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Home My WebLink About15278-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No Z-16201 Date September 24, 1987 THIS CERTIFIES that the budding . ADDIT ION tocatlon of Property 580 Private Road #21 Southold, New York H3~se Ho ................ ~;eer .................... County Tax Map No 1000 Section . 07 8 .Block 09 ...... Lot 38 Subdtvmzon ......................... Fried Map No ........ Lot No .............. conforms substantially to the Apphcahon for Bmldlng Permit heretofore fried in this office dated September 2, I986 15278 Z ............ pursuant to which Bmldtng Permit No ................. dated. . S ..e p t e mb.. e r...l 9 ,.. 19..86. was ~ssued, and conforms to all of the reqmrements of the apphcable prov~slons of the law. The occupancy for whtch flus cerhficate ~s issued is ..... ADDITION TO EXISTING ONE FAMILY DWELLING The cerhficate ~s ~ssued to EDWARD & MARIE T ILL I STRAND .......... iow. e;,/e~-r~iG'~) .......... of the aforesmd building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE NO ..... PLUMBERS CERTIFICATION DATED: N/A PENDING N/A Rev 1/81 ~OB~ NO. 1~ TOWN OF SOUTHOLD BUILDING OEFARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PER;~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ls27s z Do,o....~.~.~ ........ /...~ ...... Permission ~s hereby granted to' ~ ..... ........ ~..~~...-'~:~. ,...: :...~. ~..1... ~ ,..:..-, - ~o at premises located at ....~ ................................. I ........~~.~.-- .................................. c~,~,~ Ta× Mo~ No ~000 Se~,.on .O~ 3. ~oc~ ..~..~ ........ 'o, No...~3 ....... pursuant ,o ~ppJlcatlon dot~ .~~ ~ ..., 19~, and =ppr~ by the Building Inspector. Building Inspector FORM NO 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - [802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled ~n typewriter OR ink, and submitted m ~ to the Building Inspec- tor with the following; for new buddings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features 2. F~nal approval of Health Dept. of water supply and sewerage dmposal-(S-9 form or equal). 3. Approval of electrical Installation from Board of F~re Underwriters. 4. Commercml buildings, Industrial buddings, Multiple Residences and similar buildings and mstalla~ t~ons, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed s~te plan reqmrements where applicable. B For ex~stmg buildings (prior to April 1957), Non-conforming uses, or braidings and "pre-existing" land uses: 1. Accurate survey of p~operty showing all properW lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buddings. 3. Date of any housing code or safety inspection of buddings or premises, or other pertinent ~nforma- tlon required to prepare a certificate. C. Fees: 1. Cerbficate of occupancy $25.00 -- ]BUSINESS $50.00 ACCESSOR¥ $[0.00 2. Cemflcate of occupancy on pre-ex~stmg dwelhng $ 50.00 3 Copy of certlflcate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date ~, _ C{ -- ~ 7 New Cons truct ion ...... Old or Pre-existing Budding ............ Vacant Land ............. Locatlon of Property ...~-..~..(~, ~)~/-L. J~g. '~-J'Z I ~O~c~[-.~ [ ~[ House No. Street 1-1am/et Owner or Owners of Property . . ~ lr ~ .~, ~. 't ~ ~ ~ t~ County Tax Map No. 1000 Sect,on . ~ .'7..~ ....... Block . ..~..~. ......... Lot . .~...~. ......... Subdw~s[on ......................... Filed Map No .......... Lot No ............ M '1' Health Dept. Approval .................... Labor Dept. Approval ........................ Underwriters Approval "- Planning Board Approval Request for Temporary Certff)cate -~ .. Final Certificate ..................... Fee Subm,tted $ · ~ ~..- .O.~ .............. Construction on above described budding ar~ p. erm~t meets all apphcable codes and regulations. Rev 10 10 78 FIELD ~NSP.~,CTION DATE COMMENTS FOUNDATIO~ { 1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING 3. INSULATION PER N. Y. STATE ENERGY CODE TOWN OF SOUTtlOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 723 TOWN HALL SOUTHOLD, N.Y. i1971 TEL. 765-1802 To Whom This May Concern, We are unable to complete your Certificate of Occupancy because of the following reasons. /~/ An application for Certificate of Occupancy is not on file. /~ No Underwriters Certificate on file. /--_~ The check is(outdated/~.)~- /~/ No Health Dept. Approval on file. /~/ No final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. Building Permit # ] ~ ~ _~Q ~__ Z Building Dept. $0 No Plumber Solder Certificate on file. ( all permits involving plumbing being issued after April 1,1984 ) Occupancy or use is unlawful wlthout a Certificate of Occupancy. Clear up this matter as soon as possible that legal action does not have to be taken. Thank you for your prompt attention. 7G5-180~ BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION FRAMING BUILDING DEPT. INSPECTION []FOUNDATION 1ST [ ] ROUGH PLBG. []FOUNDATION 2ND []INSULATION []FRAMING []FINAL REMARKS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ J ROUGH PLBG. FOUNDATION FRAMING 2ND [ ] INSULATION ~ ~INAL REMARKS: DATE FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971. TEL . 765-1802 Exam,ned .~"~ .~ lei , 19~(a Approved%~'..J~...'el ,19~Pe~itNo )~ O,sapproved a/c ............ (Braiding Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a Tins apphcahon must be completely filled in by typewr, ter or ,n mk and subm,tted to the Building Inspector, wxth sets of plans, accurate plot plan to scale Fee according to schedule , b. Plot plan showing location of lot and of buildings on premises, relat,onsh,p to adjoin,rig premises or pubhc street or areas, and ~vmg a detailed descr,ption of layout of property must be drawn on the d,agram wh,ch ,s part of th,s apph cation. c. Thc work covered by ttus apphcat,on may not be commenced before issuance of Budding Permit. d Upon approval of this apphcat,on, the Budding Inspector will issued a Building Permit to the apphcant. Such penni shall be kept on thc premises available for respect,on throughout the work. e No bu,ldmg shall be occup,cd or used ]n whole or m part for any purpose whatever until a Certificate of Occupanc, shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Bmldmg Department for the issuance of a Building Permit pursuant to th, Budding Zone Ord,nance of the Town of Sou,hold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construct,on of buildings, additions or alterations, or for removal or demohtlon, as herein described The apphcant agrees to comply with all apphcable laws, ordinances, bu,ld,ng code, housing code, and regulat,ons, and tt admit authorized inspectors on prem,ses and in budding for necessary ,n~e. ct,ons ~ . (S,gnature of apphcant, or name, tfa corporation) ,6L,ooo. I. 1, o (Marling address of apphcant) State whether appl,cant ,s owner, lessee, agent, arctutcct, cng,neer, general contractor, electrician, plumber or builder ...B.&, J ........................ Nameofown. erofpremlses ~--.-dc.~.l~.J ~ m~¥ I.~ .1 ;.Il '5q V~'I.~.~ ................ (as on the tax roll or latest deed) If applicant is a corporation, s,gnature of duly authorized officer (Name and title of corporate officer) Budder's License No I ) .2) .. Plumber's License No ....... Electr,cmn's L,cense No Other Trade's L,cense No Location of land on wh,ch proposed work will be done House Number Street County Tax Map No lO00 Sectmn '] ~ Hamlet Block.. ? ........ Lot. Subdiv,siou .. Fried Map No ....... Lot ........... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction a. Ex,sting usc and occupancy .'"]~x.~_ $ I'c~' ~ n C ~ ............ ~, ;...~ .................... b. Intended use and occupancy 3 Nature of work (check which apphcable) New Building . Addition ....... Alteration .. Repair .......... Removal ...... Demohtion ....... Other Work ............. t'1'~ (Description) 4 Estimated Cost . ! '.cfi/ O/2> O , O k.~ Fee ............... · (to be paid on filing this application) 5. Ifdwelhng, numberofdwelhngunlts... /. ..... Numherofdwelhngunltsoneachfloor. ./. ......... If garage, number of cars ..... ~ .................. 6 If business, commercial or mixed occupancy, specify nature and extent of each type of use . .-'-7 ..... 7 Dlmensio,n, sofCxlstingstructures, lfany Front c/.q.~ ........ Rear ~{ O. ....... Depth 2-7 Height ~. ~='7~: ....... Number of Stones . ..~,~ .................... ~ ....... Dimensions of same structure with alterations or additions Front ~.5~(~. ......... Rear ,&. k~. ......... Depth . . '2r.. 7 ........... Height . q.7. /~ ........ Number of Stories . . ~ ......... 8. Dlmenslons of entire new construction: Front ~..O ..... Rear ~ ~.~-~. Depth ~..-~. Height .,2~..2.,.. ........ Number of Stones ..... 2~ '- ' * ' ' 9 Size oflot. Front ............. Rear ............. Depth .. I0 Date of Purchase ..................... Name of Former Qwner ................. 11 Zone or use d~stnct in which premises are situated . .2~e~ ~ d~, o W' t ~ 12 Does proposed construction violate any zoning law, ordinance or regulation 13 Will lot be regraded . ]~ CI...,.p. ...-_4.o,- t-~4 . WdI ex. qe.~ ~ILbe r. emoved from premises Yes ~N ~2r err5 o ~ ~.4tT~ld.d ~/ 14. NameofOwnerofpremlses .~r-~./././~,'~_.~.~.d.. 'Address'~a;~Ao'/~o,,,~ 'M'~ ..PhoneNo ........... ....................... Addresu.,'$:.~,.;..2- .7/. .. Phone No... ~ ........ Name of Architect Name of Contractor ~..*v....'7..~.~ct ........ Addreset''- ~J~-A~IJ. IV.~.. Phone No 15. Is this property located within 300 feet of a tidal wetland? *Yes ..... No t~.... · If yes, Southold Town Trustees Permzt maybe required. PLOT DIAGRAM Locate clearly and d~stlnctly all buddings, whether existing or proposed, and, indicate all set-back dimensions fro *roperty lines Give street and block number or description according to deed, and show street names and indicate wheth ntenor or corner lot ;TATE OF NEW YORK, 'OUNTY OF .......... S.S (Name of individual signing contract) bore named. being duly sworn, deposes and says that he is tile apphca lc is the (Contractor, agent, corporate officer, etc ) ,f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file ti pphcanon, that all statements contained m this apphcation are true to the best of Ins knowledge and belief, and that t ~ork will be performed m the manner set forth in the application filed therewith 'worn to before me this .......... .o~ ..... day of...fi~2_~... ..... 19J7~. ~otaryeubhc, ..~...~..~.L .~.~...d~.. County .... ........... [?':]UPANC~ OR ~£ IS UNLAWFUL i;.JTHOUT CERTIFICATE OCCUPANCY CODES NOT ~3PONSI£~.E FO~ ~ nE-SIGN OFI CC 4S~ucr~oN ~RRORS, / It oOlll~f tubirig II ultd for water distributing system; piping shell be of types ~ I ~'ao~T OF' E~-TEN.~tON ~ S-Cc. TIoN OPE.,v45¥11~¢