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Home My WebLink About16449-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hale Southold, N Y. Certificate Of Occupancy No .z1629~ ..... Date qqtg~E.Jp, 1987 THIS CERTIFIES that the bmldmg .... Add.~. t3qn. ........................ Location of Property . .4.25 Terry Lane Sourhold Housa ~vo. ' ............. 's't/eei .................... hi~/el County Tax Map No. 1000 Section . .065. .... Block .0.1 ....... Lot .. 2 I Subdlvimon ............... Flied Map No ...... Lot No .......... conforms substantially to the Apphcatton for Buddtng Permit heretofore filed In flus office dated .... S.e.pt.:. 9., .!987 pursuant to wluch Bmlding Permit No. 164/49z dated .8. e p.t ...9.: 1..... ,987 . .. was issued, and conforms to all of the requirements of the applicable provlmons or' the law The occupancy for Much flus cerhficate ~s issued ts ..... ..... p.e, qk..a.d.d. ~, .t.~p.q..c 9..a.n...e.x.i.s. [ ~.n g.. 9 n.e.. ~ .a.m,~.l. y..dy.e. 1. ,1,~fi.g.: ................ ARNOLD & KAREN BLAIR The certificate is issued to ............... (owner, ~,~1~,~ ~ X of the aforesmd building Suffolk County Department of Health Approval ..... .N./A. ...................... UNDERWRITERS CERTIFICATE NO. lq /A PLUMBERS CERTIFICATION DATED: Buitdmg Inspector Rev 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CrHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 16449 Permission ~s hereby granted to: _ ~ ~ , , .... ....................... ..:;~,~.....~......q. ................... t .......... ,o ..~~.......~...&.~.&......~....xc,........~.....~....m,,-, at premises located at ........ ~......x/.~fv~..~-C~.~;kx~,~, ....... ~ ............................. .............. ~....~..,...~....~.....~.~ ............................................................. County Tax Map No 1000 Section .... ..0...~...~'.. ..... Block ...... ...~....I. ........ Lot No .....-a~r..J ......... pursuant to application dated ................... ~..~.~ ...~... ..~ ........ , 19,~..~..., and approved by the Budding Inspector. Bu/rdlng Insi:mctor Rev 6/30/80 FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE ADDITIONAL COMMENTS: FORM NO. 6 TOWN OF SOU'I'HOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR ~ERTIFICATE OF Instructions This apphcatton must be filled in Wpewrtter OR ink, and submitted mm 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 topographm features. 2. Final approval of Health Dept. of water supply and sewerage disposal-(S-g form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buddmgs, Multiple Residences and similar buildings and installa- tions, a certdlcate of Code comphance from the Architect or Engmeer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of pzoperty showmg all property lines, streets, buddings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buddings. 3. Date of any housing code or safety ~nspect~on of buddmgs or premises, or other pertment mformm tion required to prepare a certificate. C. Fees: 1.Cerhficateofoccupanc¥ New Dwellzng $25.00, Accessory ,$10.00 Business $50.00 2. Certificate of-occupancy on pre-existmg dwelling $ 50.00 3 Copy of certificate of occupancy $ 5.00, over 5 years $]0.00 4.Vacant Land C.O. $ 20.00 0 5.Updated C.O. $ 50.00 Date ..... .8¢.~...(.~.). /.~;..~ ...... NewConstruct~on / Old orPre-exlstmgBulldlng .... Vacant Land Location of Property ........................ o. ....................... House No. Street Hamlet Owner or Owners of Property .....~.(.QOIc~ ~ ./~(~..~./.C~.~..r- ...... CountyTax Map No 1000Section ...~).(~ ~. ...... Block O / Lot...%/. Subdlws~on ................................ Filed Map No ........... Lot No .............. Health Dept. Approval ...................... Labor Dept Approval ........................ Unde~r~ters Approval ~ ..... Planning Board Approval ................. Bequest for Temporaw Certificate .................... Final Certificate ....................... Fee Submitted $. ,~,'~-. ~ ~ .................. Constructto-n on above described budding and per.~mlt meets all apphcabie codes and regulations. 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION 2ND [ ] FRAMING REMARKS: ROUGH PLBG. I~ULATION [/~INAL DATE FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved ~_~.g,,~. C~, 19,') Permit No J.(°~Oc-. Disapproved a/c ............. BOARD OF HEALTH 3 SETS OF PLANS SURVEY ~'~ CHECK SEPTIC FORM ............. NOTIFY CALL ................ MAIL TO: (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a This application must be completely filled m by typewriter or m ink and submitted to the Budding Inspector, sets of plans, accurate plot N:,~ ~o scale Fee according to schedule b. Plot plan showing locatmn o~ lot and of bmldmgs on premises, relatmnship to adjoining premises or pubhc str or areas, and giving a detailed descrlptmn of layout of property must be drawn on the diagram which is part of this al cation. c. The work covered by this apphcaUon may not be commenced before issuance of Budding Permit. d Upon approval of this apphcatmn, the Budding Inspector will issued a Bufldmg Permit to the applicant Such pm shall be kept on the premises available for mspechon throughout the work. e. No bmldmg shall be occupxed or used in whole or in part for any purpose whatever until a Cerhficate of Occup, shall have been granted by the Budding Inspector APPLICATION IS HEREBY MADE to the Budding Department for the issuance of a Building Permit pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordmancc Regulations, for the construction of buildings, addltmns or alterations, or for removal or demohtton, as herem descnl The applicant agrees to comply with all apphcable laws, ordinances, budding code, housing code, and regulations, an, admit authorized inspectors on premises and m bufldmg for necessary inspections (Signature of applicant, or name, ff a corporation) (Marling address of applicant) State whether applicant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buff, .~a/g'~9~,~ ............................. Name of owner of premises . z~,g,]0~9 4 ~'/gq/~-XJ' ~ g~//~ .... (as on the tax roll or latest deed) If apphcant is a corporation, signature of duly authorized officer ALL Builder's License No Plumber's License No Electrician's License No Other Trade's L~cense No (Name and htle of corporate officer) CONTRACTOR'S MUST BE SUFFOLK COUNTY Location of land on which proposed work will be done House Number Street County Tax ~ap No 1000 Section ~.~ LICENSED Block . $o o-r14oo9 Hamlet ....... Lot. ~ l ...... Subdlvlslon . . Flied Map No .... Lot (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction a Existlng use and occupancy ~l.3~- '~tt,{~/~/ 9bU~;~___.. ' ' ....... :. b Intended use and occupancy ..(( ~( . t~./.('°~. ~e-o~.' ........... 3 Nature of work (check which applicable). New Bufldxng ......... Addttton .......... Alteration, 2 4~ .. Removal ...... Demohhon ...... Other Work '~ 1~6,~(.,~ Repmr np °n) 4 Estimated Cost . . ~,P ~ .............. Fee ~ '. · ' ................ L,~:: ' ' ~ ' tto be paid on filing this apphcatmn) 5. If dwelling, number of dwelhng 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 exlsnng structures, if any Front ........ Rear ......... Depth ........ Height ....... Number of Stones ......................... Dunenmons of same structure with alterations or add~tmns Front ........... Rear ........ Depth ........... Height ........ Number of Stones ................ 8. D~rnenmons of?tire new construction Front .... 21~. ~. .... Rear .... ~ ~. .... Depth .. J.7,.-.t ...... Height .... ~ ...... Number of Stones ............ ~ ...................... ~, ........ 9. Size of lot Front . . /..~/. ..... Rear . . ~'.~.-5~r '. ..... Depth ...~.~:.~'". ...... 10 Date of Purchase . .l/]{~]~& ...... Name of Former Owner 11 Zone or use d~stnct in which premises are situated .................................... 12 Does proposed construction violate any zoning law, ordinance or regulation ....................... 13. Will lot be regraded ./Q O. ......... Will excess fill be removed from premises Yes X'b 14 Name of Owner of premises b~.~ t~.t~ gti/tgO ~ot~Address ............. Phone No ...... Name of Architect .................. Address ............. Phone No ............ Name of ContractorQ'~ll~.~gF~o*s~ ~tt. tg*~. .. Address 15¢-O .(D~q.10~t2~_c~g( .~. Phone No 76J'.-/;i-~... 15. Is this property located within 300 feet of a tzdal wet~d.~Yes ..~.. No ..... *If yes, Southold Town Trustees Permit maybe required. PLOW DIAGRAM Locate clearly and d~stinctly all buddings, whether existing or proposed, and mdlcate all set-back dnnenmons fro property hnes Give street and block number or descnphon accordmg to deed, and show street names and mdlcate wheth. interior or corner lot STATE OF NEW YORK .... COUNTY OF . .'~O~:4mC~. ~ a .... .~ O~./~.~ . F~-lg-~AJ [ . ~:~ ..... being duly sworn, deposes and says that he is the apphcm (Name of individual signing contract) above named Hemthe . .. ~.~-l-t ....................................... (Contractor, agent, corporate officer, etc ) of said owner or owners, and Is duly authorized to perform or have performed the smd work and to make and file tb application, that ail statements contmned m this application are true to the best of his knowledge and belief, and that ti work wdl be performed in the manner set forth m the application filed therewith Sworn to before me thru ....... ~....day of .~.(~.~.. ........ 19~."/. (Signature of apphcan · AT' BLA[~ O.CU~N,..~' OR USE IS UNb~¥~'~ UL WITHOUT CERTIFICATE OF ~OUP~NOY i