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Home My WebLink About15212-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Z14892 September 18, 86 No .............. Date ........................... 19. deck addition THIS CERTIFIES that the bmldmg .................................... Location of Property H~ase 31o .......................................... t 260 Hummel Avenue, ~t~eeSOUthold, N.Y. 0 6 3 1 5 Hamlet County Tax Map No 1000 Section ........ Block ............. Lot ................ Subdivision ......................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Bmldlng Permit heretofore flied m flus office dated August 11, 198.6. pursuant to wluch Bullding Permit No 15212 Z dated ...A.u.gu.s .~. 2.9.: ........... 19 $. 6 , was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which flus certificate is issued is ........ ....... .D.e.c..k .a. dd..~t.Aon., t.o.a..n .e.x.%st.z.n~ one famxly dwellxng. The certificate ss issued to . . .W.l.llAam & Grace Zukas (owner, ~oe)oK te~o~ x x of the aforesmd bmldmg. Suffolk County Department of Health Approval N / A UNDERWRITERS CERTIFICATE NO .... N/A Rev 1/81 FORM NO. 6 TOWN OF SOUTHOLD Bu ~lding Department Town Hall Southold, N.Y. 11971 765- 1802 ,'[\ti SEP -81986 L_ T_.OW~ OF SOUTHOLD APPLICATION FOR CERTIFICATE OF OCCUPANCY Thru application must be filled in typewmter OR ink, and submitted t ~ to the Building Inspec- tor w~th 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--iS-9 form or equal). 3. Approval of electrical installation from Board of F~re Underwmters. 4. Commercial buildings, Industrial buddings, Multiple Remdences and similar buddings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the budding, 5. Submit Planning Board approval of completed site plan requirements where applicable. For existing buildings {proof to April 1957), Non-conforming uses, or buildings and "pre-exmting' land uses: 1. Accurate survey of pz.~operty showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and cond~tmn of bu ddings. 3. Date of any houmng code or safety inspection of buddings or premises, or other pertinent mforma- t~on required to prepare a certificate, Fees' 1. Certificate of occupancy $5.00 2. Certlficate of occupancy on pre-existing dwelhng 3. Copy of certtficate of occupancy $1 4.Vacant Land C.O. $5.00 5. Updated C.O. $15.00 $15.00 Date ........................ New C ohs tDuc t ion ...... 2Id or Pr, e-Ffiistmg Building ............ Vacant Land ~ ,-3 ......... Locat,on of Proper ty H~;~...( ..... ~..~.....~..,..(~r%~.. ~~. Owner or Owners of P rope~y · ~.~ r~rr. --. X... ~ ~ ~~~/.. ....... - CounW Tax Map No. 1 O0 Sect,on ~ ~. ........ Block . .~..~ ....... Lot... ~..3 ......... Subdiwsmn .............................. F~led Map No ........... Lot No .............. Permit No .......... Date of Permit .......... Applicant .................................. Health Dept Approval ....................... Labor Dept. Approval ........................ Underwmters Approval ........................ Planning Board Approvat ...................... Request for Temporary Certificate ................... F~nal Certificate ....................... Fee Submitted $ ........................... Construction on above descmbed budding and permit eets all apphca codes a regulations. C::: .=.! C:: Z Z / / FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: C 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST []ROUGH PLBG. FOUNDATION 2ND []INSULATION []FINAL [ ] FRAMING REMARKS: INSPECTOR Disapproved a/c FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N Y 11971 TEL 765-1803 · 19~b Permit No ] k~.~J~ ~ (Building Inspector) APPLICATION FOR BUILDING PERMIT Rece~_ved ........... ~19... Date INSTRUCTIONS a. Tlus application must be completely filled m by typewriter or in mk and submitted to the Bulldmg Inspector, wzth 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 adjoining premises or public streeb or areas, and gwmg a detmled description of layout of property must be drawn on the diagram which is part of this appll. canon. c. The work covered by tbas apphcanon may not be commenced before ~ssuance of Building Permit d. Upon approval of th~s apphcatlon, the Building Inspector wall ~ssued a Building Permit to the applicant Such permit shall be kept on the premises avadable for inspection throughout the work. e No braiding shall be occupied or used m whole or ~n part for any purpose whatever untd a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the ~ssuance of a Braiding 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 demolition, as herein described The apphcant agrees to comply with all apphcable laws, ordinances, bmldmg code, housing code, and regulations, and to admit authorized inspectors on premises and in bmldmg for necessary msgeg}lons (S~gn~:ture of apphco,.nt, or (njg, a~ e, ff g ~orporanon) /'(Mailing address of applicant) / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Nameofownerofpremlses )~/~:~ .................... · -(as on the tax roli~ ..... If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builder's L~cense No. . '~.~.~. 2 Plumber's License No. Electrician's License No ...... Other Trade's L,cense NO .............. . [ .., k..._.,..~ ~ ..~ Locatlonoflandonwhlchproposedwor~wfllbedone ~vf~. :.". ~ .~. ~"'- ~ . ..... House Number Street County Tax Map No 1000 Sect,on ~': Block ...~ ..... Lot [~ Subd~ws~on ,.. -(~ame~ ..... Fried Map No ..... Lot ....... State exmtzng use and occupancy of premises and ratended use and occupancy of proposed constructmn b Intended use and occupancy ~Q ~ ~N~ ................... 3. Nature of work (check whmh applicable) New Bmlding .... Addition..qv'.~.'~..~.. Alteration Repazr .......s~" f'~F~'? '~'~'1~'tS~'Rem°val ...... Demolmon"~O'-'ff-/~~''~/..~,__.. OtherWork. (Description) 4 Estimated Co .......... 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 maxed occupancy, specify nature and extent of each type of use ............. 7. Dnnenmons of exlstmg structures, if any Front ...... Rear ............ Depth ........ Height .......... Number of Stones ........... Dnnenslons of same structure with alterations or addations Front ............. Rear ........... Depth ............... Height ................ Number of Stones ............... 8. Dimensions of entire new constructaon Front ... Rear ............. Depth ...... Height ......... Number of Stones .................................................. 9. S~ze of lot Front ............ Rear ................ Depth ................... 10. Date of Purchase ...................... Name of Former Owner ...................... I 1 Zone or use district an wluch premises are mtuated 12. Does proposed construction vmlate any zoning law, ordinance or regulation ....................... 13 Will lot be regraded ......... > .......... Will excess fill be removed from premises* Yes _ 14 14. NameofOwnerofpremlses .~O~..¢.~. ..... Address ............ Phone No. .~¢~.~ ?..~.~/. 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 chstmctly all braidings, whether existing or proposed, and indicate all set-back dnnenmons rrm property hnes. Give street and bloc c number or de~cr~pBor~ according to deed, and show street names and indicate whethc anterior or comer lot. I I t/~ STATE OF NFA~7~ORK., c 'o'n beang duly sworn, deposes and says that he is the apphcar (Name of mdividuaI mg tract) above named. ~He Is the (Contractor, agent, co,orate officer, etc ) of smd owner or owne~, ~d is duly authomed to perfo~ or have perfo~ed the smd work and to m~e ~d file th apphcatmn; that all s~tements contmned m thru apphcat~on are tree to the best of bm ~owledge and behef, and that tk work wflI be perfo~ed m the m~ner set for~ m the apphcation filed therewith. Sworn to before me ...... /~... dayof