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Home My WebLink About15372-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No... ~r .55.39 Date D.e..ce.m. ber 23.,. Deck addition THIS CERTIFIES that the building ...................................... Location of Property .,. 2 5~5 5. ~m.£r~. R~o.a d .......... Gu t ch.c~ g u ~.,. ,1,] ¢ w..~o r k. mouse r~o. Street County Tax Map No. ]000 Section ..... 1.0.9. .... Block ..... ~ ......... Lot ..... .8. Subdivision ............................... Filed Map No ......... Lot No .... conforms substantially to the Application for Building Permit heretofore fried in this office dated 0 ¢.~.o.h.e..r..6., .......... 19.8. 6. pursuant to which Building Permit No. 1 5 3.7. 2. .z. dated ..... ac t ob.e~. 7 .............. 19..8.4 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 ......... De.c.k addi.tion .t.o side. and rear of existi.ng one family dwelling. The certificate is issued to .. RICHARD W. GRATHWOHL & JOANN GRATHWOHL ................... io¥.'o;,x .................... of the aforesaid building. Suffolk County Department of Health Approval ........... ~/.A. ........................... UNDERWRITERS CERTIFICATE NO N / A . ..., 19..~6 Hamle~ Building Inspector 1/81 ~Olt~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDiI~IG PEP~AIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15372 Z Permission is hereby gronted to: ........................................ ........................................ ~oun,~ Tox Mop ~o. ,000 ~e~t,o~ .//....¢ ........ ~,o~ .... ,~ ......... ~ot ~o....~ ............... pursuont to opplicotion doted ...... .~.....~ ......... ~.. ............ , 19..~..~, ond opproved by the Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD 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: 1. 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. 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 property 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 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: 1. Certificate of occupancy $§.00 2. Certificate of occupancy on pre-existing dwelling $15,00 3. Copy of certificate of occupancy $1,00 5.Updated C.O. $15.00 Date ~. ........ New C OhS %puc f, i on ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property...~..~, .~...'~., ....... ~/-/-~.'~/'~...~.~.~..~/.. .... ~.~,~.~,/--(~ .... House No, / Ham/et, Street -- Owner or Owners of Property ,f~.'. ,~..~.~l .~~.~/, Z .................. CountyTax Map No. 1000Section ..//-/.~. ....... Block ..... ~ ...... Lot..~'' ........... Subdivision ................................. Filed Map No ........... Lot No .............. Permit ,o./~.~'"~..~.~.. Date of Perm, t~.~'7~.. ~./Z?~'~.Applicant..~./~.z'Z.. ~ .~"..~/.~. ~/ ...... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate . ~ .............. Fee Submitted $ ..... ~z~. ~, .~.~. ................. Construction on above described building armrests all a,p~_~ an~flg~tions. Applicant~,~:~./~ ................ Rev, 10-10-78 FIELD INS~ECTION FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL.: 765-1802 ^pprove,I . . ."7. .... l g Pernfft No. Disapproved a/c ..................................... (Building inspector) APPLICATION FOR BUILDING PERMIT Date ................... 19... INSTRUCTIONS a. Tiffs application mnst 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 afljohfing premises or public streets or areas, and giving a detmled descnphon of layout of property must be drawn on the diagram which is part of this appli- cation. e. Tile work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of tins apphcatxon, the Bmlda g 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 MA~DE 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 denmlition, as herein described. The a licant agrees to comply .with all applicable law~, ordinances, b.)qlding qo~de, hous~n~ code, and regulations, and to · PP-. . ,.' ..... ~fnrs on nremJses an, it building for necessary i/5~lSectl/of}s/ ~:/ ~ adnutauulorlzcumol ....... r . '. ' , , ~ - ;... io.,V · · · ~A/S~nature of applicant, or name, if a cot; orat' . .................... . ..... (mai~n~g addrgss'P[ app;tic.ant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrlcmn, pmmt~er or ounaer. ...... ~..c~.. 