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Home My WebLink About15814-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z16787 Date April 12, 1988 THIS CERTIFIES that the building Alterations Location of Property . .80.3...R...O. :.W:..I~.apl e Lane Southold House No. ' .................................... Street Ham/et County Tax Map No. I000 Section .6.4. ......... Block 0 I .Lot 3 0. 1 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated M a r c h 23, I 987 pursuant to which Building Permit No. 158 14 Z - dated .~.a.r.c.h.· .........28, ' 1987. ... ..... .. . 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.l.terations as applied for in an existin~ one family dwellin~ The certificate is issued to NICHOLAS & CORNELIA TltEOHARIDIIS ..................... ................... of the aforesaid building. Suffolk County Department of Health Approval N/A UNDERWRITERS CERTIFICATE NO ................. ~/.3.. ............................. PLUMBERS CERTIFICATION DATED: N/A B ui~ffg Inspector Rev, 1/81 ~OE~[ NO. JJ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLE'rlON OF THE WORK AUTHORIZED) N~ 15814 Z ....... ..~ ............................................ ,9.~..7.. Permission is hereby granted to: ..~.~ .... .......... ~..~, ~.~ ~ ......... ~t ~,~,,,, ,,.,.,,,..~.-~-~...~ ...... ~............ ..................... County Tax Map No. 1000 Section ..... ..C~.....(R...~. ...... Block ...... ..O...L ......... Lot No..~J~,.~..;...! ........... pursuant 'o application dated ......~.~......~...!. ............... , 19.~..~., and approved by the Building Inspector. Fee $.~..: .............. Building In.~ector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y, 11971 ' APPLICATION FOR CERTIFICATE OF OCCUPAN~Y A. This application must be filled in typewriter OR ink, and submitted m ilaamcmma to the Buildi 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 equa{). 3.Approval of electrical installation from Board of Fire Underwriters. 4.Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- '[ions, 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-exisdng" land uses: d. Accurate survey of property showing all property tines, streets, buildings and unusual natural or topographic featuros, 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 POOLS $25.00 1. Certificate of oecupancy New Dwelling $25.00, Accessory ,$]0.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date .......................... New Cons b~uc t ~ on ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property .~...~..~..,~., .~?..~.. ~..~..,~.~..~~ ~ '/~/ Owner or Owners of Property . ~~.~(~~..,Z.~.~~¢) CounW Tax Map No. 1000 Section ...... ~.~ ...... Block ...... ~. ( ...... Lot., ~, / Subdivision ............................. iZ .Filed Map No ........... Lot No .............. Permit No../.~..~f..~/~.. Date Of Perm,t .~.~.<~'.~.~ZApplicant./L..~..~, ./~/...~., ,z~...~. ......... Health Dept. Approval ' ,Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $..~. ,~,'?, ,'~. ................... Construction on above described building and permit meets all appli~e co. and regulations, Applicant~. ,'~.../~..'~¢~-r.....~..~~ ................... OUNDATION (1st) OUNDATION (2nd) OUGH FRAME & PLUMBING NSULATION PER N. STATE ENERGY CODE FINAL ADDITIONA'L COMMENTS Memorandum from.... BUILDIN(~ INSPECTOR'S OFFICE TOWN OP $OUTHOLD Town HALL, SOUTHOLO, N, Y. 1197! 765-1802 OOf,~AH~Y OR IJ~ IS IJNLAVVFUL Wrl~m,T FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 .TEL.: 76§-1802 Examined...~~.~ .8., 19~..'7. Approved ..~..~..~.., 19~..7. Pennit No.)..~..~../.~..~.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date . · · .~. · ./.Z~.. ..... 19... a. This 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 construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to inspectors on premises and ~r~:~ ' ~a' i.,,, ...... admit authorized in building for necessary inspections. //(Signature of appjicant, or name, if a corp t'on) ~ ~, Z~'>"' ..... ................... .... ........ i~fiiiifi~'addre~s of a~licant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · ~...~..~..Z:. ~ .............................................................................. Name of owner of premises . ff./..~' .~../'5../~... ~.~..~..ffr.~t..'~../.'~..-c~....ff....~./.~. · .~. .......................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) 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. ~/../~.~..~'.....~..~.../?/.~. ......................... ..... ...... ....... .......... House Number Street Hamlet County Tax Map No. 1000 Section ....... .~i .,~. ...... Block.. / .............. Lot .,~...dT/. </ ........... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 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 ....~.~../~..~. ~.,] ....................................................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration . .~.~. ..... Repair .............. Removal .............. Demolition .............. Other Work .' .............. 4. cost ...... ...................... ................................ , ..... "~ ~ ~ (to be p~d on filing this application) 5. If dwelling, number of dwe~units ...... ~ ..... Number of dwelling units on each floor ............ If garage, number of cars ...; ....... ~ ......................................... ' ............... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ..... ~ ........ Rear ......... ~-r~. Depth .... ."J77.. ........ Height ............. ~.~'~rmber of Stories . ..-%-. .................................................... Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................. !... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Nuinber of Stories ....................................................... .. 9. Sizeoflot: Front ......... , ......... ;.. Rear ...................... Depth ..................... 10. Date of Purchase' . ~ ....... ~ ................... Name of Former Owner ............................. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction viplate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ....... i .................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises . ~ .................. Address ................... Phone No ................ Name of Architect ........ ~ .' ................. Address ................... Phone No ................ Name of Contractor ....... 4 .................. Address ................... Pho~o~?~ No ................ 15. Is this property located withinl;00 feet of a tidal wetland? * Yes ..... No ..... · If yes, Southold Town T~ustees Permit may be required. PLOT DIAGRAM 'i Locate clearly and distinctly ~11 buildings, whether existing or proposed, and. indicate M1 set-back dimensions from property Hnes. Give street and bloci: number or description according to deed, and show street names and indicate whether inte]5or or corner lot. STATE OF NEW YORK, COUNTY OF ................ (Name of individual si above named. S.S ~ · .................... being duly sworn, deposes and says that he is the applicant ning contract) He is the ......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d~ly authorized to perform or have performed the said work and to make and file this application; that all statements cogtained 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 flied therewith. Sworn to before me this ............. .~, ,_3. ..... ...day ;f ...... ~ ...... , 19 .~.7. TAR¥ POBLIC, §tareNo, 4107878, Suffolk° f~J eW York ~'/ .................. ( S; g ~at~r'e';; ~ pp ' li~an't') Cou~ll~,, ~ Term Expires M~rch 30, 1~