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Home My WebLink About15890-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of' the Building Inspector Town Hall Southold, N,Y. Certificate Of Occupancy No Zi~91~ ...... Date.. Ju%¥ .~(.~9~7 . THIS CERTIFIES that the bmldmg al. te.rat.i.o.n. ............. Location of Property 4.400 ....... Va. ns..to.n. ~..d ............. C.u.~.c.h.o.~..ue .. . House No Street Hamlet County Tax Map No. 1000 Section ...1.1.1. ..... Block ....lp .......... Lot .... .2.0. .......... Subd~wsion .... Filed Map No ...... Lot No ......... conforms substantially to the Apphcahon for Building Permit heretofore filed in th~s office dated .Apr.%l..8, .1.987.. pursuant to wluch Building Permit No 158..9.0.Z ........ dated . Ap. ril 12, 19.~7. was ~ssued, and conforms to all of the reqmrements of the apphcable prowmons of the law The occupancy for wluch flus certificate mtssued ~s . .t.o. ~n.close The certificate ts issu~d to ........ Th.o. ma.s .Lon. qn..ec.k, er. ........... {owner, lessee or tenant) of the aforesa,d bmlding. Suffolk County Depa[tment of Health Approval ........................... UNDERWRITERS CI~RTIFICATE NO ...hi. BJ. 706J. ........................... PLUMBERS CERTIFICATION DATED: Rev 1/81 FO~ NO. ~ TOWN OP $OUTNOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. 8UILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 15890 Z Permission is hereby granted to' ....... .~...~.~.~......~.~.~.: ................. ............................. ..~. .......... ~...?. ........... ~ ;'"'2~;;;, ';;'Z;"~'~'~'~~ ...... ~..~....~..~ .............................. ~~ ........... County Tax Map No. '1000 Sectio, p~.....I.~.;/ ........ , pursuant to application dated ....... ~ Building Inspector. .................... , 19..~...?., and approved by the Building Inspector Rev. 6/30/80 APPLICATION FOR CERTIFICATE OF OCCUPANCY FORM NO 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 76.5- 1802 Instructions Th~s application must be filled in Wpewriter OR ~nk, and submitted m ~ to the Building Inspec- tor with the following; for new buddings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographm features. 2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical ~nstallat~on from Board of Fire Underwriters. 4. Commermat braidings, Industrial buddlngs, Multiple Residences and similar buildings and installa- tions, a cert,ficate of Code comphance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing braidings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses' 1. Accurate survey of p~)perty showing all property lines, streets, buddings and unusual natural or topographic features. 2.Sworn statement of owner or previous owner as to use, occupancy and condition of buddings 3. Date of any hoqsing code or safety inspection of buddings or premises, or other pertinent reforma- tion reqmred to prepare a certihcate. C. Fees: i 1. Cert~flcate of occupancy New Dwelling $25.(10, Accessory ,$[0.00 Business $50.00 2 Certificate of-ocCupancy on pre-existing dweJhng $ 5 0.0 0 3 Copy of certlflcate of occupancy $ 5.00, over 5 years $10.00 A.Vacant Land C.O. $ 20 O0 5.Updated C.?- / $ 50100 Date .~Qd~...~./.J.~../.. Newconstrucbion] wOIdorPre-exlstmgBuildtn Vacant Land .... Owner or Owners of Pr~r~'....-)...~.. · .'~.. ~ County Tax Map No. 1~)00 Section .... /.J..J ........ Block .../.O. .......... Lot..~..~ ........... Subdlv,slon ...... ' ................. Fded Map No ........... Lot No ............. Health Dept. Approval , ..... ~ ................. Labor Dept.~pprova} ........................ gnde~rlters Approval; ................. Ptanmng Board ApprovaJ ...................... Request for Temporary'Cert~hcate ..................... Final Certificate . Construction on above described budding and permit meets all apphcable~odes and regulations. THE NEW YORK BOARD OF FIRE UNDERWRITERS ~.o0ZUTZ .URE^U or E~-ECTR,C,TY l ~rT-, ~- 85 JOHN STREET, NEW YORK NEWYORK 10038 ~.,. ,~,~ .