A. dd. z.t.l.q .n ........................... I 84 15 Bay Avenue Locatmn of Property ................................... P e c on ~ c ' House No Street ..................... /q~/e} CountyTaxMapNoil000Sechon . !.04 ..... Block ..0.3 ...... Lot. !2 ........... °1179 Subdivision Nassau Farms FiledMapN LotNo. conforms substantmlly to the Apphcat~on for Building Permit heretofore fried in tins office dated · . . 4 an,. 1~ 3. ~. 1.9.87. pursuant to winch Building Permit No .15.643. Z. ........... · ., was msued, and conforms to al/of the requirements law The occupancy for winch this certificate is zssued is ....... e~st~g ?~e ,fa¢i.!Y A. HILLENBRAND ....... dated J .an.., .2.8 , 9.87 of the applicable prouimons of the ... DegJ~. a~cJ~tz.t,~pn..tq The certificate mlSsucd to of the aforesaid budding Suffolk County Department of Health Approval .... N. [A ......... UNDERWRITERS CERTIFICATE NO ....... N ./.A ................ PLUMBERS CERTIFICATION DATED: N/A Building Inspector 1/81 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) NM 15643 Z Permission is hereby granted to: ~..~.~~....~...v.....~..~.: .... .... .... ~.,,,~........~...~.,.......L!...~.~ ......... . ,o ...~.~.....~....~t,.~.....~....~.. ~.....~,~....~ ...... ot premises Iocot' e~ ot ....~...t~?...~..~'...~..~.....~.~..-..--..~.~...~r~.. ........................... County Tax Map No. I000 Section ..... J...O...~.. ..... Block ....... ..C)....~ ..... Lot No .....!...'~.. ..... pursuant to application doted ..~. ~...]L..'~ ............. , 19.~..'].., and approved by the Budding Inspector. Fee $..~...:..../.... ..... 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 - BIJ3G. DEPT. TOWN OF SOUTHOL~O ..... 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, Muhiple Resldences and similar buildings and mstalla* tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5, Submit Planning B~ard 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 ofI property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement ofI owner or previous owner as to use, occupancy and cond.tlon of buddings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion reqmred to prepare a certificate. C. Fees: 1. Certihcate of occupancy New Dwelling,S25.00, Accessory ,$10.00 Business $50.00 2. Certificate of occupancy on pre-e×istmg dwelling $ 5 0.0 0 3. Copy of certificate 0f occupancy $ 5.00, over 5 years $]0.00 4.Vacant Land C.O. $ 20.00 5.U~dated C.O. $ 50.00 Oate ......................... 6. Alteration $25.00 NewConstruction..,... OidorPre-extstingBuilding . ......... .. VacantLand .......... . .. kocat,on of Proper~ .~...~ay.~ ............ QU~.~bg~. ........................ .. Hou~ No. St~et H~let Owner or Owners of ProperW A. ~[[e Qb~d County Tax Map No. 1000 Sectmn 10~ ...... Block O~ ...... Lot. Subdivision Nas~Su .~a~m~ ......... Filed Map No. 3 ~9 ...Lot No. ~A-1A PermitNo..%~., Date of Perm'it 1/28/87~.~ ~.~nv~r~ent East ~ for ~. Hill~ ........ t' "'~" ....................................... ~ r a ~d Health Dept. Approva~ ..................... Labor Dept Approval ~k ............................ Unde~nters Approval. ?//~ ................... Planning Board Approval .~/~ ................ . . Request for Tempora~ Certificate Final Certificate X . . Fee Submitted $ 2~ O~ Construct,on on above descr,bed burn. odes and regulations. App~cant _~--/~~ $... Mr. 10 10 Y8 ~ 3r7~7 OUNDATIO.U (1st) OUNDATION (2nd) OUGH FRAME & PLUMBING ';SULATION ?ER N. Y. STATE ENERGY CODE ADDITIO~AL COMMENTS: 765-1802 BUILDING DEPT. NSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [/~FINAL INSPECTOR Examlned ~c9,,,u~.9-~. ~.."2,1 i .%.-] Approved x}~ .,1,~., 19"~-~ Disapproved a/c .. FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N Y, 11971 TEL 765-1802 Permit No / (Budding Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS din 1 3 1987 Received .......... ,19. · . Date ............. , 19 a. Tins application must be completely filled m by Wpewnter or m ink and submztted to the Building Inspector, with sets of plans, accurate plot plan to scale. Fee according to schedule b. Plot plan showing locatlofi of lot and of braidings on premises, relahonsinp to adjmnmg premises or pubhc stree or areas, and giving a detmled description of layout of property must be drawn on the dmgram winch ~s part of tins appl cation. c The work covered by tins ~pphcation may not be commenced before issuance of Building Permit. d. Upon approval of thzs apphcahon, the Building Inspector will issued a Building Permit to the applicant. Such perm shall be kept on the premises avadfible for