The URL can be used to link to this page

Home My WebLink About16064-z TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20464 Date JANUARY 10~ 1992 THIS CERTIFIES that the buildin~ FOUNDATION Location of Property 160 LAKEVIEW TERRACE EAST MARION~ N..Y. House No. Street Hamlet County Tax Map No. 1000 Section 31 Block 9 Lot 17 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 30, 1987 pursuant to which Building Permit No. 16064-Z dated JUNE 14~ 1987 . was issued, and conforms to all of the requirements of the applicable previsions of the law. The occupancy for which this certificate is issued is FOUNDATION UNDER EXISTING BUILDING AS APPLIED FOR. The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED NORMAN & JUNE WOODCOCK Rev. 1/81 Building Inspector TOW~ OF SOfT,OLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No_ 16064 z Permission is hereby granted to: ~._.~...~,..~:.~.~.....~!.~.!...o. ............. ~ ~ ...~..~,~- .~ .~u:~.' .~ ..... ......................... ................ : :~ o~i~ ~<~ted ot ...l.~..~....~~.~....J...~.~.,...&~L~. ....... ~~.. County Tax Map No. 1000 Section .... ..~....'~..~ ........ Block ...... ..~..~. ........ Lot No .......~..~. ............. pursuant to application dated ......... ~ ...................... , 19.~...~..., and approved by the Building Inspector. Fee $...~...~...~....i~ ........ Rev. 6/30/80 Form No. 6 TOWN OF SOUTIIOLD BUILDING DEPARTMENT TOWN IIALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This.application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. SWorn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. ' 6. Submit Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9 1957) non-conforming uses, or buildings and pre-exzst&ng land uses: 1.Accurate survey of property showing ali property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C.' Fees I. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2.Certificate of Occupancy on Pre-existing Building - $100.00 3.Copy of Certificate of Occupancy - $5.00 over 5 years - $I0.00 4.Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ................................ ..u~ Construction ........... Old Or Pre-existing Building ................. I,oca~ion of Property...f~{L.~/~/~.~*.q4.,. j7~.¢~4~ · · - · .......... ........ House No. Street Hamlet ...... ~awer or Owners of Property.. ~7.~%~?~y~...~.ff-~Y.~.~-, .~.q~.~j~ founty Tax Map No 1000, Section...~. ; .... Block .... ~. .......... Lot. ~.? .... ;ubdivision .................... .................. Filed Nap ........... Lot .................... 'ermit No. 2 .V. ' iealth Dept. Approval .................... · Underwriters Approval laoning Board Approval ..................... equest for: Temporary Certificate ........... Final Certicate....bl ...... Submitted: $.~3/' OUNDATION ( OU!~DATION OUGH FRAME & FLUMBING iNSULATION PER N. Y. STATE ENERGY CODE FILIAL ADDITIONAL COMMENTS: BUILDING DEPT. INSPECTION [~/FOUNDATION 1ST []ROUGH PLBG. FOUNDATION 2ND []INSULATION FRAMING []FINAL 'FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL,: 765-1802 Examined..t.J,,~'Lt~.l..~..., 19~. 7. Approved...~A'I'/D~. ! .~..., 197.~. Permit No. J..~..O..(q. 9..~ Disapproved a/c ..................................... (Building Inspector) APPLIOATION FOR BUILDING PERMIT BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... CHECK .......... SEPTIC FORM ............. : NOTIFY CALL ................ NAIL TO: BLDG. DEPT. TOWN OF SOUTHOLD Date ..... .~. ~. ~../. Z ....19 ~.? INSTRUCTIONS 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 permil 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 u~til a Certificate of Occupan% 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 th~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances oI 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 tc admit authorized insp ectom on premises and in building for nece ssary2 i~ns .~.? /~,~ - (Signature of applicant, or name, if a corporation) v. . . . .1¢, ..... ¢. .... , r3,¢ . .., .... J, .... (Mailing address of applicant) State ~vhether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ,~.££/, /c.,~. .~.T ~ .f . e.~. ............................... Name of owner of premises . .~.o..ff.m~Ad. d~*..k4d. · .o.o.0. 6,.4 9..~. ............................................