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Home My WebLink About15177-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No Z15117 November 21 86 Date THIS CERTIFIES that the building . ]~o.o ~. ........................... Location of Property HDuse'lVo' 35 Second Avenue Peconxc · Street Ham/et County Tax Map No. 1000 Section . .67. Block . .2. ...... Lot.. 'I 9 ............ Subdlmslon ................. Filed Map No ....... Lot No ........... conforms substantially to the Apphcatlon for Bmlding Permit heretofore filed m this office dated ..... Au.g:..5 ....... 1,98 .6 pursuant to which Bmlding Permit No.. 15. l..7 ?.g ........... dated ~. ~t...~ .......... 19 8. 6, was issued, and conforms to all of the requirements of the apphcable prowsions of the law. The occupancy for which this certificate ~s issued ~s .... The certificate is issued to MARILYN Q. HOFMANN of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE NO N/A N775023 Rev, 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PER~4.1T (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 15177 Z Dote ~.,~...~........~. ............ , Permission ~s hereby' gran~ ~~.....~.~..~ ...... ~.~ ............. ,o .~~...~...~,~.~,,~.~ .~...~..~ ~.~.....~.....~~. at premises located ot , County Tax Map No 1000 Sect,on ~ ~ ~ . Block .....(~.....~.... ....... Lot No. ......... ~ ...~ pursuont to opphcotion dated . . ~' ~';~. ., 19.~.~°., and approved by the Building Inspector. Rev 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Bu ~lding Department Town Hall SouthoM, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A This apphcat~on must be filled ~n typewriter OR ~nk, and submitted ~n duplicate to the Building Inspec- tor w~th the following; for new buddings or new use' 1. F~nal survey of property with accurate location of all buddings, property hnes, streets, and unusual natural or topograph m featu res. 2. Final approval of Health Dept. of water supply and sewerage d~sposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercml buddings, Industrial buddings, Multiple Residences and similar buildings and mstalla- t~ons, a certificate of Code comphance from the Architect or Engineer responsible for the budding. 5. Submit Planning Board approval of completed s~te plan requirements where applicable. B. For ex~stmg buddings (prior to Aprd 1957), Non-conforming uses, or buddings and "pre-existing" land uses' 1. Accurate survey of p~*operty showing all property hnes, streets, buddings and unusual natural or topographm 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- tlOn required to prepare a certificate, C. Fees' 1. Certificate of occupancy $5 00 2 Certificate of occupancy on pre-ex~stmg dwelhng 3. Copy of cert~fmate of occupancy $1.00 4.Vacant Land C.O. $5.00 New Building .......... Old or Pre-existing Budding Location of Property ...':-'~.....'~%..'~.?,~'.'~...¢~...~..O.~.. House No $15.00 ........... Vacant Land ............ Stmet Hamlet Owner or Owners of Property . ,4.-;,¢,~/~Y'/¢' ~. County Tax Map No 1000Section ~'-~'-/~ Block Lot Subdw~s~on ........... Fded Map No ....... Lot No ......... /,~/77Z Date of Perm.t .F'/.A./.~., Apphcant ~::~"fJ '~' ~,4¢~,~ Permit No. Health Dept Approval ................. Labor Dept Approval ....................... Underwriters Approval .v..¢~../.~. ¢~./~.$¥/ ....... P~annm§ Board Approva{ Request for Temporary Certificate ............. Final Certificate '/ Fee Submitted $ Construction on above described budding and permit meets all applicable codes and regulations. Rev 10 10-7a 1. FOUNDATION ( ls t) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND £ ] INSULATION [ ] FRAMING REMARKS: [ ] FINAL loo]3sl THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~--IP'.g B5JOHNSTREET, NEW YORK, NEW YORK 10038 ~.t~ ~to~r 17, 1~ A..,,~.,,o.~o o.~.~ ~6~/,~ N 775023 ~,~ide ~sexa~nmedon J~ ~} 1~ a~dfoundtobemcomphaneeu~ththerequ~rentent~ftfit~Bo~rd ~RVt~ m~ONNECT / ~ ~ S E R V I C E (~ipg ~,~) TMA ~ificate ~Ve~ ~lia~ at the dae of in~aion only. ~e of ~1 en~nts it is ~s~le to have f~nt t~/a~ or rep~ t~e by a q~lified Jody Punlllo Pat Lane Mat~ituck, N.Y. 11952 Lic. 2300E OENF~.AL MANAGER 11 j: This ¢erhhcate must not be altered m any manner, return to the off~ce of the Board f ncorred nspectors may be ~dentlfmd by their credenhals ~ COPY FOR BUILDING DEPARTMENT THIS COPY OF CERTIFICATE MUST HOT BE ALTEEED IN AHY MANNER Approve~t.~l~'[ "'x I ~ D~sapproved a/c ~ ' ,, .,'t~ .~ ' FORM NO 1 '~ ~"~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y 11971 TEL,: 765-1803 · , 19~]* Permit No 1.