inspection throughout the work. e. No building shall be occupied or used in whole or zn part for any purpose whatever until a Certificate of Occupanc shall have been granted by the Bmldmg Inspector APPLICATION IS HEREBY MADE to the Bmldmg Department for the ~ssuance of a Bmldmg Permit pursuant to tb Building Zone Ordinance of the ~own of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c Regulations, for the constructmn~of bmldmgs, additions or alterations, or for removal or demolihon, as hereto describe, The applicant agrees to comply ~ith all apphcable laws, ordinances, building code, housing code, and regulations, and t admit authorized inspectors on premises and m building for necessary~!)spectlons. (Signature of applicant, or name, ~f a corporation) (Mailing address of applicant) State whether apphcant is owner, lessee, agent, architect, eno~neer, general c~ontractor, electrician, plumber or builder Name of owner of pre,roses ..... .. (as on the tax roll or latest deed) If ~:~,~nature of d~y authorized officer '~ffme and ht[e o~co~orate officer) Plumber's License No Electrmmn's L~cense No . .Al./9. ..... Other Trade's License No ....... Location of land on which proposed work will be done House Number Street Hamlet County Tax Map No 1000Section .... !Q.~.... Block ,-~ ......... Lot. J..'~. ........ Subdivis~on '~",/~ .7.$..~/~ P-~/lq~" .... Fried Map No /17~r .... Lot ?~. ~t~ .~... · , (Name) State~ex~stmg use and occupancy of premises and intended use and occupancy of proposed construcnon a. Ex~stmg use and occupancy t~¢/.~¢.(? .C &' ........... b. Intended use and occupancy '~ ¢~). , 3r4,x,, ~. ~..~ ,~,$~?... ............... 3 Nature of work (check whlc) applicable) New Budding .. Addition Alteration Repair Removal .... Demolition Other Work qf~'"'rY/V "[ ~" (Description) 4 Estimated Cost .,._~y.~}C~ O... .......... Fee .... I (to be paid on filing this application) 5 If dwelling, number of dwellmg umts ...... / ...... Number of dwelling umts on each floor If garage, number of cars .................................................... 6 If business, commermal or mixed occupancy, specify nature and extent of each type of use ............ 7 Dmmnsionsofexlstmgstrnc!ures, lfany Front /.-f(7' . ... Rear . . z.f? :' .... Depth ~e~r ......... Height /L~ .... Number of Stones . . / ....................... Dimensions of same structur9 with alterations or additions Front . ~--~c,". .... Rear .~ .~..f4..£~( ...... Depth . . ~ ...... Height.. ~'4- . ....... 8. Dimensions of entire new cohstruction Front .,. . Rear .. .,q .... ./D,~pth .... 9 SlzeofIot Front . f/~t I ....... Rear. /.(~( /.... / .... Depth ......... 10 Date of Purchase .................. I N,a~ne of Form.er Owner ~ ~ ~../.ff'.~.o.~! .... 11 Zone or use district in whlchl premises are situated . .~,x./< ~ .... 12. Does proposed construction v~olate any zoning law ordinance or regulation. ,'~o. 13 Will lot be regraded . ,~/~ .......... Will excess fill be removed from premises Yes N 14 NameName of°f Owner of premlseSArchttect I F'/~././C'~F,,*~I' Address 7~. ~"°~P Z~ ~'~'' ' ~'~c Phone. ,N° 2. t l-~ .~(-..I.~'. .~ ~.Fo... ...... ~ ................... Address ................. Phone mo Name of Contractor .... ~ .............. Address ............. Phone No ........... PLOT DIAGRAM Locate clearly and dlstmctlyI all bufldmgs, whether existing or proposed, and md~cate all set-back dm~ans~ons fro~ property hnes Give street and block number or description accordmg to deed, and show street names and mdmate whethe interior or corner lot STATE OF NEW YORK, S S COUNTY OF ........... (Name of individual signing contract) above named being duly sworn, deposes and says that he is the apphcan tie ,s the .......... ~nt, 'c;ri~orate officer, otc ) of said owner or owners, and Is duly authorized to perform or have performed the said work and to make and file thi apphcation, that all statements contained in this apphcat~on are true to the best of his knowledge and belief, and that th work will be performed in the manner set forth m the application filed therewith Sworn to before me this Notary Public, ',l I WITHOUT CERTIFICATE I~dl;~eFr~ublng Ia used . system; piping shall be ~z~ of ~pes K or L only ~' ': / PLUMBER CERTIFICA T/ON [I L ,/ ON LEAD CONTENT~EFOR£ . ' ~ ' :r ' ~, ' Ju,',:F~ CERTIFICATE OF OCCUPANCY ......... 1~' : Il ' -- -- Main Road P.O. Box 1412 Southold NiY. 11971 SOLDER USED IN WATER '"'~' ' ~ -"': ~ v 516 - 765 - 5455 d.~, SUPPLY SYSTEM CANNOT ~' ~' ' ....... .~ ,a, s .... EXCEED 2/I 0 of I% LEAD. ~.~o~' ,'~ >' ~ GARRETT A. STRANG architect