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Home My WebLink About15211-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No .... ~.~.5.59.~ ....... Date . D.~.c. ?.m.~.e.v...1.5., .................. 19..~.6 THIS CERTIFIES that the building .... .~?.q 9 n .d..~. ~ 9 .vy'..a..d .d 3.~.~ 9 .n..~.q. ?.x.~ ~. ~ 3.r~.~.. 9 .n.~ famzly dwellzng Location of Property ....1.~.O..O.l.d..M~.l.q. ~p.a.d...: ......... M.g.L.~.%L. 9?.2.,' ~.o~..Y..q.r.~ ...... House no. Street Hamlet County Tax Map No. 1000 Section . ,1.2.~ ........ Block ,...0 2 .......... Lot.. 2 Sub&vmion ............................... Filed Map No ......... Lot bio .............. conforms substantially to the Application for Bmlding Permit heretofore fried in this office dated 3.u. fi u..s .~.. 1. ]: ......... ,198..6. pursuant to which Bmlding Permit No. ! 5 2 q. 1 Z dated .~.u.gu. s. t..2.9.: ................ 198.6. ., was issued, and conforms to all of the requirements of the apphcable provisions of the law. The occupancy for which this certificate is issued is ......... ·..~ ~.o.r~d.. &~.qc.~..a ~.d. ~..~ 3.o.n...t.o..~.¥ .~.s.~.~. n. & .qn.e...r.a.m. ~. 3Y..d.¥? .~.~.~.n. ~: ............ The certificate is issued to . MILDRED LAUBE.NGEIGER & GILBERT KOLLOFF (owner, I~s~'j~ ~rXt~rR~ X X of the aforesaid building Suffolk County Department of Health Approval ............~ / .A .......................... UNDERWRITERS CERTIFICATE NO ~.7.7. ? J 3.8. ............ ?~umbers Certzf~cat~on dated November 171 1986 R~ 1t81 ingInspector IFOILM NO. It TOW'N OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, FI. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Perm~ssron ~s hereby granted to ...... ................. at promises I~ated at ....l.~ ........ ~...~ .... ~ ~ ....... ~..~~ ............ I :Z~~- County Tax Map No 1000 Section . Block .......~.......'~.. ...... Lot No .....~ ...... pursuant to application doted (~ ~. LI .... , 19~.~, and approv~ by the Budding Inspector Fees ~.'./ 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 OCCUPANCY NOV I 1986 A. This application must be filled in typewriter OR ink, and submitted m ~ to the Budding Inspec- tor w~th the following, for new buildmgs or new use' 1. Final survey of property w~th accurate location of all buddings, property lines, streets, and unusual natural or topograph ~c featu res. - 2. Final approval of Health Dept. of water supply and sewerage disposat-(S-9 form or equal). 3. Approval of electrmal installation from Board of Fire Underwmters. 4. Commercial buildings, Industrml buddmgs, Multiple Residences and simdar buildings and installa- t~ons, a certificate of Code comphance from the Architect or Engmeer responmble for the buildmg. 5 Submit Plannmg Board approval of completed site plan reqmrements where apphcable. B. For existing buildings (prior to Aprd 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operty showmg all property hnes, streets, buddmgs and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buddmgs. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a cert~fmate. C. Fees: 1. Cert*ficate of occupancy $5.00 2. Certificate of occupancy on pre-exmtmg dwelling $15.0 0 3. Copy of cert~fmate of occupancy $1 00 4.Vacant Land C.O. $5.00 5.Updated C.O. $15.00 Date ...~.d~J,.J~,./ .~,~. .... NewConstructzon ..... Old or Pre-existing Budding [/' Vacant Land LocatJon of Property ~0 .~?,/--.~ ~..~,;?..~.5, House No. Street ~ Ham/et Owner or Owners of Property .... .~J L../~. '~. /~¢ Z.j~ .~ ~.~"....~.gO. ¥ .~R ~7.B County Tax Map No. 1000 Section ... ~..~. ~ .... Block .... .0 .~. ....... Lot.....~. .......... Subd~wmon ................ Fded Map No ......... Lot No .......... PermltNo !~.~.. J J .~... DateofPermltf~..~.?.%. Applicant .... ~.0.~... ~ ........... Health Dept Approval ......... Labor Dept. Approval ..................... Underwriters Approval...~...~.7.~ ~..~. ~. .... PJannmg Board Approval ..................... Request for Temporary Cert~hcate ................. Final Certificate / Fee Submitted $ .................... Construction on above descmbed building and permit meets all applicable code~..~ regulat~on~ App[,cant . . . ~r-(~ .~/~.. p~.,..~./~. .... ~' ~ ' 'c/' '~t~' .... Rev 10-10-78 ._% 0 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Permit No. i S2. Owner (please pr znt) Plumber~ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. lunfoer s slgnature) Sworn to before me this /7 day of ~'- , 19 ~ · / Notary Public, ~~ County Notary Public NOTARY PUBLIC, State of ~ ~ No 4707878, Suflo~ ~ lerm ~W~ ~;ch ~ I~ FOUNDATION (1st) FOUNDATION 2. ROUGH~& PLUMBING (2nd) INSULATION PER N. STATE ENERGY CODE ADDITIONAL COMMENTS: OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY D, &TI NOTIFY Bt,IILD~NG OEPART'A/IENT AT 765 1802 9 AI~ TO · r,~V rFOR THE FOLLOWING INhPEC:TION.'., FOUi~ OA'rlf, jl~, tWO F~R ~OUREO COI~q:;F'I: 2 RO,J.~.r.I FRAMI~'~f.- .~ PL?Or~,iGING 4. FfNAt CO~$TRUC'FIO~ '~UST TH[ ~EQUIF~N~ Of THE N Y ~IGN OR CC ~STHUCTtO~' ~RRORS JOHN C. BORN BUILDER co7v~. 6c 516-477- 1095 765-1802 BUILDING DEPT. INSPECTION [ ] FRAMING REMARKS: [ ] FOUNDATION 1ST []ROUGH PLBG. [ ] FOUNDATION 2ND []INSULATION []FINAL DATE //~/~/'~/~" INSPECTOR///~'¢~'~'~ 765-Z802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. I* '] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING REMARKS: DATE 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST []ROUGH PLBG. FOUNDATION 2ND []INSULATION []FINAL [ ] FRAMING REMARKS: llllllllllJlllllllUllilillllllllllll~lJ~ t{I~U Jllttli~lliliiJllitllJtllll hi~ I ~m IIIhlJlllJtlllllllltllllllllt~ tlJlllllJlillllllliltlll[llllllilllt~ Approve~.~ ~,?~-.' ~c} Disapproved a/c .. FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL.: 765-1802 , 19]~~ Permit No (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .......... 19.. INSTRUCTIONS a. This application must be completely filled m by typewriter or an mk and submitted to the Building Inspector, with sets of plans, accurate plot plan to scale. Fee according to schedule b Plot plan showing location of lot and of bmldmgs on premises, relationship to adjoining premises or pubhc stree or areas, and g,vmg a detmled description of layout of property must be drawn on the d,agram which as part of tins app caD. on. c. The work covered by this application may not be commenced before issuance of Budding Permit i d. Upon approval of this application, the Building Inspector will issued a Bmldmg Permit to the applicant. Such peru- shall be kept on the premises avadable for mspectmn throughout the work e. No building shall be occupied or used ~n whole or m part for any purpose whatever until a Certificate of Occupan, shall have been granted by the Bufldmg Inspector APPLICATION IS HEREBY MADE to the Buildmg Department for the issuance of a Budding Permit pursuant to tl Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances, Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as hereto describe The apphcant agrees to comply with all apphcable laws, ordinances, bufidmg code, housing code, and regulations, and admit authorized inspectors on premises and m building for necessary mspeffli°n~/~-/1 ~/~ . ....... (Smna~ure of apphcant, or name, if a corporation) ..... ?:p.. ...................... 