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Home My WebLink About15748-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building....D.e.qk...a.d.d.J: .t.ip.n. ............................. Location of Property 1895 Old Orchard Rd East Marion h~s'o hie: ....................... 'S't/e~i ....................... h~,~/ol County Tax Map No. 1000 Section ....3.7. ...... Block ..... 3. ......... Lot ..... 9. ........... Subdivision ...... '~77 ..................... Filed Map No... T.'~...Lot No...'77 ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated · ~ ~glz~J~ .~3J..~ [1.7 ..... pursuant to which Building Permit No.....1.5..7.4.8.g. ........... dated ..... ~r.c.h. ~[ 3.,.. ~ 9 B.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 . .~.o. ..... · ~ons.~zzuct..deck..addi.~.ior~..~q. q>rt~..~rn,/-.J,7. ~t.w.e.]~ .1 i.n.~ ....................... The certificate is issued to ............... Ed. Gen,,der ................................ (owner, lessee or tenant/ of the aforesaid building· Suffolk County Department of Health Approval ........ I~I/3, .............................. UNDERWRITERS CERTIFICATE NO ............ I~/.A .................................. PLUHBERS CERTIFICATION DATED: N/A Building Inspector Rev. 1/81 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 15748' Z Permission is hereby granted to: ........ at premises located at / ~ Co.n~ To× Mop No. 1000 Sect,o.....~...~. ..... ,,ack ...... ~ ........... 'at No ..... ~ .............. pursuant to application doted ..... ..~...~ ............ /.....~.. ........ , 19.~7..~, clnd approved by the Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFIC BLDG. Dr=. PT, 'tOWN OF SOUTHOLD Instructions A. This application must be filled in typewriter OR ink, and submitted ~ 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 topograpl~ic 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 survey of p~-~operty showing all property lines, streets, buildings and unusual 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: Additions $25.00 Pool $25.00 1. Certificate of occupancy New Dwelling. S25.00, Accessory,~10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, oYer 5 years $]0.00 4.Vacant Land C.O. $ 20.00 ~ /)/ ~,-~ 5.Updated C.O. $ 50.00 Date ...~.~...~..~.~ .... NewC°nstruction ...... Old or Pre-existing Building ..... ~-,.j ../' Vacant Land Location of Property l .(~...C ..... ~.5..~7/'.~--~....~.'./ ........ House No. ~ Street H~r~let Owner or Owners of Property .~.. ~~ .%. County Tax Map No. 1000 Section...~. ~ ...... Block,...~. ......... Lot .... .~. ......... Su bd iv is/on~' ..... ,--.~"~t~---/'?'2 ............................ Filed Map N~.~ .......... Lot No ....... Permit No...~ .9.g~/..~. Date of Permit ....... Applicant..~j'.~.(~..~..~/~ . .~..~./..~.. Health Dept Approval '~- ~ Labor Dept Approval ' Underwriters Approval ;~ .............. Planning Board Approval .... . ~ ~.,-¢ ........... Request for Tem?~rary Certificate ..................... Final Certificate ... ~ ................ Fe~ Si~cm itte¢~-~ ~"~ ,~',, ,~'' .................~~ ,.~ Applicant ................................. R,v. ~o4o-7e ~~2/' '~ ' ' ' gndersen~ STURTEVANT MILLWORK CORP. Windowalls~ comCOm.e home to quali~ e home to Andersen~' 75 N. INDUSTRY COURT DEER PARK, N.Y. 11729 PHONE 516-667-6700 DATE JOB : :ANpER?EN PERMA-SHIE~D~ ~WIN/DOWS &IGL[DI~G DOORS F~)R ~OM~IER~IAL & ~NS~ITU~TIONAI~ USg ELD INSVECTION UNDATION (2nd) UGH FRAME & ?LUMBING SULATION PER N. Y. STATE ENERGY CODE ADDIT!ON~L COMMENTS: ~t2)o~r, ,'~,, I'v'~ BOARD OF HEALTH 3 SETS OF PLANS ....... 'FORM NO. 1 SURVEY ....... : · · /OWN OF SOUTROLD CHECK .......... BUILDINGDEPARTMENT SEPTIC FORM ............. : TOWN RALL $OUTHOLD, N,Y, 11971 TEL,: 765-1805~ CALL .......... r ..... MAIL TO: isapproved a/c ..................................... (Building Inspector) . APPLICATION FOR BUILDING PERMIT Date INSTRUCTIO~qS a. Tlfis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ts of plans, accurate plot plan to scale. Fee according to sclledule. b. Plot plan showing location of lot and of buildhags on premises, relationship to adjoining premises or public streets areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- tion. 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 all 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 ?i Certificate of Occupancy all have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Depfirtment for the issuance of a Building Permit pursuant to the ailding Zone Ordinance of the Town of Southold, Suffolk County, New york, {.cd other applicable Laws, Ordinances or egulations, for the construction of buildings, additiol3s or alterations, 9{4~r r~n~bval or demolition, as herein described. ~e applicant agrees to comply with all applicable laws, ordinances,.