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Home My WebLink About15949-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Budding Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ..Z-1613.2.... THIS CERTIFIES that the budding . Ap,I)IT. .I9,N' .Tg. ,E.X. I, ,S.T,I. NG..ON.E., .F,AM.I,L, .Y, ,D.W, E, .L,L.I, NG Location of Property 3.80.0. V. au..s t.o.n House No County Tax Map No I000 Section ,111 Road ......... Cu.t ch. qg.ue ,..N?.w .Y .o.rk ..... Street Hamlet Block .05 ........ Lot . .ltl. .......... Sub&vmon ..................... Fried Map No ...... Lot No ............ conforms substantially to the Apphcatton for Bud&nE Permit heretofore filed tn this office dated Ap r ~. l 20, I 987 pursuant to wluch Bmld~ng Permit No 15949 Z dated . ..Ap.ril...2.8,..1.9.8,7 .... wasissued, and conforms to all of the reqmrements of the apphcable provtmons of the law The occupancy for which ttus certfficate m issued is ..... ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR PETER J. STAHEL The cerhficate ~s msued to ......... {oWner, ~~{ X .............. of the aforesaid braiding. Suffolk County Department of Health Approval .., N/.A. ...................... UNDERWRITERS CERTIFICATE NO ...... N / A PLUMBERS CERTIFICATION DATED: N/A Rev 1/81 FO~ NO. II TOWN OF $OUTHOLD BUILDING DEPARTI~AENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT CI'HIS PEPJ~IT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) N~ 15949 Z Permission is hereby gr~ntecl to: ...'w~.~.~....~.......~.~..L.. .......................... ...... ./..~.~....~.~.......~. ....................... .~.~....~....~.,~.:.....:..:.~... ot,~,~,,,,~,~,~,,,..~.~..~.......f.~....~ ............. ~~ ............... pursuant to application dated ....~.~......,~....0. .............. , 19.~.J.., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY- A. Th~s 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 w~th accurate location of all buddings, property hnes, streets, and unusual natural or topograph ~c feat~ 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 F~re Underwriters. 4 Commercial buildings, Industrial buddings, Multiple Residences and similar buildings and mstalla- t~ons, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5.Submit Planning Board approval of completed s~te plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buddings and "pre-existing" land uses 1. Accurate survey of p~operty showing all property hnes, streets, buildings and unusual natural or topographic features. 2Sworn 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~ t~on required to prepare a certificate. C. Fees: Additzons $25.00 1. Cert~f[cate of occupancy ~ew Dwe~z~ $25.00, Accessory ,$10.00 ~usi~ess $50.00 2. Certificate of occupancy on pre-ex~st~ng dwelling $ 50.00 3 Copy of cert~flcate of occupancy $ 5.00, over 5 years $10.00 5.TJ.od.a~ced C.O. $ 50.00 Date .............. NewCoz~st~ruct~on ...... Old or Pre-ex,sting Budding ........... Vacant Land ............ Location of ?roperty ............................................. Owner or Owners of Property ............................................. County Tax Map No 1000 Section ...... ,~// ...... Block .... .~. ....... Lot ..... .'/'..~. ....... Subdiv,s,on · .~.-~'"~-~.~, ..~h~..~..~.~/...C~.~..'~'F,led Map No.../.~.~... Lot No....~..~.~/ ..... Permit No ......... Date of Format .Applicant ....................... Health Dept. ApproYal ........................ Labor [lept. Approval ....................... Underwriters Approval ~ ~ . . ..................... Planning Board Approval ................. Request for TemporaryCert~f[cate.. .............~ ..,FinaICertificate ............... ... .. .. · FeeSubm~tted$.. ? ~' ~ Construction on above described budding and nd regulattons. Apphcant ........................ Rev 10-10 78 o Il I I Il I I II I I l~ I I OUNDAT!O~ (1at) OU~DAT! ON ( 2nd ) OUGH FRAME & FLUMBING NSULATION FERN. STATE ENERGY CODE FINAL ADDITIOn;AL CO?ME~TS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION [ ] ROUGH PLBG. 2ND [ ] INSULATION FRAMING ~FINAL Examined Approved Disapproved a/c FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 · ,19. ·, 19 ·.. Permit No ,19. (Braiding Inspector) APPLICATION FOR BUILDING PERMIT Date . ~)t°£t£ ./St .... 