3. ....... tmailing address or appJ_:tcanc) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bmlde Name of owner of premises a I L0;~'~ (as on the tax roll or latest deed) If apphcant ]sa corporation, signature of duly authorized officer Bmlder's L~cense No. Plumber's License No Electrician's L~cense No (Name and title of corporate officer) Other Trade's License No 1. Location of land on winch proposed work will be done House Number ' ] ~ ~ ' 0/-~. S~t'~ ~ County Tax Map No 1000 Sectmn .. Block . Hamlet 2 Subdlms~on .. Filed Map No .... Lot .... (Name) State existing use and occupancy of premises and ~ntended use and occupancy of proposed constm, ctmn a Exlsnng use and occupancy QM.~.... ~Jl,~l.l,,..)/ '~'L~l~.l .t~r~. ................... b Intended use and occupancy /~0.D ~.~/9v¢:.~ ~ -- -- -- ~.~ .~t'I~F-,~kl~..--~.~,.I~..,~7~I.L¥ ...... 3. Nature of work (check which applicable) New Bmldmg ........ Addition.. ....... Alteration ..... Repmr .... Removal ...... Demolition ......... Other Work .......... ~ Fe L~..~.~ ~.~. (Description) Est~nated Cost .......... O0~.~).U~i~. ........... ..... 4 (to be paid on fihng this application) 5. If dwelling, number of dwelhng units .......... Number of dwelhng umts on each floor ........... If garage, number of cars .................. 6 If business, commercial or mixed occupancy, speedy na}ure and extent of each type of use ........ ~. j ...... 7. Dnnenslons of ex~stmg stractures, if any Front.. ~.~c ...... Rear ............ Depth . ~.. Height ............ Number of Stones . ' a ~'~-- .... j.'igi'~ ................ ~' ....... Danensmns of same structure with alterations or additions' Front .... -t ........ Rear .. o~ ........... Depth ........... Height ............... Number of Stones. . ~7~ ............ 8. Dimensions of entire new construction Front ......... Rear ........... Depth .......... Height .......... Number of Stones ........................................ 9. Size of lot Front .............. Rear .................. Depth ............... 10 Date of Purchase .................. Name of Former Owner .. 11 Zone or use district in which premmes are situated ............ 12 Does proposed construction wolate any zoning law, ordinance or regulation- .1~ ~. .................. 13. Will lot be regraded ............... Will excess~.~ -~._, ,..~.£H1 be removed from premises Yes Name of Owner of premises ~J~2~U,~f~ J~J~.'~.a.~]q~ddress . ~-%c'.~ ....... Phone No. 14. Name of Architect ~ ..... tO ....... Address ............... Phone No Name of Contractor . CI~ .~qO...q. ItX.~,,t,l ........ Address ?-..P<~T /0'~. P~. . Phone No * Yes ..... No ..... 15. Is this property located wzthinl00 feet of a tidal wetland? * If yes, Southold Town Trustees Permit may be required. PLOT DIAGRA~ Locate clearly and distinctly all buildings, whether existing or proposed, and, mdlcate all set-back d~nensions fr, property lines. Give street and block number or description according to deed, and show street names and indicate whorl interior or corder lot STATE OF NEW YORK, COUNTY OF. . SS (Name of individual s~gulng contract) above named being duly sworn, deposes and says that he is the apphca He is the ............................. (Contractor, agent, corporate officer, otc ) of smd owner or owners, and is duly anthonzed to perform or have performed the said work and to make and file tl apphcatlon, that all statements contained m this application are true to the best of his knowledge and belief, and that t work wdl be performed in the manner set forth m the apphcat~on ~ed therewith. Sworn to before me this ..... .... Notary Public .......... County /'~ ,'1 f/~ ...... / (Signature of apphca~