~g/~_f~/{,)ousing4~e, and regulations, and to hnit auth°rized inspect°rs °n premises an: in building f°r necessary.~. ° .~.~X. ~07o~'~applic~, or.~e, if a corporation) ~ ~_~.. ~.~~o..o. .......... (Mailing address of applicant) tare whether applicant is owner, lessee, agent, archii~ct, engineer, g~neral contractor, electrician, plumber or builder. ~;~O I[-~)C~4L ............................ ~ . ~.. ~-, ............ ~.'~ ....... o. · · ..................... · .... .... . / ~ ~ (as on the tax roll or late~?y ~"~}~g ~ EPAR'FM~T~ 765-1802 9 AM TO 4 PM FOR THE ~ applicant is n corporafion, signature of duly authorized officer. ~OLLOWING INSPeCTIoNs: ]. FOUNDATION _ TWo REQUIRED ............................................. FOR POURED CONCRETE (Name and title of co~orate officer) · 2. ROUGH ~ FRAMING & PLUMBING AL~ .CONYR~CYOR~S ~SY BI S~FFO~K gO~NY~ ~lC~NS~D 3. INSULATION Builder's License No. 1~ ~ ~. ~ . · ~ ~'. ......... 4. FINAL ~ CONSTRUCTION MUST ~ BE COMPLETE FOR C. O. Plumber's LicenseNo. ........................ ALL CONSTRUCTION SHALL MEET ~ THE REQuIREMENTs OF THE N.Y. Electrician's License No ....................... STATE CONSTRUCTION & ENERgy ~ CODEs. NOT RESPONSIBi E Other Trade's License No ...................... D~SIGN OR CONSTRUCTION Location of land on which proposed work will be done] ................. . ......................... ~ ...... .... ...... : ....... .< .... House Nmnber Street Hamlet ~o~n~,~o.,000~=~,on ..~.7 ......... ,,o~ ..3 ...... : ...... ~o~ ..... 7 ............ Subdivision ..... ................................ Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended~ ~ ~-~ ~//~use and ocsupancy ~f p;oposed construction: ...... ................ b, Intended use and occupancy , · ~~.. ,~~] ...... ~ ,~ ...................... 3. Nature of work (check which ~pplicable): New Building ,, .... ' ..... Addition .......... Alteration__r,,~ ......... D~m01ifion Repair .............. ,/ Removal . ....... ,.. ...... , ~, ' ',, : ', ',,~, ~ ~ , .... (Description) 4. EstlmatedCost... ............................ Fee ..-. ~..-,.o ...... , .....' ............... ' " (to be paid on filing this application) l 5., If dwelling, number of dwellin units ............... Number of dwelling units on each floor ............... number of cars If garage 6. If business, commercial or mixbd occupancy, specify nathre and extent of each type of use ................... 7 Dimensions of existing structures if any: Front ; R~ar ' Depfh Height ............... Nu~nber of Stories ........ ; ............................................ .... ~/ith alterations or additions: Front Dimensions of same structure .;..., ..... ' iNumber x, ,,' Depth .................. ~... Height .................. '... of Stories ............ ; ...... 8.' Dimensions of entire new construction Front, Rear Depth Height Nutnber of Stories , ' 9 Size 0flot: Front ' Rear Depth 10., Date iof Purchase ............................. Name of Former Owner ......................... 1 1 lone'or use district in which premises are situated 12 Does'proposed construction violate any zoning law. ordinance or regulation: ' 13. Will 10t be regraded ........ '. i .................. Will excess fill be remove~d frQ~ljpr'emises: Yes N~ 14., Name of Owner of premises Cz~ .~:..~.a?..~.O..~. ...... Address .O.C.O..at.~. (.t9. ~..~..~..~one No .............. - ' Name of Architect ......... J ...... ~ ......... ~. Address ............ ....... Phone No ........ 2 ...... ~ Name of Contractor }4.XJAR, T2.~-? ................ Address ~.Oib...~.. ~9. I~.'[~/}~. Phone No. ?.{??.tg.W.. ~ .... 15. Is this property located within 300 feet of a tidal wetland? *yes ..... No ~... *If yes, Southold Town T~ustees Permit maybe required. : PLOT DIAGRAM ' Locate clearly and distinctly ell buddmgs,.whether existing or proposed, and. intimate, all set-back dimensions fret property lines. G~ve street and block number or descmption, accordm to deed and show street names and indicate whethc interior or, corner lot. i .... : STATE OF NEW YORK, S,S COUNTY OF ................. ................................................. being duly sworn, deposes and says that he is the applican above named.(Name of individual sig;' ng contrac0 , .,,,,?,,, ""~"".'"""'i'"~, He is the , ' (Contractor, agent corporate officer, etc ) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file thi application; that all statements contained in this applicatioR are true to the best of his knowledge and belief; and that th, work will be perfonned in the mare:er set forth in the applidation flied therewith. Sworn to before me this ...: .................... day of.....~.f. ?..-p:c..' .~_<.. ........ 19 ....... ount, NOTARYPUBtlC,_Sta.t.e..of.N?~o~k i.. /[,~..1~./. ..... ~l~re df p;l ~a'n't, ' ' No. 4707878, SU~O}K COUnqX:- 9 Term Expires M&rch $0,