The URL can be used to link to this page

Home My WebLink About15050-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No .... Jg.~.4 ~.5.4 ....... Date ..... ~.u.l.y...~.6., .................. ,19 .8.6. THIS CERTIFIES that the building .~..c.c.~.$.s.o..ry..b.u..i3.d.~.n. g' .d.o.~..~..h..o.u..s.e ............. Location of Property . .1.1..3. 0.9.~.e.n...R.o.a.d. ...................... S.o..u.t.h.q~..d~..~..: .Y.. ....... House No. Street Ham/et County Tax Map No. 1000 Section . 9.7.8. ....... Block ..... 0.2. ........ Lot ....0,2.9. .......... Subdivision..~/.o..W~..~ .r.o.e.k...g.s~.a.~.¢.~ .... Filed Map No. 3..8.4.8....Lot No. , .~.3. ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ·, .q .u.np..2. .5 · ......... ,19 8, .6. pursuant to which Building Permit No...1.5.0..5.0.z ............. dated .... ~ .up.o. ,2.~ ............... 19.8..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 ......... a .doll house accessory building as applied for The certificate is issued to ..... ~a..r.s, .T.o..r.k.e.l.s. 9.n ...................................... (ownof~~x of the aforesaid building. Suffolk County Department of Health Approval .............. ~/.& ........................ UNDERWRITERS CERTIFICATE NO ...................... .I5/.~. ........................ Building Inspector Rev. 1/81 ~zzx~ ~i'O. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDIHG PEItJ~41T (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15050 Z Date Permission is hereby granted to: ..... ~ ....... ~.~d...~ .................... ~ '~' " ~.. l/ /,.. ,o ..~....~i'.L~...~....~~...~~ .......... at premises located at ...L/...~.....~.......~..~...~ ....... ~ .................................... County Tax Mop No. 1000 Section ..... ...C:~.....~)..~ ...... Block ..... ...~)......~--,. ...... Lot No....C)..~-....Oi. ........ pursuont to application doted Building Inspector. approved by the 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 Instructions This application must be filled in typewriter OR ink, and submitted I ~ to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of propertv with accurate location of all buildings, property lines, streets, and unusual natural or topographic featu res. 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 sifnilar 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. 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 $5.00 2. Certificate of occupancy on pre-existing dwelling $15.00 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. Upclated C .0. $15.00 Date ..L?..~.~. ?.-~' ..... ~..~, .~. ..... New Building .~ .;~. .......... Old or Pre-existing Building ............ Vacant Land ............. Location of Property . ./.'J. 30 GL ~'~' ~oA)~ ~ o~/.-r../~..o House No. Street Ham/et Owner or Owners of Property ........................................... County Tax Map No. 1000 Section . .~). ~.~. ....... Block .~..~. ......... Lot...O..°)-~. ~. ........ Subdivision . .~..~...~-~....~.~..E.E..~...~..~..~.[.//'.~. .... Filed Map No..~..~. ~..t~...Lot No. Permit No. ~ Date of Permit~./~..~...Applicant..~...~..¢L.~......~7~?.~..~.~.~. ~ ....... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and p~ermit meets all applicable codes and regulations. Applicant..~...~~ ...................... Rev, 10-10-7S FIELD INSI~ECTION COHME~T$ · FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE 4. FINAL ADDITIONAL COMMENTS: NOTI~ BUh.t~m~ ()EPARTM~T AT FOLLOWiN~ 1 FOUi~D~ ~D~v ~%VO ~QUIRED 2 ROUG~ ~RAM~NG & PLUMBING 3. INSULA ~, FINAL. CONSTRUCTION ~UST BE COMPLETE FOR C,O ALL CONSTRUCTION SHALl. MEET THE REQUIREMENTS OF THE N,Y ~'rATE CONSTRUCTION & ENERGY CO~. NOT ~NSISLE ~R n~N OR CONSTRUC~O~ ~RORS. OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE ~;';~F OCCUPANCY FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y, 11971 TEL,: 765-1803 Examined . '1 'ad"gO4" '~'t~ ' '" 19~..¢. Approved ... '.~.4,a~-~. .~..~ ....19~..~'. Permit No./.~ .'~. Disapproved a/c ..................................... BLDG. OEPT. TOWN OF SOUTHOLD Received ........... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tkis 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 authorized inspectors on premises and in building for necessar~ i]~spections. ,_3q~_~' /, / ..'"" .,,..,. . 5/ . . . .... ................ (Signature of applicant, or name, if a corporation) (mailing address of applicant) State whether applicant is owner, lessee, agent, architect, enfjneer, general contractor, electrician, plumber or builder. .... ................................................................................ Name of owner of premises . ~.~. ~ .~... ~ .F~. )~..L.3}4~ .~.~. ............................................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. 5'V b- l ot4( / cvx-e r (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. · .~]. ~y ~r//~ ....... ........................................................................ House Number Street Hamlet County Tax Map No. I000 Section ....O.~'..~. .......... Block ...~..~. ............ Lot...O..~. ]. ........... Subdivision..b~..b.r':~..~.....~.'.~../ar.~..~.....g.~.~.'~.'~.'?.~..~. · Filed Map No..~ .~...~.~. ...... Lot. ~.~'~ ........... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .~ t'~-/P.~l.('/TM /¢t..,'.Z,L ./ I°~l~-,F~ ~lP~t#~..-ci~ l~ 'Ti~cr t~g~#~ /vvF b. Intended use and occupancy .....dL~~tz"'':''~"t9'"''" ....................................... 3. Nature of work (check which applicable): New Building .......... Addition .. ........ Alteration ... Repai[ .............. Removal .............. Demolition ........... :... Other Work ............... 130~uOi,~& ....... ~ Zi/'O"~ ./.~I.~X '°O'tT" .................. ~)/7/2L t4OV.~ .............................. ~..~....~,. ,?~.~ (Description) 4. Estimated Cost ~. ~ Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling unit~ on each floor ................ If garage, number of cars .... ........................................ i ............................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front..&.;}.: .Z'. ....... Rear . .ir .;1.,..~. ......Depth . .~.~ J.'~' ...... Height . ~ 0 ............ Number of Stories.. ~ ......................... : ............................ Dimensions of same structure with alterations or additions: Front ............ l .....Rear .................. Depth Height Number of 'Stories 8. Dimensions of entire new construction: Front ............ Rear .... : Depth Height ............... .Number of Stories. . ................. 9. Size of lot: Front.. ]b~ ................ ~'e'a; i ~'.~ ~'.~.i ¢ i ~ft{~.i ~.~ i i i [ i ] ~'e;i~ '/)i~} 2rT..J..~.~.'..~..~ ....... 10. Date of Purchase ............................. Name of Former Owner ............................. 11 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: Yes No 14. Name of Owner of premises .................... Address ............... i .... Phone No ................ Name of Architect Address" Phone No Name of Contractor .......................... Address ............... .... Phone No ................ 15. Is this property located within 1.00 feet of a tidal wetland? *.Y~y~ ..... No ..... * If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly nil buildings, whether existing or proposed, and. indicate all set-back d/menslons from propertyilines. Give street and block number or description according to deed, and sho~ street names and indicate whether interior Or corner lot. STATE OF NEW YORK, COUNTY OF ................. i ....... L..A..~.~....'./.O.~.lf.~.~....~/. ................... being duly sworn, depokes and says that he is the applicant (Name of individual signing contract) above named. He is the... ~...b~. ..................................................................iI/.&rta.- (Contractor, agent, corporate officer, etc.): of [ald owner or owners, ~d is duly authorized to perform or have perfo~ed the said work arid to m~e and file this application;that all statements contaned ~ this application are true to the best of his ~owledge and belief; and that the work ~jl be perfo~ed in the m~ner set forth h the application filed therewith. Sworn to before me this of Y; NotawPublic, ...~.~..~V'~... County W ~~ Z : SURLY FOR LARS TORKELSON ~ ASTRI TORKELSON DEC 19~198~ LOT ~, "WEST ~EEK ESTATES" s[~l.~o, AT SOUTHOLD DATE: AUG 22, ~983 ~WN ~ SOUTHOLD SCAL[= ~"=40' ~ SUFFOLK COUNT~, NEW ~RK NO. 83-653 HEALTH DEPARTMENT-DATA F~ APPRO~L TO C~STRUCT aaO ~ HIS aEHALF m THE TITLE C~P~Y, GOV~N- WILL C~FORM ~ THE $TAN~I OF THE SU~K GOUTY DEPARTMENT TO EX[STIH6 S [S ARE FOR A SPECIFIC OFH~LTH I~ICE~, PURPOSE ANO ARE NOT ~0 BE USED TO ' - I ~~~~u~ W.YOUN~,PeOFESSIONAL ENOINE[~ ~ OS~NOER AVE~E YOUNG a YOUNG ELEVATIONS SHOWN THUS~ ~3 ARE REFERENCED TO MEAN SEA LEVE~ ~LAND SURVEYOR N.Y.S. UCENSE NO. 12845 .... ~o .... ~I~T CO~TOU~ HOWARD W. YOUNG, LAND SURVEYOR