19 ~ INSTRUCTIONS a Tbas application must be completely filled in by typewriter or in Ink and submitted to the Buddmg Inspector, sets of plans, accurate plot plan to scale· Fee accordmg to schedule b Plot plan showing location of lot and of buddings on premises, relationship to adjoining premises or public sim or areas, and giving a detmled description of layout of property must be drawn on the diagram which is part of this ap cation c. The work covered by ttus application may not be commenced before issuance of Budding Permit d Upon approval of tins application, the Building Inspector wdI issued a Budding Permit to the applicant Such pen shall be kept on the premises avadable for mspectlon throughout the work e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupm shall have been granted by the Building Inspector· APPLICATION IS HEREBY MADE to the Budding Department for the issuance of a Bmldmg Permit pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordmance- Regulations, for the construction of buddings, additions or alterations, or for removal or demolition, as herein descnb The apphcant agrees to comply with all applicable laws, ordmances, bufld~g-co, de, housing code, and regulations, and admit authorized inspectors on premises and in budding for necessary mspecftlons/ (Signature of applicant, or name, if a corporation) (mail~.ng ad'dress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electnclan, plumber or budd .............. Name of owner of premises P!gT'~'t~ ~ ~' 4~/l~/~,q/l~ ~ ,$%W~ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer 2 (Name and title of corporate officer) Builder's L~cense No Plumber's License No .. Electrician's License No Other Trade's License No Location of land on which proposed work will be done ttouse Number Street County Tax Map No I000 Section Hamlet Block ... ~.. Filed Map No Sub&vision ~ll~k'~,l~l~'~ ~/~P (Name) State existing use and occupancy of premises and ~ntended use and occupancy of proposed construction a Exmtmg use and occupancy ~'IA~fAE ~t~//,~/ /ltO/d~ .. b. Intended use and occupancy · Lot /q~ Lot 32.~ 3 Nature of work (check which applicable) New Budding Addition . .~.. Alteration ..... Repmr .... Removal .......... Demolition ........ Other Work ........... I~ ~ (Description) 4. Est~nated Cost ~ ~'0~, --~ Fee (to be prod on F~mg th~s applicatmn) 5. If dwelhng, number of dwelling umts ... ~ ~t .... N~ber of dwelhng umts on each floor. ~.~,. Ifgarage, numberofc~ . ~.~, . .......................................... 6. If business, commercial or m~xed occupancy, specify nacre and extent of each type of u~ .~., ......... 7. D~ens~ons of ex~stmg st~ctures, ~f any Front. ~'0". Rear ~ ~ 0"... Depth . ~'.~ ~ .... Height J~ t~*~ ~qO~ Number of Stones . .O~ .................................... D~ens~ons of same structure with alterahons or additions Front . .~ *.$ f*. . Rear ~ ~ ~" Depth ~ n ~ ..... Hei~t g~ * ..... Number of Stones .. ~.. 8 D~ens~ons of entre new constmctmn. Front .., ~ ~ ~. Rear ... ~. ~ ...... Depth .~ fi4" Height Iff Off ..... Number of Stones . , .~M~ ............................... 9. S~zeoflot Front /~/ ~ ....... Rear .~$~%Of'.... 10. Date of Purchase .~ ~ I~ ..... Name of Foyer Owner ~t~.M~a~ ~(66 (~$... 11 Zone or use d~stnct m whmh premises are s~tuated ~~& .... 12 Does proposed constructmn wolate any zomng law, ordinance or regulation' ~ ................. 13. W~I lot be regraded . . ~ ~,. .......... . Will excess fill be removed from premises ~,~,Yes N~e of~ch~tect . ~ ........... Address .......... ~ ?Phone No N~e of Contractor . ~ .~.~qt¢ ..... Addres . .~ ....... Phone No.. ~... i5. Is th~s property located withinl00 feet of a tidal wetland? * Yes ..... No .~.. · If yes, Southold To~ Trustees Permit may be required. PLOT DIAG~ Locate cle~ly ~d d~s~cfly ~1 buddings, whe~er exmtmg or proposed, ~d. mdmate ~ set-back d~ens~ons fro prope~ ~nes G~ve s~eet ~d block number or descnpbon accord~g to deed, ~d show street n~es ~d red,cate whorl interior or co,er lot. STATE OF NEW YORK, _, COUNTY_OF. /% O~.¢~o~,x0 a a (Name of individual signing contract) above named being duly sworn, deposes and says that he ~s the apphc He ~s the OO, ltd~ .... (Contractor, agent, corporate officer, etc.) of said owner or ~, and ~s duly authorized to perform or have performed the smd work and to make and file apphcatmn, that ail statements contained m this apphcation are true to the best of his knowledge and belief, and that work wdl be performed in the manner set forth m the application filed therewith Sworn to before me th~s Notary mubhc, .~~~~.--'k- County (~/"~/"5 ~ Notary Public, State of New ~ .... g.~t...~5~.~ ~?~'~ . . No. 31~4786958 (Signature of apphc Oualiflad tn Naaaau Ooal~gt (~q ~ommisslon Expire, Maroh 30° lathd