7.~',~-. ..... ,~..' · · ~" ";' '~ '. / / / / ~ow~ ~s ~OXm Nmne of owner ofpre'mses .~1../.'~ ·~.. .~..~<1~/ ~-'/*'~' ' ~t~t~x~:late~ B[P* If applicant is a corporation, siguature of duly authorized officer. (Name and title of corporate officer) Budder s L,cense N ................ l'lumbm"s Licansc No ...... .~..",~ ............. Electrician's License No ' · Other Trade's License No ...................... I. Location of land on which proposed work will be done ............ r~,[~lGr, D[~" ' '~"~'" ::t~IRD' "~ ........ .................. ltouse Number Street County Tax Map No. 1000 Section .. ~ Block Lot ........... Subdivision ......... ' ......' ...................... Filed Map No ............... Lot ............... (Natne) 2. State existing use and occupancy of premises and intended use and occupancy of proposed constn~ction: a. Existing use and occupancy . · · ~"~. ' ~-' ' .'" ' '": ' .": ...... . '~ ........ b. Intended use and oc,,:,-,~ncy ,,~,,t-r'~,..~..~ ~ .............................. / atim{ N f rk (el k whiclfapplic bi )' New B ilding Addition Alter 3. atureo we 1¢c , fl e. u ........................ ... 'i .... ............ epair ............ Removal .......... Demohtion .~ .......... Other Work (D ripti ese on 4. Estimated Cost ....................... .. .. . . .. .. .. . . Fee.~..t~.~.~..C~.. ....................... (to be paid on filing this application) i . , N tuber f dw lling its hfloo 5. If dwelling, number ofdwellipg umts ............... u o e un on eec r.. ............ If garage hum bet of cars ...~. · · '" · · 6. If business, commercial or miked occupancy, specify nature and extent of each type of use .......... ~.. ..... ' ' ' if any Front ' Rear Depth 7. Dimensions of exmtmg stmctgres, · .......... ~. .......................... lteight ............... N~mber of Stories .................................................. · ' ' Front Rear Dhnensions of same structure with alterat:ons or addmons: ............................. Number of Stories' Depth ................. ~ .... Height ...................................... 8. Di~nensions of entire new coOstruction: Front ............... Rear ............... Depth ......... Number of Stories lteight ....................... ~ ......................................... 9. Size of lot: Front ........ , ..... ........ · ........ · ' D h ' ",:'! m -;; 10. ate of Purch se ....... ~ ............ . ..... ,... N of Former Owner . :.. 11 Zone or use district in whmhipremmes are mtuated .................................................. 12. Does proposed constructl%n vtolate any zoning law, ordinance or regulatmn ............... . ............... 13. Will lot be regraded . ././(9~ ................. Will excess fill be removed from premlses: Yes ' Address Phone No 14 Name of Owner of premises ............. ' Phone No Name of A~chitect' i Address · · , ; Phone No ............ Name of Contractor ...... ~ ................... Address ............. ~¢ ..... No ~'~.. 15. 'ts LbJs property located withinl,00 feet of a tidal wetland? Yes ..... · If yes, Southold Town Trustees Permitp~be required. i ' DIAGRAM Locate clearly and distinctlyl all buildings, whether existing or proposed, and, indicate all set-back dimensions property lines. Give street and block number or description according to deed, and she street names and indicate whel interior or corner lot. OCCUPANCY OR U. IS,.UN WFUL STATE OF NEW-/~O[>,I~, ~ o e ·..~..~. '~,~'~4. Z.( ~ ...... '~.. ........ being duly sworn, deposes and says that he iS the appli. (Name of individual]signing contract) above named. ~llcisthc [ ...~~'''"' '." .............................. ,' (Contractor, agent, corporate officer, etc .) of said owner or owners, and i~ duly authorized to perform or have perfo~ned the said work and to'm~e and application; that all statements Contained in this application are true to the best of his knowledge and belief; and tha~ work will bc performed in thc m~nner set forth m the application~filed therewith. Sworn to before me this ,