~. ~-, .~,,~.,,o~,,,. ,~ N _.~ i061 the e~tr~c~ ~ulpme~t ~ ~sc~ ~w o~ int~c~ by t~ ap~icant ~m~ on ~he ~e ~catlon n~m~er ~ t~ prem~s of Tho~s Longnecker, Va~lbton R~, Cutcho~ue, N.Y. ~sexommedon ~'~lZ~ ~1~ 1~7 andfoundtobetnco.tpltonceu,ththereq~re.~e~t~oftl.~Board DRYERS FIXTURES RANGES OVENS DISH WASHERS S E R V I C E EXHAUST FANS DIMMERS Room Heaters: 2-1.5kw 11971 Lic~578E OEN~EAL MANAGER Th~s certificate must not be altered ~n any manner, return to the off~ce of the Board if incorrect Inspectors may be ~denhfied ~y ~he~r credenhals -- COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. FORM NO 6 TOWN OF SOUTHOLD Building Department Town Hall $outhold. N.Y, 11971 JOHN BERTANI BUILDER, INC 1380 OAKWOOD ORIVE SOUTHOLD, NY 11971 THE NORTH FORK BANK & TRUST CO SOUTHOLD. L,I, NY 11971 AMOUiT DOLLARS I 50 791 214 27, CHEC: AMOUF i~'OO2772,' i:O2&NO?q~21: ,'O % ~,,,, :, t, B8q C, Fees: 1. Certif[cate of occupancy New Dwellzng $25 O0, Accessory ,$10.00 Buszness $50.00 2. Certificate of-occupancy on pre-existing dwelling $ 50.00 3. Copy of certlficate of occupancy $ 5.00, over 5 years $ ]0.00 4.Vacant Land C.O. $ 20 O0 ~' % 5.Updated C.O. . $ 50]00 Date ,..~.~,../J~ /. /.~./.~.. NewC°nstructl°g....~.../--~OId°rPre'exlstlngBulJdmg~J ). ..... ~ .. ~cantLand ........ . . Location ~ O. ~ ~ ~ Street /, // ~am/et Subdw,slon ........................... Fded Map No .......... Lot No .............. Perm,t No. ate of Permit . .Apphcant . ~...b.~ Health Dept Approval .... ~ · · ~ ............... Labor Dept. 'Approval Unde~nters Approval Planmng Board Approv3~ Request for Temporary' Certificate ................. Final Certificate ~¢ Fee Submitted $... ~_~. ~,~. ................ Construction on above described budding and per. it meets all applicable Codes and regulations · .......... ' ...... z/J, ........ Re~ 10 10 28 OUNDATION ( ls t ) OUNDATIO~ 12nd) OUGH FRAME & PLUMBING ~USULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMME}ITS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FO~DATION ZNO [ ~1 INSULATION [~]~FRAMING [ ] FINAL REMARKS: '-// / , INSPECTOR~._ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [. ]~RO~H PLBG. FOUNDATION ZND [/~J~INSULATION FRAMING REMARKS: FINAL DATE Examined ~ [ ~-' ApprovedC~.t _ [~- D~sapproved a/c FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL gOUTHOLD, N.Y. 11971 TEL,, 765-1802 , 1~ 7 Penmt No / ~."'l?c~ b.-~--' (Bmidmg Inspector) APPLICATION FOR BUILDING PERIV]IT INSTRUCTIONS TOWN OF_~SOUTHOL~.~,~,~ Received ........... , 19.. Date 2t~£. °c, . ., 19d~ a Tins apphcat~on must be cpmpletely filled m by typewriter or in ~nk and submitted to the Bmldmg Inspector, with sets of plans, accurate plot plan to. scale. Fee accordmg to schedule b. Plot plan showing location of lot and of buddings on premises, relatlonsh,p to adjo~mng premises or pubhc stree, or areas, and plying a detmled descnptmn of layout of property must be drawn on the diagram whmh ~s part of tins appl Cat[oi1, c. The work covered by tins apphcatzon may not be commenced before issuance of Bufld,ng Permit. d Upon approval of tins application, the Budding Inspector wall issued a Bmldmg Permit to the apphcant. Such perm shall be kept on the premises available for inspection throughout the work e. No budding shall be occupied or used in whole or m part for any purpose whatever untfl~ Certificate of Occupant shall have been granted by the Budding Inspector APPLICATION IS HEREBY I~IADE to the Budding Department for the ~ssuance of a Bmldmg Permit pumuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances c Regulations, for the constructaonI of buddings, ad&Irons or alterabons, or for removal or demohtlon, as here~n descnbe, The apphcant agrees to comply w~th all apphcable laws, ordinances, budding code, housing code, and regulatmns, and t admit authorized mspectors on premises and m budding for necessary inspections. (Signature of applicant, or name, ff a corporation) State whether applicant ]s owner, lessee, agent, arcintect, en~neer, general contractor, electrtclan, plumber or builder ameofown. ofprem,ses 7 , ns ........ (as on the tax roll or latest deed) If apphcant ,s a corporation, s,gna[ure of duly authorized officer e and htle of corporate officer) Plumber's Lmense No Electnc,an's L~cense No Other Trade's L,cense No Locabon of land on which proposed work will be done ~ouse ~mn ~er Street County Tax Map No lO00Sect,on ltl . Block / 0 . Lot . ~(~ Subd,v~s~on Fried Map No Lot .. (Name) State ex,sting use and occupancy of premises and intended use and occupancy of proposed construction b Intended use and occupancy Hamlet //f.B~' ? 3. Nature of work (check which ~pphcable) New Budding .. Addttmn ...... Alterat~on . .w/ .. Repmr ..... Removal ....... Demohhon ......... Other Work ............. (Descnphon) 4. Estmaated Cost'~w~,.~. ·O. . i ................. Fee ................................. (to be paid on fihng this apphcatlon) 5. If dwelhng, number of dwellmg umts ........ Number of dwelhng uruts on each floor ........ If garage, number of cars ................................................... 6 If business, commercml or m~xed occupancy, specify nature and extent of each type of use ............ 7. D~menmons of ex,sting structures, if any Front .... Rear ...... Depth ......... Height ...... Number of Stones ............................... Dm~enslons of same structure with alterations or additions Front ............ Rear ........... Depth ....... I . Height .... Number of Stones ................... 8 Dimensions of entire new construction Front 257~.44~. ~$. . Rear ......... Depth .......... Height ..... Number of Stones ~/~..~c~Z;~ ............................ 9 Size of lot Front .. I ..... Rear .............. Depth .............. 10. Date of Purchase ........... Name of Former Owner .................... 11 Zone or use d~stnct m whmh premises are situated ............................... 12 Does proposed constructmn m61ate any zomng law, ordinance or regulation .......................... 13. Will lot be regraded . . .ti-/<Z ........... Will excess fill be removed from premises Yes No 14 Name of Owner of premises gtg~ 77. /;o~,q~c/~r4z . Address .r?O ~Ol~ o~.~f.. ;PhoneNo .......... Name of Architect ............... Address .~ .°r/~. ~.~t/&. ././.~ Phone No ........... Name of Contractor ~D"~X. ~.t/-d'D~w~37... Address t~R0. ~a/~t.~t~tPhone No..~l$r- ./~'-~..~f 15. Is this property located within 100 feet of a tidal wet~f~d~.--'~v~Yes ..... No /¢~... · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and dmtmctly 011 bmldmgs, whether ex,sting or proposed, and. ~ndicate all set-back dLmenmons from property lmes. Give street and block number or description accordmg to deed, and show street names and indicate whether ~ntenor or comer lot STATE OF NEW YORK, COUNTY OF. ~.~'~"t~"o~.l.<.. ,.S.S (Name of md~v~duai signing contract) above named being duly sworn, deposes and says that he is the applicant He :s the dxp~./.90.t~ .Z~... IC%c:/~Z¢~mfi--~ ............... (Contractor, agent, corporate officer, etc.) of said owner or owners, and ~s duly authorized to perform or have performed the smd work and to make and file thru apphcat~on, that all statements contamed m this application are true to the best of his knowledge and behef; and that the work wall be performed m the manner set forth in the apphcatmn filed therewith. Sworn to before me this Notary Public, OCCUPANCY OR USE IS UN~WFUL WITHOUT CERTIFICATE OF OCCUPANCY