The URL can be used to link to this page

Home My WebLink About16156-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.Z 15903 Date July ], 1987 THIS CERTIFIES that the building . .A.c.c.e..s ,s.o. r, y. .................................... Location of Property .. ! .3.2..5..S..O.U.N.D.V. IEW RD. ORIENT House lye. ' .............. 'S'tie i ....................... County Tax Map No. 1000 Section 0 15 .Block 3 .Lot 15 p/o 19 & all Subdivision Orient By The Sea .Filed Map No. 27777 .LotNo. of 20 conforms substantially to the Application for Building Permit heretofore filed in this office dated June 29, 1987 . pursuant to which Building Permit No. 16156Z dated . .J.u..n.e..2.9. ,..1.9.8..7 ........... 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.cc.e.s..sp.r.y. deck as applied for. The certificate is issued to ROBERT S. MUMFORD ..................... ................... of the aforesaid building. Suffolk County Department of Health Approval ...... .N ./.A ................................. UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED: N/A Building Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 16156 z Permission is hereby granted to: .. 0 t" ff .~.....~..~.,..L.L~...'2./. .......... , ~ at premises located at ..~/..~..~.~...~-~.~ ........ m.~ ....................................... County Tox Mop No. I000 Section ....~.1..~.. ......... Block ...... ...~.~ ...... Lot No......(~.L.~....: ..... pursuant to application dated ......... 5.~..~m..~. ............. , 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 OCCUF 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 topograpl~ic 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 p~operty showing all property lines, streets, buildings and unusual natural or topographic featu res. 2.Sworn statement of owner or previous owner as to use, occupancy and conditipr~f buildings. 3. Date of any housing code or safety inspection of buildings or premises, ore, thor pertinent informa- tion required to prepare a certificate. C. Fees: Additions $25.00 1. Certificate of occupancy New Dwelllng.$25.Q0, AccEssory i$[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 .............. NewC°nstruc%i°n ..... ~rPre-existing 8uiJ~ing .~ .... Vacant Land ............. ~ocation of Property.../.~. ~':~-".' ...................... ~ '.'~.. ..... ~ ....... ~+. '..~'.~.... House No. Street Ham/et Owner or Owners of Property .... .~,~...----...~....-~- ............................................ ~'. County Tax Map No. 1000 Section .............. O/~. Block .... ~. .......... Lot.. .............. Subd,vlslon' '' ,c.~.~.~L / ......... ~ 777 ............. /.'.. · · ·....~> ..... 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 I~ermit meets all ap,plicable codes an.~i regulations~. OLD Ge~ENWI~H, ~;ONN, 0~70 Southold Savings Bank Southold, N.Y. Dear Sirs: This will certify that my home on lot 20 on Soundview Road In Orient by the Sea is a residential property and was built prior t o ~9 57 · Yours ty~ Subscribed and Sworn to before me, a Notary. IRENE M. KEEGAN NOTARy PU~3LIC Co~nmissJon exprres March 31, 1991' 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [~INAL REMARKS: DATE 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH ,PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING DATE. UND~TION (1st) UNDATION (2nd) UGH FRAME & PLUMBING SULATION PER N. Y. STATE ENERGY CODE FINAL - ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT SEPTIC TOWN HALL SOUTHOLD, N.Y. 11971 ~ TEL.: 765-1802 CALL MAIL .... Aeb~-~ .,R~t., 19~ .7. Examined ~ . Approved ... ttt~...~..~., 19~ .7. Permit No. ~..~.{ .~..~..~.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... CHECK .......... FORM ............. : TO: Date .................. , 19... INSTRUCTIONS a. This application must be completely filled in by Wpewriter 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 b~ti~j~gs on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description qft i~ >u~ ~l?¥rope~y must be drawn on the diagram which is part of this appli- cation. ~ ~ ~,~ v .~? ~ c. The work covered by tlliyt/~p '~a~n'~] ~a~ ~n~o~n?