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duty authorized officer. (Name and title of co,orate officer) - ALL CONTRACTOR'S ~DST BE SUFFOLK COUNTY LICENSED Builder's License No .......................... Plumber s Lmense No ....................... Electrician's License No ....................... Other Trade's License' No./~flff. A/./?(;.~t "- .... o~ ~l.~.~ ~/~M 1. Location df land on which proposed work will be done .................................................. I.~ o. .b ~ /~. V ~ a .~. ,¢ ~"' ~ . . - .7'~. R~.c¢¢ .... / ..... E.. tfffl4/~tO ........................ ; ............. House Number Street Hamlet County Tax Map No. 1000 SecIio.n .....O.~..J..: ........ Block ...~. ........ ....Lot ZT.~'.£~'~r.¢.F./.~. ' Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ~ ,~x 1{~.~.'7. a. Existing use and occupancy . . ~. 3'..~. ..................................................... b. Intended use and occupancy . .~..~-.~...~..~.(':'....~.~..~."~. ~2.g.~.. ~l..~. O...~..~./~.... 9(7.l..".7..I.$..'~/.~..~. ........ Nature of work (check which applic, ble): New Building Addition~..~..~ '.~.~...'2..'~... r'Alteration .......... '. Repair f.t~u~OA .TlO'~. Removal ............. Demolition .............. Other Work ............... , (Description) ' Est/ '~ ~.q ~' · mated Cost. o .............. Fee .............................. ~' (to be paid on filing this application) If dwelling, number of dwelling milts .. · .J .......... Number of dwelling units on each floor ..... /. ........... If garage number of cars ' If business, commercial or mixed occupancy, specify hat, ute and extent of each type of use ........ ~.... } ......... Dimensions of existing structures, if ~ny: Front....~.(~ ......... Rear ...). ~'. ~. ....... Depth .. ~ .~. .......... ' ' ~eight ...~.q .......... Number of Stories ..................................................... Dhnensions'of same structure with al~terations or additions: Front . ~.~ .' ............ Rearr . } .~ ~ ............ Depth . ~.~..~...~[J. ,.; ....... Height ....~.o. ~ .............. Number of Stories .. ]/,~, ................. Dimensions of entire new constructi6n: Front ' ' .... ~ ......... Rear .......... Height . .~.8 ~' ..... Number ~f Stories .~?~.YP?g¢~...~.. .....t~. ........ Depth- .. Size of lot: Front ~.?. ' ' R ........... , ........ ear ............... De .................. Date of Purchase . ] .?.'~ .% ....... [ ....... ' ... Name of Former Owner .... ~.o.~/.~Xo..tQ .............. Zone or use district in which premisds are situated ..... t.t~ ¢.o. ........................................... D ' ocs proposed construction violate any zoning law, ordinance or regulation: . .~0.q ....................... Will lot be regraded .... Y'~' '~ .... i'':: ........... Will e.~cess fill be temo~ed .fr,_om premises: ~ No Name of Owner of premises3). ~B~. ~. W ~O.~qr~Addresst~.~'.j~°~0~.fo.~,~..'' Phone No.o~ o%.~ .-.'~.~ ~q~... Name of Architect ............. '. ............. Address ................... Phone No ................ Name of Contractor ~>.~ ~..P,21,4/*.~. ~ ............. Address/~/TJ.T.~?..~. ...... Phone No.o~ ~.~. ~.~ ~.... Is this property located within 300 feet of a tidal wetland? *Yes ..... ~ ..... · If yes, Southold Town Trustees Permit may_ be required, PLOT DIAGRAM Locate clearly and distinctly all buil.ldings, whether existing or proposed, and. indicate all set-back dimensions from )petty lines. Give street and block number or description according to deed, and show street names and indicate whether erior or corner lot. ATE OF NF4t/AYORK, ..... s.s ...-,'~ - ~, .,tr,~:,~. fl~.'~..-.-.-.-.-.-.-.-.-~(,,,~.~.-- ~ -- -- ~/~. ~/..~. · ~ ............. being duly sworn, deposes and says that he is the appIicant (Name of individual signing dontract) ~ve named. J is the .................................................................................. (Contractor, agent, corporate officer, etc.) said owner or owners, and is duly au'thorized to perform or have performed the said work and to make and file this >lication; that all statements contained in this application are true to the best of his knowledge and belief; and that the rk will be performed in the manner sei forth in the application filed therewith. om to before me this ......... t ary Pu bl~.~'~/q. · ._../~..~ · .'~r('1~'~....~ ..... County ./ / ~LY~ LASKOWSKI '' NO*^ Y No, 52-452~700 ................... {~ualtfled In SuffoJl<. County (Signature of applicant) I Commission Expires ~ :.~,~.o~~' I [ i ;