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Home My WebLink About15223-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No., .Z~,5.2..~.6 ......... Date ,, ,~.a.n,u.a. fy, ,2.3. r..1,9,8,7 ........... , ,., THIS CERTIFIES that the bufldmg . J-n~rg.u.nd..Pg.°.1. . an.d .F.e.n.ce. .................. Locatmn of Property 9.5 ............. .In.I..e.t..V.%e.w. ?.a.s.t ........ M.a.t.t.J:..t:.u.c.k... House No. Street Hamlet County Tax Map No 1000 Sechon 19.0 ..... Block ...0.3. ....... Lot ...~9...q6. ....... Subd~ws[on. ~.rtl01:..l~a;~.t..t~s.t;a~.es .... Fried Map No 6.2. 4. .9...Lot No....6 ......... conforms substantially to the Apphcat~on for Bmld~ng Permit heretofore ~ed ~n this office dated · .~USr. tl~:. ~-Q, J-~.~6 , pursuant to which Braiding Permit No....1.5.2.2.3..Z ........... dated ....... Aug. u$ I:. 29., .... 1986 , was ~ssued, and conforms to all of the reqmrements of the apphcable prov~s~ons of the law. The occupancy for whtch tlus certfficate ~s assued is ........ ..... In.g. noun.d Poo'l .and, .Een~.e .................................. The cerhficate ~s Issued to .Georse arid.. Z&Dh~ra.a. $~i~ ............... (owner, lessee or tenant~ of the aforesaid building. Suffolk County Department of Health Approval ....... /'I/A .......................... UNDERWRITERS CERTIFICATE NO ....... N 7 ~. 032.7 ............................... PLUMBERS CERTIFICATION DATED: N/A Rev 1181 nk'Ins;;c't;r ........... TOWN OF SOU'I'HOLD BLIILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Yo N9 BUILDING PERM, IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15223 Z Oa~e ..~.,9,~...~.......--)...~ ............ , / /~.,.-., County Tax Map No 1000 Sectlon~/..~-~ ~-..), Sl~k pursuant to appJlcotlon dated ......~. ~? ./~ ....... Building Inspector ......... Lot.oJa, ., 19.~.~., ond approved by the .T... 'BuiTding Inspector Rev 6/30/8D FIELD IN$1~ECTION DATE COMMENTS 1. FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE .............. 4. ADDITIONAL COMMENTS: A FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This apphcatmn must be filled m typewmter OR ink, and submitted m ~ to the Building Inspec- tor with the following; for new buddmgs or new use' 1 F~nal survey of property w~th accurate location of all buildings, property hnes, streets, and unusual natu raj or topograph ~c featu res. 2 Fmal approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical mstallation from Board of F~re Underwriters. 4. Commercm[ buddmgs, Industrml buddings, Multiple Residences and similar buddings and installa- tions, a certlhcate of Code comphance from the Architect or Engineer responsible for the buddmg. 5 Submit Planning Board approval of completed rote plan requirements where apphcable. For exmtmg buddings (pmor to Aprd 1957), Non-conforming uses, or buildings and "pre-existmg" 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 buildings. 3. Date of any housing code or safety mspect~on of buildings or premises, or other pertment informa- t~on required to prepare a cert~hcate. C. Fees. 1. Certificate of occupancy SB.00 2. Certificate of occupancy on pre-ex~stmg dwelhng $15.0 0 3. Copy of cert~fmate of occupancy $1.00 4.Vacant Land C.C. $5.00 5.Updated C.C. $15.00 Date ..... --.~'~/ .......... NewConstruction .... Old or Pre-exmtmg Buddmg ..... Vacant Land ............ Locat,on of Property..~.C. ~/?/,~.C?! .~.c~ ~ ~./.--7. .... ./~../~. ~.(/./.--~.{.~....~/.Y ..... House No Street Ham/et Ow.er or Owners o4 rope . .'ZS.e.H .t .. .......... County Tax Map No 1000Sect,on .l.O.,c). ..... Block .~).3 ......... Lot ..I.0..'.~6 ..... Suud~wmon .................... Fded Map No ......... Lot No ............. Perm,t No }.~..~.>. Date of Permit ...... Applicant J.-~iQu~ Health Dept Approval ................ Labor Dept. Approval ........................ Underwriters Approval .................... Plannmg Board Approval ..................... Request for Temporary Certificate ................ Fmal Certificate ...................... Fee Submitted $ ~,~7~.. ~,~L-~..).~.! .... Construction on above descmbed buddmg and p~_.~.~eet~_~a~pl,,~ca~le codes and regulations. Apphcant .... '~-~.' ~..~--~¢ ~ .'~.-'~c ........................... Rev 10-10 78 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL $OUTHOLD, N.Y 11971 TEL. 765-1802 To Whom This May C~ncern, We are unable~to complete your Certificate of Occupancy because of the following reasons. /Z~ An application fo~tificste of Occupancy is not on file.~ ~ / / No Underwriters Certificate on file. /_~ The check ~s(e~l~e~/not on file.) /~/ No Health Dept. Approval on file. /Z/ NO final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. Building Permit # ~ J c~ ~ Z Building Dept. ***/Z/ No Plumber Solder Certificate on file. ( all permits involving plumbing being issued after April 1,1984 ) TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 'rEt,. 7aS-1 To Whom This May C~ncern, We are unable~to complete your Certificate of Occupancy because .of the following reasons. /Z~ An application is not on file. d~~- /--/ No Underwriters Certificate on file. /--_~ The check is(e~a~e~/not on file.) /~/ No Health Dept. Approval on file. /Z/ No final inspection has been made. for Certificate of Occupancy Please contact our office on this matter. Thank you for your'cooperation. Building Permit # / ~ ~ ~ Z Building Dept. ***/Z/ No Plumber Solder Certificate on file. ( all permits involving plumbing being issued after April 1,1984 ) 7GS-~802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION []FRAMING []FINAL REMARKS: ~) ~/'~ INSPECTOR IIItlllllll |IIIIIIIHIIItlIIIIIIIIIIIIIIIIIIIIIIlll Itlll~tl,llllnlllllleltilllliltlllll~ ~ 'tfllH IIH IIH IIItlllllilllllllllll ~ g '{{IIHItlIIIIIIIIIIIHIIIIIII{tlIil{ qlllllltllllllllllllllllllflllilllll UIIIIIIIII}IItllllIIIII}IIIlIIIIIIIIt M4Y / , 1~5 4S F/L6 NO 6Z49 ~ ~,'I I" .... , ................................ ,,,- .zv,s*ons YOUNG & YOUNG R~./~/~X~ 400 OSTRANDER AVENUE, RIVERHEAD. NEW YORK SURVEY FOR: GEOPGE GA BP~E1 10T NO ~, ' INLET EA S7 at ,////.4 T TI TU C I< SUFFOLK CO, N Y 1"-' 50' Jo^'rl~ $£PT22,1975 Jn°'YS-S$~ 0 ' 1 Examlned~_ ~-~x~- Appro,.,ed~-~b4~' & ~ Disapproved a/c FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL gOUTHOLD, N.Y. 11971 TEL.: 765-1802 (Bulldmg Inspector) APPLICATION FOR BUILDING PERMIT Recezved ........... ,19. Date INSTRUCTIONS a. Tins application must be completely filled m by typewriter or in ink and submitted to the Building Inspector, wtt sets of plans, accurate plot plan to scale Fee accordxng to schedule. b. Plot plan showing location of lot and of buddings on premises, relahonsinp to adjoining premises or pubhc stre or areas, and giving a detmled descnptmn of layout of properW must be drawn on the dmgmm winch ~s pa~ of th~s ap~ cation. c. The work covered by t~s appllcat~on may not be commenced before ~ssu~ce of Building Permit d Upon approval of tins apphcat~on, the Bmld~ng Inspector will ~s~ued a Budding Pe~t to the apphc~t Such pert shah be kept on the premises available for mspechon throu~out the work. e. No bu~dmg shall be occupmd or used in whole or ~n p~t for any purpose whatever until a Ce~ificate of Occup~ shall have been granted by the Bmldmg ~spector ~PLICATION IS HEREBY MADE to the Building Depmtment for the ~ssuance of a Bmldmg Pemlt pursuant to t Bmld~ng Zone Ordinance of the Town of Southold, Suffolk County, New York, ~d other apphcable Laws, O~m~ces Regulations, for the constmctxon of buildings, additions or alteratmns, or for removal or demohtion, as hereto descnb~ ~e applicant agrees to comply with aH apphcable laws, ordm~ces, building code, hous~ code, a~d regulations, and admxt authomed lnspecto~ on premises ~d m bmldmg for necessa~ct~ ~/~ -i. (Signature of a~hc~nt[ or name, ff a corporatton) .... .......... State whether apphcant ~s owner, lessee, agent, ~cintect, en~neer, gener~ contractor, electncmn, plumber or build, or owner o prem,s¢, .. (as on the tax roll or latest deed) If apphcant ~s a co~oratton, s~gnature of duly authorized officer (Name and title of corporate officer) Builder's License No Plumber's License No Electrician's License No Other Trade's License No 1 Location of land on which proposed work will be done House Number Street County Tax Map No 1000 Section Subd~~ ~-/~'~ : (Name) / Hamlet Block JO ..... Lot ..~. Filed Map No ~ Lot State~,~[n~d occupancy of premises and intended use and occupancy of proposed construction a Existing use and occopancy b Intended use and occupancy .S~'].~ IX)/ .-~ ~ ~ ........ 3. Nature of work (check which applicable) New Building .. Addition ... Alteration ...... Repmr ....... Removal ........ ~ Demolition ....... Other Work ~'.R .~.~.r~... .~l~/~m~, '~,~oC, ~(2~' "~ ~:>.~E' [..~1~: ~ox~, ~0 //~ ,~/_.. ~/~YL, (Description) 4 Estunated Cost... ~.. t~ .~.~t~oc,>. ............ Fee ........ )J~ .~...~? ................. (to be paid on filing this application) 5. If dwelhng, number of dwelling units ...... ~2~ Number of dwelhng units on each floor .......... If garage, number of cars .............. ~ ................ ..f ...................... 6. If business, commercial or mixed occupancy, spe/~y nature and extent of eacj~ype of use .............. 7. Dimensions of existing structures, if any Frofkt/ ...... Rear .//. .......... Depth ......... Height ........ Number of Ston/gs ............... ./ ....................... Dumenslons of same structure with alter,atz~6nsor addittons Front . ~, ; ....... Rear ............ Depth ............. Hei~14~t . . ..... //Number of Stones ............. 8. Dumenslons of entire new constructlor)/Front ......... R)ffar ............ Depth ........... Height ......... Numberf ~o~ ~ , // 9 Size of lot Front . . / .... Rear ........ / ......... Depth ......... 10. Date of Purchase .. ~, . .. Name of Former Owner ............. 1 1. Zone or use district in which premises are situated .......................... 12. Does proposed construcbon wolate any zoning law, ordinance or regulation' . .,~/~. ......... 13. Will lot be regraded ..... P/~ .... · .... Wtll excess fill be removed from premises. ~ _1~. 14. Name of Owner of premises . .~:~-o.~'~-. ~./e./~%~--. Address .~/.~.r7 .F_~...~.~'.~). ~z~.4~.. Phone No. ~.~ ~---~./'~.. · Name of Archttect ............. Address .............. Phone Name of Contractor .-~..ffof~./29/2~..Z~.~ ...... Address ~'~..t~...rI~A'F../~. ?r~.ffh~one°~;¥.. · Yes ..... No 15. Is this property located w~thint00 feet of a tidal wetland? * If yes, Southold Town Trusgees Permit may be required. PLOT DIAGRAM Locate clearly and dmtmctly all buildings, whether existing or proposed, and, indicate all set-back d~rnenslons fro property hnes. Give street and block number or description according to deed, and show street names and indicate wheth mtenor or corner lot STATE OF NEW YORK, S S COUNTY OF ............... - ...... ~5>/~' ....~. ~/.~(.. being duly sworn, deposes and says that he is the apphca: (Name of individual s~gmng contract) above named He ,s the ..... ~...ff~- -~. -~ : ........................ (Contractor, agent, corporate officer, etc.) of smd owner or ownem, ~d ~s duly authomed to perform or have perfo~ed the smd work and to m~e and file ff apphcatmn, that ~1 statements contamed m thru apphcabon a~ true to the best ofh~s ~owledge and behef, and that tl work will be perfo~ed m the m~ner set for~ ~n the apphcatmn filed ~erew~th Sworn to before me this ~f ~ ~'~~:o. ~.~ Not~ mu , . .... '~[N.i ~~