~ ~fore issuance of Bufld~g Permit. d Uoon anvroval of t~b~v, lida :~o~, t$a ~ ~s~t~fwill'i~iued a Bufld~g Pemit to the appHc~t Such pemit sh~l be kept on the prem~se~va~bR ~ [~] ~~e work. e. No bulldog shall be %c~g ~se~ ~ ~~t for any purpose whatever until a Ce~ificate of Occup~cy shall have been granted by the~{~; g I~ [~ ~ ~ ~PLICATION IS HEREB~ aE"t~ ~l ~p~tment for the xssuance of a Bmldmg Pe~xt pu~u~nt to the Building Zone Ordinance of the~o5 n ~g~ 7~ ~,'guffolk County, New York, ~d other applicable Laws, Ordm~ces or Regulations, for the constmctio~'b~ bd}fl~g ~ additions or alterations, or for removal or demolition, as here~ described. ThE applicant agrees to comply ~it all appficable laws, ordinances, building code, housing code, and regffiat~ons, and to admit authorized ~spectors on premises and ~ bulldog for necessa~ inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee,~architect, en~neer, general contractor, electrician, plumber or builder. (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... ............ (as on the tax roll or l~aee~~/ ...... If applicant is a corporation signature of duly authorized officer FEE,~..'~ % F.O~i C.O. AL~ : '~ON Other Trade's License No ...................... ~-~ .~> -,~.,:,, c,,OCgJ~t 1. Location of land on which proposed work will be done.. ~'{~ ....... ',~'~ . d.: 7...::;:~ ':'>: ~.'. ..... .................. ...... .... : ............. House Number Street Hamlet County Tax Map No. 1000 Section 0/~ ¢~ Block ~'~ Lot. 7 ...... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............................... ~ ~ l~.k,~.~,> ........................... b. Intended use and occupancy .......................... ~.. ,,,~,? .~i,,~e;.:. m.~,.~,~...~:, ....................... 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... Alteration .. 'j~t ..... Repair, .............. Remov. al .............. Demolition .............. Other Work, ~ ...... 4. Estimated Cost . .~-~"-~....~.... i. ........................ Fee ..................................... ' (to be paid on filing this application) 5. If dwelling, number o f dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars .... ; .................................................................... 6. If business, commercial or mixed~,qqc,.upancy, specify nature and extent of each type of use,.. '. .................. 7. Dimensions of existing structureJ?~'tf~'~y· Front . Height .... ; ....... '. ;'. Number of Stories ....... J. 7. '.; ........... '. ..... : ......................... Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth; ............. , .....;.. Height ...................... Number of Stories ...................... Dimensions of entire new construction: Front: ......... . ..... Rear ............... Depth ............... t?ight .... ~ ........... Numl~er of Stories ...................................................... 9. Size of lot: Front ...,~/.'~...aT..'J".4 .......... Rear .... . ./.2. 37.-~.ff-. i ......... Depth .... .~.O..~. i'.~. .......... 10. Date of Purchase .. ~; .~.~ ./. g.b. J/. ........ ,~a~m,.e~.of_F/qr~n~er Owner ............................ 11. Zone or use district in which premi§es are situated... ~q-r-,g~pr'~.._ .......... ' 12. Does proposed construction rio!ate any zoning law, ordinance or regulatinn: ....... ' ......................... 13. Will lot be regraded ........ ,, ..... ~'T ...... ~ .... Will excess fill be removed from premises:_ yes -, No 14. Name of Owner of premises .~,~--M'~...: .~./.ooA?~...J~Address /fi/,~.t~..('..~...~...<~..~PT'. Phone No.~.~.4."~.Y.~: .~. ~J."~- Name of Architect ......... ; ................. Address ................... Phone No ................ Name of Contractor .......................... Address .... : .............. Phone No ................ 15. Is this property located within 300 feet of a tidal wetland? ~Yes ..... No ..... · If yes, Southold Town Trustees Permit maybe required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or. p~:opo~ed, and, indicate all set-back dimensions from property lines. Give street and block number or description according t~ de~c[~ and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, -- '' S.S ': ................... ~ ............................ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the .................... . .................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is, duly authorized to perform or have performed the said work and to make and file this application; that ali statements contained in this application are true to the best of his knowledge and belief; and that the work will loc performed in the manner set forth in the application filed therewith. Sworn to b~fore me this (Signature of applicant)