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Home My WebLink About15480-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hail Southold, N.Y. Certificate Of Occupancy Date July 14, 1987 THIS CERTIFIES that the bmldmg .a. ? .e .e s.s. o. r y .......................... Locat~on of Property 1280 Deidrzcks Road Orzent House No Street Hamlet County Tax Map No. 1000 Section . 91.8. .... Block 0.3 ........ Lot 28 Subd~wmon .................. Fried Map No ..... Lot No ........... conforms substantmlly to the Apphcation for Bufld~ng Permit heretofore rifled m tins office dated · N. qv.:. 5.~ .19.86... pursuant to wluch Bmldmg Permit No. 15480z dated .. Nov. 8:..I.986. ..... was~ssued, and conforms to all of the reqmrements of the apphcable prows~ons of the law The occupancy for wbach flus certificate ~s msued xs ........ ?c.c?s.s.o.r7 .~a.r.a.g.e..a.s..app.15e. d The certificate ~s msued to . JEFFREY..S.. of the aforesmd building ROGERS ROSEMARY CAUFIELD ROGERS ............. Suffolk County Department of Health Approval . . . .Iq / A. ......................... UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED: N/A Bmldtng Inspector Rev 1/81 I~OR~ NO. · TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDIHG PEIUvt IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N©. 15480 Z Perm,ssron is hereby granted to ~ ..... ......... .J.!a z%.. ~.~~..1~?..~... ........ ...... ..o...~....~.:~... ................................ et premises located et ....~...~,.~..D,..i.~...~..~......-~.',...~. ,.~........~.........~~ ............................. County Tax Mop No 1000 Sect,on pursuant to application doted .. Building Inspector. F*e $. Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewmter OR ink, and submitted I ~ to the Building Inspec- tor with the following; for new buildings or new use' 1 Final survey of property with accurate IocaUon of all buddings, property lines, streets, and unusual natural or topographm features. 2. Final approval of Health Dept of water supply and sewerage disposal-(S-9 form or equal) 3 Approval of electrical mstallatlon from Board of Fire Underwmters. 4. Commercial buildings, industrial buddings, Multiple Remdences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responmble for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (pmor to Aprd 1957), Non-conforming uses, or buddings and "pre-exmting" land uses: I. Accurate survey of p~operty showing all property hnes, 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 inspection of buddings or premmes, or other pertinent mforma- t~on required to prepare a certificate. C. Fees* Additions $25 O0 1 Cert~ficate of occupancy New Dwelling $25.00, Accessory ,$]0.00 Business $50.00 2. Certificate of occupancy on pre-exmtmg dwelling $ 5 0.0 0 3. Copy of cert~flcate of occupancy $ 5 00, over 5 years $]0.00 4.wc =t c.o. 20.00 5.Updated C.O. $ 50.00 Date .. J(~ ./.. ............ . NewComs tructzon .... Old or Pre-existing Bu Haling ....... Vacant Land ........ Location of Property . 12~, .... [.'.~.~v~',I.¢,[,C. ,~'; . · ~.<~ ............................... House No l~ Street , Hamlet Owner or Owners of Property .~-~,F~.~?../ ~ ,.~.Q,XV'$ . County Tax Map No 1000 Section ............... Block ............. Lot .............. Subd~vlmon .......................... Filed Map No ......... Lot No ......... Perm,t No/'~/Mi~¥: Date of Perm,t ......... Applicant ............................. Health Dept. Approval . .~/. lQ. .................. Labor Dept. Approval Request for Temporary Certificate .............. F mai Certificate . .L~.. ............. Fee Submitted $./~.~,,, 0.0.. ............... Construction on above described budding an~ permit meets all apphcab[e codes and regulations Applicant ~(.,~c~,~j.~.~'" .~.~¢~ ............. ~.~ ~a ~-~ ~ ~d~ ' '4 ..... 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INS/ULATION FRAMING [~I=INAL REMARKS: DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION ZND FRAMING ROUGH PLBG. INSULATION [~INAL REMARKS: ~,~_ ~~~ DATE OUNDATION (1st) ~ OUNDATION (2nd) OUGH FRAME & PLUMBING ~NSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 7GS-'I80Z BUILDING DEPT. INSPECTION [ ] FOUNDATION /ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING REMARKS: FINAL DATE Approved ~Q.~'~....'~ Disapproved afc .. FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 , 19~G Permit No ] ~¢~. O..~. (Building Inspector) APPLICATION FOR BUILDING PERMIT Received .......... 19. , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ~nk and submitted to the Building Inspector, wttl~ sets of plans, accurate plot plan to scale Fee according to schedule. b Plot plan showing location of lot and of buddings on premises, relationship to adjoining promises or public stm~ or areas, and glvmg a detailed description of layout of property must be drawn on the diagram winch is part of this apt' cation. c The work covered by tins apphcatmn may n~t~ commenced before issuance of Budding Permit uhe ,f t~o~t~, const mctio~l&~ tto~ d Upon approval of this application, the shall be kept on the premises available for e No budding shall be occupied shall have been granted by APPLICATION IS tlERE Budding Zone Ordinance of Regulations, for the The applicant agrees to cpm admit authorized Inspectors on dl issued a Building Permit to the applicant Such pern urpose whatever until a Certificate of Occupan rth issuanc of Bu n r · rt ne fo e ' e a lldi g Pe mit pursuant to t ~ l~nty, New York, and other applicable Laws, Ordinances atlons, or for removal or demolition, as herein descrlbt hnances, building code, housing code, and regulations, and State whether apphcant ~s owner, lessee, agent, arcintect, engineer, gel~eral contrac~F,7~t_f~n&~lq'q~ql~,.q~ b d ......... "J Lt ' ...~ ,~ ......~,P ~ ..~.. Name of owner of premmes //~ . . ~ ...... ~.~ .j~-~-.~ ~ If apphcant ~s a corporation, signature of duly authorized officer (Name and title of corporate officer) Buttder's License No ,:~-'ffa~. Plumber's L~cense No ...... ~'rq~ ~,~,,, ..... ~-,, ,~ ~ Electnctans License No ........ ~3~,,:~, ,~ · ~ -, ~ Other Trade's L~cense No ......... Locahon of [and on winch proposed work xw[I be donq~.o,x O0 t~-,-,~[7~.'~ · ,~'~.~<- · .~. Hous~[nbe~~ ~ / 'Street Hamlet County Tax Map No 1000 Section / ~ ..... Block . .3 ....... Lot.. 2 Subd~v~slon ..... Fded Map No ........ Lot ........... (Name) State extstmg use and occupancy of prenuses and intended use and occupancy of proposed constrUction. 3. Nature of work (check which applicable): New Building )(~ ..... Addition ........ Alteration . Repair .............. Removal .............. Demolition ........... Other Work ..... 4 Estimated Cost ' Fee ............................... (to be paid on filing this application) 5. If dwellmg, number of dwelhng uni}s ............... Number of dwel. hng units yn ~ach floor ......... If garage, number of cars ....... [ .................................................. 6. If business, commercial or m~xed occupancy, specify nature and e3tent of each t¥~eof use ................ · Front r d~.~,.../ 4~'~e. 7. Dxmension%of,4x~$tmgstractures, ifany. ~.. Rear Depth. .... Height . ..~.~. ........ Number of Stones ...... ~ ............................... D~nenslons of same structure with alterations or additions Front ......... Rear ............. Depth ................... Height .............. Number of Stories 8. D~mensions of entire new construcfion' Front .... ~..ff ..... Rear . ,Y~. ~. ...... · Number of Stones · Height ' ff/~" ..................... cJ .................. ~ v '~-,~ .......... '/'9 .~ ............ .~. ............ . ................ S~zeoflot Front ........ Rear ..~ ~. . . Denth 0. Date of Purchase ...... ~...,:../,2....-: .~.e_~. ...... Name of Former Owner . ..~7~. 1. Zone or use district in which premises are situated ................ ~ .............. ~ ..... 2 Does proposed constructaon vmlate any zoning law, ordinance or regulation' ...~7_~--,~. ..................... 3 Will lot be regraded .....'?~...: .... .....,~ ....... Will excess fill be removed from premises Yes 4. Name of Owner of premmes .~.q.~. ~ddress .~ o.~ .~,~.o. 2~. ...... Phone No. ~.2~..q .3'.q$~..'7.. Name of Arcintect ...... .c--~.C. ·. f..~ ./..f ........Address .............. Phone No .............. Name of Contractor ............ ?~ ......... Address .............. Phone No ............. 5. Is this property located withinl00 feet of a tidal wetland? * Yes ..... No · If yes, Southold Town Trustees Permit may be required. ! PLOT DIAGRAM Locate clearly and distinctly all buddings, whether existing or proposed, and. ~ndlcate all set-back dimensmns fro~ 'operty hnes. Give street and block number or description according to deed, and show street names and indicate wheth. tenor or comer lot. ~ATEOF NEW YORK,~ S S )u rvo ;. ' ore named. is the (Contractor, agent, corporate officer, etc.) said owner or owners, and ~s duly authorized to peffo, rm or have performed the said work and to make and file th phcatlon; that all statements contained m this application are true to the best of his knowledge and belief; and that >rk wilt be performed in the manner set forth in the application filed therewith. ~orn to before me this ............. 2 ...... ........ ...... ,tary Pubhe, ~<~g~.. ~.-. Dt-~ Ut~ County ~ ~ - ~J (S~gnature ofapphcan