~']-2 ~ (Budding Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a Tlus application must be completely filled m by typewriter or in ink and submitted to the Building Inspector, wlth 3 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 premises or public streets 'or areas, and gtvmg a detmled description of layout of property must be drawn on the diagram which is part of this appli- cation c. The work covered by tlus apphcat~on may not be commenced before issuance of Budding Permit d Upon approval of th~s application, the Building Inspector will issued a Budding Permit to the apphcant Such permit shall be kept on the premises available for inspection throughout the work. e. No braiding shall be occupied or used in whole or in part for any purpose whatever untd a Certificate of Occupancy shall have been granted by the Budding Inspector. APPLICATION IS HEREBY MADE to the Bufldmg Department for the issuance of a Bmldmg Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordmances or Regulations, for the construction of buddings, ad&tmns or alteratmns, or for removal or demoht~on, as herren described The apphcant agrees to comply with all apphcable laws, ordinances, budding code, housing code, and regulations, and to admit authorized inspectors on premises and m budding for necessa~m~~/b,~ ./~..6~.~ (Szgnature,~f apphcant, or name, if a corporatmn) .............. State whether apphcant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumoer or builder c. .............. Name of owner of premises ,/~r'~-,~' (~./-/'~. zvlzl ~v' ................. (as on the tax roll or latest deed) If apphcant zs a corporation, signature of duly authorized officer 2 (Name and title of corporate officer) Builder's L~cense No 7~;J7~''' Plumber's License No EJectncmn's License No Other Trade's License No ~ g- Location of land on which proposed work will be done ~5'?co?~. ,4~ ~v~?./. *P~o-~,~re... House Number Street Hamlet County Tax Map No I000 Sectmn I~ 7, - :2 -./~ Block . . Lot. Subdlws~on Filed Map No . Lot (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction a Ex~shng use and occupancy ~-,,~',~ z~or /' ~-~t'/,)~f,,~'(2~' ..... b. Intended use and occupancy ~'/,~,~zMF~-. ,~ooz- ~ ~r'~.~_~g? .... 3. Nature of work (check which apphcable) New Building .. Addition ....... Alter~ion Repair .... Removal .- . . Demolition ......... Other ~ (Description) 4 Estunated Cost. · ~ ................. Fee .............................. (to be paid on filing this application) 5. If dwelling, number of dwelling 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. Dunenslons of exmtmg structures, if any. Front ......... Rear ....... Depth ..... Height ........ Number of Stones ................................. Dunenslons of same structure with alterations or additions' Front .......... Rear ............ Depth ........ Height ............ Number of Stones ............... 8. D~rnenmons of entire new construction Front ......... Rear ........ Depth ......... Height ... Number of Stones ........ ; ..................... ; ..... 9. Size of lot Front ~: ...... Rear . . .'~'..~ .......... Depth .... ./.~-.q ...... 10. Date of Purchase .... /.17.~. ............... Name of Former Owner 11 Zone or use district mwhlchpremlsesaresltuated . . . .. ... .. .. . .. .... ..... 12 Does proposed construction ylolate any zoning law, ordinance or regulation ./~Jl~) ...... 13. Will lot be regraded ,/~.-~.~ ..... ._.., ~ . . Will excess fill be removclt from premises ..... Y;s ' ' ' 14, Name of Owner of premises fit. I~r~/tl//x-J a~ /a~C. dAddress .~]~..~.-q~?~.xJ. ~.~.. Phone No .......... Name of Architect x~ .: .... Address .......... t. Phone No .......... Name of Contractor ~'~:X$tx.? ~..- ~.~. ii . Addresst~dt:TWdD~-v~>../L~q, Phone 15. Is this property located withinl00 feet of a tidal wetland? ~ Y65 ..... N~ ..... · If yes, Southold Town Trustees Permit may be required. PLOT D~AGRA~ Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dnnenslons frm property hnes Give street and block number or descnphon accor&ng to deed, and show street names and mdmate wheth~ lntenor or corner~qt STATE OF NEW YORK, COUNTY OF S.S (Name of individual signing contract) above named being duly sworn, deposes and says that he is the apphcar 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 th application; that all statements contmned m this apphcatmn are true to the best of his knowledge and behef, and that ti~ work will be performed in the manner set forth m the application filed therewith. Sworn to before me this .... f... dayof ~ ...... 19~. Notary Pubhc, ~ . .~ .~.~../~..~ ..... Cou~/~ Ig~l~'y~t~.~#~ (Signature of apphcan '~tOTF:Y ~UILD!NG OEPARTMF3NT AT ?~5 180~ ~ e~ TO ~ ~ ~R THE FOR ~OURED ,~O~RETE 2 ROUGH FRAMING a ~UMBING 3. INStJLA rlOr~ &, FINAL CONSTRUCTI~ B~M~ETE FOR C.O. ALL COmeCON ~ALL ME~ T~ aEQU~S ~ mE N.Y ~A~ CO~~ & ~aY ~N OR C~ON OCCUPANCY OR ~ USE IS UNLAWF~ WITHOUT CERTIFI~RTE OCCUPANCY 14-