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Home My WebLink About15875-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z17161 Date AUGUST 5, 1988 THIS CERTIFIES that the buildin~ ADDITION Location of Property 1270 MIDDLETON ROAD House No. Street County Tax Map No. 1000 Section 041 Block Subdivision Filed Map No. GREENPORT Hamlet 02 Lot 01 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 3, 1987 pursuant to which Building Permit No. 15875Z dated APRIL 4, 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 DECK ADDITION TO EXISTING ONE FAMILY DWELLING. The certificate is issued to HALSEY A. STAPLES (owner, of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A ~u~ldin~'~ginspector Rev. 1/81 FORM NO. ~ TOWN OF SOUTItOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NE 15875 Z Permission Is hereby granted to: ......................... .......................... ...~...~.....~.~ ................................................. ..~.~.~ ~. ~. ~ / ~ ,-/,../* ,o ..~.;..~.......~...~...~.o.....~....~ ................ at prem ses located at .......~...~.....~....~....~........~....: ...........~.?~ ................ County Tax Map No. 1000 Section ......~.....~...~ ......... Block .......(~.......'~'., ...... Lot No......~....~ .............. pursuant to application dated ........ ....~.....~. ...................... , 19~...'~.., and approved by the Building Inspector. Fee $...~).."~)....: ............ Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold,'N.Y. 11971 765 1802 TOWN OF SOUTHOLD APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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, 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 property showing all property lines, streets, buildings and unusual natural or topograph ic 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 p_ertinent informa- tion required to prepare a certificate. C. Fees: Additions $25.00 POOLS $25.00 ALTERATION 825.00 1. Certificate of occupancy New Dwelling $25.00, Accessory ,$ lO.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 $]0.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date .......................... NewCons truc tion ...... Old or Pre-existing Building ...; ........ Vacant Land ............. Location of Property .~. ~///,J~fL~h/ I~/P: House No, Street Ham/et O ty wner or Owners of Proper ..... , ............ : .......................................... County Tax Map No. 1000 Section .... .?.l ........ Block . ?' , Lot Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. 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 applicable codes and regulations. Memorandum from .... BUILDING INSPECTOR'S OFFICE TOWN OF ~UTI-IOLD Town HALL, SOUTHOLD, N. Y. 11971 765-1802 (1st) OUNDATION ( 2nd ) OUGH FRAME & ?LUMBING 'NSULATION PER N. Y. STATE ENERGY CODE FINAL 'FORM NO. 1 TOWN OF $OUTHOLD CHECK BUILDING DEPARTMENT SEFTIC TOWN HALL NOT T FY $OUTHOLD, N,Y, 11971 TEL.: 765-1803 CALL MAIL BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... FORM ............. ; Examined.. ~ .t..., 19~ 7. Approved .~..q. ..... 19~. 7. Permit No. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................... 19... INSTRUCTIONS a. Tkis 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 show/ng 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 Southo[d, 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. admit authorized inspectors on premises and in building for necessary inspectio~ts. ~ , /) .......~. ,~ ~._ .m~...~....~.,. ~4 ............... (Signature of applicant, or name, if a corporation) .... i~.~....~0/.~!.. >. ~/.~.~. ~..~/V. ?~.~/.~f,. :~.~..~ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· 0 ~n Name of owner of premises .......................................................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of co¢orate officer) ALL CONTRACTOR'S NUST BE SUFFOLK COUNTY LICENSED Broider s License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done, . ~~ ....................... / ~ :to:' .n. ...... .~ .............. .:-. ~.::b!~. .~. .,~. .' .?.q..: ..... - ........ ~. : ............................. House Nnm her Street Hamlet County Tax Map No. 1000 Section .... ?.(*. .......... Block ...... ~ ......... Lot .... I ............... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. 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 .... .fl.~. 5. .j ~.~..~./?. / .~..~. ................................................ 3. Nature of work (check which applicable): New Building Addition ]~F C~ Alteration Repair .............. Rem!oval .............. Demolition .............. Other Work ............... ~ (Description) 4. Estimated Cost .... 7 ~ ~.I ...................... Fee ...................................... (to be paid on filing this application) 5. lfdwelling, number of dwelling units .............. .. Number of dwelling units on each floor ................ If garage number of cars 6. If business, commercial or mix6d occupancy, specify nature and extent of each type of use .................... 7. Dimensions~ of es, isting structurbs if any: Front ............... Rear .............. Depth .............. Height: .... !.~ ....... . .....Number of Stones .................................................. D~mens~ons of same structure w~th alterations or add~tmns: Front ............... Depth . ~afJt ~ ~, ~. · .' ...... Height ...................... Number of Stories ..................... '--8. Dimensio~'entire new const!ruction: Front ..... &. ~..' ..... Rear ... l ~, ......... Depth ............. Height ............... Number of Stories ........................................................ 9. Size of lot: Front .... 17~.'.1/~. ........... Rear ... ~/fi.: ? ....... ' ....... Depth ... (/.7. :~.~. ............. 10. Date of Purchase ... 1 .~.. J.., ................... Name of Former Owner ........................ 11. Zone or use district in which premises are situated ..... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... 13. Will lot beregraded......''i'"'................Willexcessfillberemovedfrompremises: Yes X No 14. Name of Owner of premises .. i .................. Address ................... Phone No ................ Name of Architect . ~J,~ ..... ~....5.7~.t g,5 ......... Address . gl ~. ~.,O./p(.. ~ ~ c:~.~.~P.~one No..q.7.~.\ q p'.7.~ ...... Name of Contractor . .~.*.~.'..P.~.4.7~ ............... Address ~.~t34~[/:/ ff~'f, ii... Phone No ..... ~.o..~.? ...... , ×. 15. ts th±s property lecal:ediw±th±n 300 feel: of a t±dal wetland.* *Yes ..... No . .. · lf yea, Soul:hold Tox, m Trvstees Perm±l: maybe requ±red. ' PLO-T DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Gwe street and block number or descnptmn according to deed, and show street names and ~ndicate whether interior or corner lot. U[- ~, , ~ ~, i' I STATE OF NEW YORK, ! S.S COUNTY OF ........ . . ............................ , ..................... being duly sworn, deposes and says that he is the applicant (Name of individual sigoing contract) above named. He is the i i (Contractor, agent, corporate officer, etc.) of said owner or owners, and is du!y authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manngr set forth in the application filed therewith. Sworn to before me this ................ ,. U~/~. · ...... County g PP HELEN IL I)E ~E NOTARY PUBL C, S~ate of NeW Yak No. 4707878, Suffolk i ~ Term Expires Mai'ch 30,1~ 98 / Jr' FtoD£'~i~:-~ VAN TI.~YL, LICENSED LAND SURVEYOR5 GREENPORT NEW YORK SUFFOLKCO HEALTH DEPT. APP~OVAL H $ NO. I STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO. DEPT. OF HEALTH ~ERVlCES. APPLICANT SUFFOLK COUNTY DEPT. OF HEALTH SERVICES - FOR APPROVAL OF CONSTRUCTION ONLY DATE: H. S. REF: NO.: APPROVED: SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT BLOCK PCL. OWNERS ADDRESS: ':~'-~: t',* '>": ' '" Z:; ;5 ' L...,q,. ~ P.,,~....L~ , ; TEST HOLE 5TAMP ~;AL