The URL can be used to link to this page

Home My WebLink About16088-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z17044 Date July I, 1988 THIS CERTIFIES that the building .... 6,~.d.i~ .i gB ................................... Location of Property 80 gill Creek Drive Southold House No. Street Ham/et County Tax Map No, 1000 Section 135 .Block 03 . .Lot 39 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated May 28, 1987 pursuant to which Building Permit No. 16088Z dated......................,.....June 1'8, 1987 was issued, and conforms to all oftberequirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Dormer addition to an existing one family dwelling. ' Tile certificate is issued to PAUL KAYSF. R ..................... ..................... of the aforesaid building. Suffolk County Department of Health Approval .... ,N/.A, .................................. UNDERWRITERS CERTIFICATE NO. N01 §846 June 6, 988 PLUMBERS CERTIFICATION DATED: Henry J. Smith & Son, Inc. 5/4/88 Building Inspector Rev. 1/81 FORM NO. S TOWN OF SOUTHOLD 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_ 16088 Z Permission is hereby granted to: .................. ~' .... tF' .............................. .~ ......... .....~..~..~...~..'!.~ ................................................ ............. .................................................................... · '" b. 't ,---- t~_~ . ,[~. . o, p,em,se,,oco,ed o,...~ ......... ~.~.....~..~ ........... ~ ................... County Tax Mop No. 1000 Section ..... ]L..~.c~ ........ Block. ...... .,.C~.....~... ...... Lot No......~...c~ .............. pursuant to application dated ......... ~.~...~...~.. ..................., 19..~...~.., and approved by the 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 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: I. 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. §.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: t. Accurate sUrvey of pzOperty showing all property lines, streets, buildings and unusUal natural or topographic ,features. 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 ALTERATION $25.00 1. Certificate of occupancv New Dwelling,$25.Q0, kccessory-,$10.00 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 ..'~,.u.,l~.¢. New C OhS t r uc b i on ...... Old or Pre-existing Building ............ Vacant Land ............. tocation of Property .... [O.~.~.. ,.. .~.'1[ I, ¢%~--¢~%~ House No. Street HamJet Owner or Owners of Property .... ~.~.V..L..., .~...~.~/.$.~.1~ ......................... ...... . County Tax Map No. 1000 Section .... ].~.~.'~. ..... Block ..... ~. ........ Lot... ~-~.9. ........ Subdivision ................................. Filed Map No ........... Lot No ............. Permit No.~ ~,~. ~,~ ~ Date of Permit .......... Applicant., ,~.~. ,1~,, .~T{O. ,1:~, ,~-,, .~,l~; ......... Health Dept. Approval ........................ Labor Dept. Approval ......................., Underwriters Approval.,. ,~'~., ................. Planning Board Approval ....................., Temporary Certificate ..................... Final Certificate ..... ~ ............. Request for Fee Submitted $~.~. -~ ~..,..¢¢. ................ Construction on above described building and permit~q~/¢ts all applic~gulations. Applicant ........ . ..... ........... E.o. ¢¢ HENRY J. SMITH & SON, PLUMBING, HEATING & FUEL OIL MAIN ROAD SOUTHOLD, N,Y. 11971 (516) 765--,3690 lac, CERTIFICATION D a t.e- N_a2~ _~ _ 19_8_8 ....... Building Permit Ne._~O_8~_ ....... Owner Paul ~_a~E .............. Plumber HenMz J. Smith & Sonz_~AS~ I certify that the splder used in the water supply system contains less than 2/10 of 1~ lead. Sworn to before me this _~_day of _~a_x ....... , 19 88 Notary Public, Suff~ County me FOUNDATION {lst) FOUNDATION (2nd) ROUGH FRAME & .FLUMBING !12~Tz !1 INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONA'L COMMENTS: 7G5-J.80~ BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION 2ND FRAMING ROUGH PLBG. INSULATION [~FINAL 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [~ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [ ] FINAL DATE INSPECTOR, 765-~802 BUILDING DEPT, INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [~RAMING [ ] FINAL DATE INSPECTOR 44' · ,) 2'8 fgS? Examined. ,q"3:~,... ~..~...., 19~. ?. Approved....~t4-~../.~...., 19~'7. Permit No../. ~.?.~ .~..~. Disapproved a/c ..................................... ................................ ~~ ~ildTng InspeJ~ ....... APPLICATION FOR BUILDING PERMIT --~' '"' BOARD OF HEALTH · 3 SETS OF P~ANS FORM NO, 1 SURVEY ¥4 TOWN OF SOUTHOLD CItECK ........ BUILDING DI~PARTMgNT SEPTIC FORM ............. TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 76§-1802 CALL ................ HAIr. TO: Date .... .~..a.x/ ........... 'R~g 1957. INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter orin ~k 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. oThe 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 inspections. (Si=nature of applicant, or name, if a corporation) . (MaiIing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .... . .~&W .k,...~..~.~.} .~'.~. .................................................... (as on the tax roi1 or latest deed) If applicant is a corpora~on,,~g~a~ lure of duly authorized officer. ,/(Name and title of corporate officer) AL~L..,~,ON, TRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder 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 ...... ~ ............................ .,3~ ......... [.. ................. .9.9 ...... 01..Cv ?..e. ..... House Number Street Hamlet County Tax Map No. I000 Section ....... .') .~..~. .....Block .......... ~ ...... Lot ..... .~.~. ........... 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 .................. .~. ~.,0~r~.;.~.~ ....... e.~'~< 0.~.k"~'~..;~ ................ 3: Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ~.~ ~. v:~,e,,~,~.. (DescripIion) 4. Es'timated Cost ......... P..q .................. ....Fee ........ :.. .......... ~. ~:~... ......... i ' (to be.pa(~ on filing this application) 5. lfdwelling, number of dwelling ~nits ........ '~. ...... Nu~aber of dwelling u~its on each floor . . [ .......... If garage, number of cars ..... i ..................... /.~ ...................................... 6. If business, commercial or mixeO occupancy, specify nature and extent of each type of use .... ,~,!./.~.. ......... ?. D~manmons of exisBng structures, ff any Front .... .~. ......... Rear ...'3. i ....... Depth...: ~b.t{ ...... Hmght ............... Number of Stones ....................................... DLmensions'of same structure with alterations or addLtions: Front ....'~ ............ Rear .... '~.~ .......... Deptb ....... .~ ."'l ....... .... 8. Dimensions of entire new construction: Front .......... * ..... Rear ............... Depth ...: ........... Height ............... Number of Stories ....................................................... 9. Size of lot: Front .... ~.C.. ~.u. ¥.v.e¥ .... ' Rear.. ~ .... :. .............. Depth ...................... 10. Date of Purchase .......... ! .................. Name of Former Owner ............................ 11. Zone or use district in which pr~mises are situated .................................................... 12. Does proposed construction rio!ate any ~oning law, ordinance or regulation: .... I~o ........................ 1 ' 13. Wi I lot be regraded ...... .r~i ........... , ........ Will excess fill be removed fr..om premises: Yes No 14. Name of Owner of premises .~.~ v.k,...[d.,e.L~.q~. .... Address ~0 ~[1..C¥~,.~, .F-. ~.t.,y.-,. Phone No. '/to.ff :..I.kq ? .... Name of Architect ....... i ........ Address ............... Phone No... ' ........... Name of Contractor ~..~ ~-. 0~,~,*.'~.'~. 1~: ~ .[k..)~.~. Address~ ~....~:~.7 .~.j ~Ve. ?~.'.~. Phone No.~..'l.'J .-: %9~.~.$ .... 15. ]Cs this property located iwithtn 300 feet: of a tidal wetland*. ~Yes ..?'f... No ..... · If yes, Southold Town Trdstees Permit may be required. : PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and blocklnumber or description according to deed, and show street nantes and indicate whether interior or corner lot. STATE OF NEW y,;ORK COUNV¥ ..... .'7....~r~.Q~...~.. ~. ;~ .c'~q-4. ~. ~-'~ .. being duly sworn, deposes and says that he is the applicant .... (Name of indJvidual signing contract) above named. (Contractor, agent, corporate officer, etc.) of said owner or own~m, ~dris d~ly authorized to perform or have perfomed ihe said work and to m~e and file this application; that all statements contained h this application are true to the best of his knowledge and belief; and that the work w~l be perfomed in the m~ner set forth in the application filed therewith. Sworn to before me this .......... ~ '. ............. day of ]Z~/~ .......... , 19~/ : Count, Nota~ ~a'~b~''''' ~' ~, .u.o,~ coun ' ................. ~l~l~n ~l[es ,V eL 1~ (Signature of