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Home My WebLink About15034-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy PLUMBERS CERTIFICATION DATED: No. Z16025 Date August 7, 1987 THIS CERTIF1ES that the building raised house, addition, & deck addition. Location of Property ...... .6 .2.5 ........... .R.a..b.b.i.t..-.L .a.n.e. ............. E..a.s?...~.a.r.J:o..n... House No. Street Hamlet County Tax Map No. 1000 Section ....... .3.1...Block 17 . .Lot 15 Subdivision ............... .X ............... Filed Map No ...... X...Lot No. X conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... .~.u.n.e...1.8.,.. 1..9.8.6. · . pursuant to which Building Permit No ....... .1.5.0. 3. .4 .g ........ dated ..... q.u.n.e..2. 7 ~. .1. 9. .8 .6 ......... was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Raising of house, 5X7 addition,and deck addition in rear of house. The certificate is issued to ............ I~DW~I~D. F.-..&...B.&R.B. &R~....K.....B.E.T..S.C.H. ............ fowner, of the aforesaid building. Suffolk County Department of Health Approval ................ 3q/.~5 ...................... UNDERWRITERS CERTIFICATE NO ........................ 3q/A ...................... N/A Rev. 1/81 FORM' NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Z Permission is hereby granted to: .~,~,..~...~~.,,.~..~.~ .~..-,.~.~. ........ ~.~.~...~ ............................... .~.~.~...~......,...~..:.~.: .............................. . ~ 1. ~ at premises located at ....~....~-...~.........~~~......~. --.~-....'~'~.~ .......... County Tax Map No. 1000 Section ..... .,0,...~..~ ........ Block ........ 1..~.. ....... Lot No ......,I....~.. ............ pursuant to application dated ........ '~.-'~j,,~(~':~qLg~..I..~ .................. , 19.?..~.., Building Inspector.. Fee $...~....!.....'~... ....... and approved by the Bu ding nsoector Rev. 6130/80 FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCU[ BLDG. DEPT. ,~ oF sOUm~? Instructions ~~ A. This application must be filled in typewriter OR ink, and submitted ~ ~ to t ec- tot with 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--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~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 condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $25.00 -- BUSINESS $50.00 ACC~,SSORY $10.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 o.oo 5oU~.~e. C.O./ $ 50.00 Dite ..,.~. ............ ' J-- NewC°nstruct'i°n ...... Old or Pre-existing Building ............ Vacant Land ............. House No. Street Hamlet Owner or Owners of Property ~-~-~) (~/~¢~ L~ ./~'. / .~...~ ~//~/~/~/~ /?. CountyTax Map No. lO00Saetion ...~...~..I ....... Block .... ./.~. ....... Lot .... Subdivision ................................. Filed Map No ........... Lot No .............. ,ermit No./.~. ~..~... Date of,erm,t ~./.~?~ .~..App,icant ..~? .~.'.~... ?: ............. ~ .~..?~....~. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate/ ..................... Final Certificate ....................... Fee buomittea ~ ............................. Construction on above described building and permit meets all applicable codes and regulations. '~."'flO. ';~g~) ~a- ( Applicant ................... Rev, 10-10-78 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION ZST [ ] ROUGH PLBG. [ ] FOUNDATION ZND [ ] INSULATION [ ] FRAMING [ , / ,. REMARKS: ~5~~ BUILDING DEPT, /~'~-~ ~ INSPECTION FOUNDATION ~.ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING /~ [, ] FINAL REMARKS:, ~/~/~5~ ~,~ , REMARKS: ~-~2 BUILDING DEPT. I'NSPECTION [~~OUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND_~~TION [ ] FRAMING DATE, 7//~,~/~/', NSPECTO R/~ ~' ,~ TOWN OF SOU'IIIOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL $OUTIIOLD, N.Y. 11971 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. 5/ 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 ~I ~_ ~ _~ ~ c_~Z Building Dept. ***/~/ No Plumber Solder Certificate on file. { all permits invol~ing plumbing being issued after April 1,1984 ) Occupancy or use is unlawful wlthout a Certificate of Occupancy. Please clear up-~is matter so that Jegol action does not have to be taken. Thank you for your prompt attention. FIELD INSFECTION ADDITIONAL COMMENTS: FINAL FORM NO, 3 TOWN OF $OUTHOLD ~U]LD[NG DEPARTMEN'I[' TOWN CLERK'S OFFICE SOUTHOLD, N.Y, NOTICE OF DISAPPROVAL To · . PLEASE TAKE NOTKYE thai your apphcalion dated ....... N~u~o A o ~tm~r H,~mlo~ County ~ ~x Map No. 1000 Sechon '~ ( Block ... [ ........ [~l , ~., ~ ....... SubdM~on Fried Map No .~ b ri:tumid h~with and disapproved on the followa$ ~ounds~a~., ~, ,~Oi,,. ---'I ,d 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved --~ ~,ft~L..,~., 19~.~ Permit No~.~.~..~..~.~.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT TOWN OF '3OUTHOLD Received ........... ,19... Date ................... 19... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink anlfi submitted to the Building Inspector, with 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 streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been gffanted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building 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 applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspec~o%s. .~/~52 /~ ~× ....... .......... (Signature of applicant, or name, if a corporation) Pi. (Mailing address of applicant) f kJ ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 6 .................... Name of owner of premises A- ¢ ~J o~ v~.~ ................. l" '('ak ;n't'~e tax'ro'li If applicant is a corporation, signature of dul;~ authorized officer. (Name and title of corporate officer) · Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Location of land on which proposed work will be done.... . , ..; . ~ .... ri ~_~.... ............ ............................................................ .~. .'. .g?. ?? ?. .,.q n ................. House Number Street Hamlet County Tax Map No. 1000 Section .... i%/ .......... Block ...... ! '..~. ........ Lot .... [..~. · .......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy ........ OJ'J~ .'7'..~.Pl I..~ ~.. ~ :~ t ~.e~..C~...~q. .......................... Intended use and occupancy .......................... . .~.:[ .... 3. Natt~re' df'wOrk (check which applicable): New Building .......... Addition .......... Alteration .......... Repa/r Removal .... Demolition ther Work ~;5~e/7. ~..~.. ~ :~.~..~. i (Description, 4. Estimated Co · .. ........................ Fee ...................................... I " (to be paid on filing this application) ~ ' ~ ~' nit 5. If dwelhng, number of dwelling u s ............... 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. Dimensions of existing structures, iifany Front Rear Depth . eight ............... Number of Stories ................................................ Dimensions'of same structure wittl alterations or additions: Front ................. Rear .................. Depth ..................... [ Height ...................... Number of Stories $. Dhnensiqns of entire new construqtion: Front .......... ..... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9 Si ' D pth · ze of lot: Front ............ [ ......... Rear ...................... e ...................... 10. Date of Purchase ............ t ................ Name of Former Owner ............................. 1 1 Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded .... ....... i ....... ' .......... Will excess fill be removed from p~e~es 14. Nmne of Owner of premises .... ! ............... Address ................... Phcine Noi.a.I 4.% .~. ~ .~. ~..g..~'./.~'~ Nasne of.Architect ........... i ............ Address ................... Pho~ae No ................. Nmne of Contractor ....... i.. ! ........... Address ' Ph~,~ 15.,Is this property located w{thin ~00 feet of a tidal wetland.~ *~;;'~i~7~'~i~'.''...~'~ If yes, Southold Town Trustees Permit maybe required. .,'~ ~ .~.~- PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and~ indicate all set-back dimensions from property lines. Give street and block nfimber or description according to deed, and show street names and indicate whether interior or corner lot. iTATE OF NEW YORK, ~OUNTY OF ............................... , .................. being duly sworn, deposes and says that he is the applicant (Name of individual signin~ contract) bove named· ~ Ie is the ' i (Contractor, agent, corporate officer, etc.) ,f said owner or owners, and is duly ~uthorized to perform or have performed the said work and to make and file this : pplication; that all statements contain!ed in this application are true to the best of his knowledge and belief; and that the ~ork will be performed in the manner s~t forth in the application filed therewith. worn to before me this l ~ I~lB[~. ~&f~w ~ (Signature of applicant) No. 4707878, $Comity P 7 ~ Torm Ex,res Mir*h SO. 19-..~ / ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ................ , 19 . . . Received ........... ~19... Approved ................. 19... Permit No ............ Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ...... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 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 streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building 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 applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit auth°rized inspect°rs °n premises and in building f°r necesi~7, i~..~....~4~ ............... (Signature of applicant, or name, if a corporation) ..... - (Mailing address of applicant) t 't'~"~'~/'' State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... f/x Other Trade's License No ...................... 1. Location of land on which proposed work will be done .... ~... ~.~.q ?. 'h...~..~.. 1~. t..~. ~ ..................... .... .4... ........................................................... House Number Street Hamlet County Tax Map No. 1000 Section Yt/ . Block / 7 ~'~ ................................. Lot .... /. .............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......... .o. 0.*. ~'~;~,~.~,~.~.0l.¢.2~. ,~ ..,,~,~,'~ ...... ~ J] ~.~ .......................... b. Intended use and occupancy ........ '~...~t~*.~d>.~.~.~*,,t~.~'?;~..~,~ ....................................... 3. Nature of work (check which applicable): New Building ... Addition / ' . ......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... I (Description) 4. Estimated Cost .... '7[.0.]...tKO. ........................ 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 .... i .................................................................... 6. If business, commercial or mixbd occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... ' Height Number of Stories Dimensions of same structure With alterations or additions: Front ................. Rear .................. Depth ' Height Number of Stories 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Nu~nber of Stories ........................................................ 9. Size of lot: Front .......... ! ............ Rear ...................... Depth ...................... 10. Date of Purchase i Name of Former Owner 1 1. Zone or use district in which premises are situated ....................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ......................... 13. Will lot be regraded ........................... Will excess fill be removed from premises:t ~ Yes No 14. Name of Owner of premises ..................... Address ................... Phone Nb./7 ! .~. Name of Architect ............................ Address ................... Phone No ................ Nmne of Contractor ........ ~ .................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEWJYO~R~K2 ! COUNTY OF ~ ..... S.S ...'..~..d)..(~.~.~./.3....2ff7.. ~ .~..~.~ .~../~.. ............. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d~aly authorized to perform or have performed the said work and to make and file this application;that all statements cm rained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this Notary Publtc .... ~ ~/. ............... County no. ~a~a, ~~ (Signature of applicant)