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Home My WebLink About14795-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy g-1518I January 8, 1987 No .................. Date .................................... Deck addition & alteration to existing one family THIS CBRTIFIBS that the building . 'dwe'l'l'in'g.' ..................................... 1045 Uhl Lane Orient, New York Location of Property ............................................................... House No. Street Hem/et 015 5 161 County Tax Map No. 1000 Section ............ Block ............... Lot ................. Subdivision..M./.o..0.r.i.e.n.r..b.y..t.h.e. fi.eft..8.c.c...3...Filed Map No. 3,4.4.4. .... Lot No. 161 conforms substantially to the Application for Building Permit heretofore filed in this office dated April 18, 1986 pursuant to which Building Permit No. 14795 .Z dated April 26, 1986 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 ......... DECK ADDITION & ALTERATION TO EXISTING ONE FAMILY DWELLING. ROBERT W. NILSEN The certificate is issued to ..................... [o~n'o),'le~7o'~:~[~ ...................... of the aforesaid building. Suffolk County Department of Health Approval N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED: uil~g Inspector Rev. 1/81 FORI~ NO. $ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERJ~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N'.' 1~795 Z Permission is hereby granted to: ........... ...... ...................... ..~..~...~:..%.......~J..~..~ .................. at premises Iocate~l at ../.,~...~,.,~........,.- '' ''~' I.,.~,..,,~,.,....~ ........ ~ ........................................ County Tax Map No, 1000 Sectign-"'""C?'"/':'''~'''/' N, .,, ...... Block ...... ..c~.......~,.. .... Lot No ....... l...~,..f ........ pursuant to application dated .~ ....... /....~,. .................. , 19.~...~., and approved by the Building Inspector, Fee $....~.,...M...'~.. ...... Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ,~ ~ to the Building Inspec- tor 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- lion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $25.00 -- BUSINESS $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50-. 00 3. Copy of certificate of occupancy $ 5/00, over 5 years $i0.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date .......................... /o Newconstpuc%±on ...... Id or Pre-existing Building ............ Vacant [.and ............. Location of Property ................................. ~ ........................... House No. Street Ham/et Owner or Owners of Property .... ~.~...~.....~..- ..... i ~.~. .......................... County Tax Map No. 1000 Section ...O..f. ,~.'~. ..... Block .... O..~...".. ...... Lot ..... ./..~. ...... Subdivision .... z'v~...~¢~-~..~ ............... Filed Map No ........... Lot No .............. PermitNo. /~. ~',~.~.."Z Date of Permit ?.~.~.~/..~.~. cant ................. Appli .................................. 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~t meets all ap~l~cabl.~codes and regulations. Rev. 10-10-78 765-1802 BUILDING DEPT. INSPECTION FIEL~ I~[~ECTION FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & FLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL COMMENTS ADDITIONAL COMMENTS: FORM NO. 6 TOWN OF $OUTHOLD 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 .. ~ to the Building Inspec- ,~.rFwith the following; for new buildings or new use: inal 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic featu res. 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 $15.0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 ~.,./.~..~.. 5 .Updated C.O. $15.00 Date ......... -, ...... New Building .... .~..' .... Old or Pre-existing Building ' Vacant Land ............. Location of Property /~ ,~,. ~, ,~,/,. ~,4~.~- ............................... Q~¢~. ...... House No, Street Ham/et Owner or Owners of Property .~/. ~....~.'. ~x..~. · .~,~-f ....................................... County Tax Map No. 1000 Section . . . .~../~. ....... Block .... ~. ......... Lot .... ./.(~./. ....... Subdivision .~..~..~.....~./~'. ,~ /~-4~ ...Filed Map No. .Lot No. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Depto Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and ,/~,,it meets~,~/lic, able codes and regulations. Applicant. ~4~...~'.', ~ ....... ' ...................... Rev. 10-10-78 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y, 11971 TEL.: 765-1802 Examined. ~..~..h, .... , 19 ?9. Approved .~..&..q'. .... 19 Pk. Permit No..~..~.~..~.~..~. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERIVIIT Received ........... ~ 4~4 Date ................... 19... INSTRUCTIONS a. This application must be completely filled in by type,~riter or in ink and submitted to the Building Inspector, with } 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 necessary in~.~t~~, (Signature of applicant, or name, if a ~o~rTy,'on) State whether applicant is,,~.wner~, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .~i~ .~. ................................................................. (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 ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................... ~ ............ ................................. .... .............. House Number Street Hamlet County Tax Map No. 1000 Section .... ~.~.~. · ....... Block...~..~.. ........... Lot,.. ~.~. .......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ..... ................................. a. Existing use and occupancy /2 (/ ' x-~- ~ ~//~ b. Intended use and occupancy ..... .~r~q~-....&~P~.... ~2~./-.. ~ ........................... 3. Nature of work (check which applicable): New Building ' Addition .... Alteration v'/ ..... Repair .............. Removal .............. Demolition ............ .. Other Work ........ . ....... (Description) 4 ~ · Estimated Cost ............................... Fee ........... : ........................... ' (to be p~id 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 mixed occupancy, specify nature and extent of each typ~ of use ..................... 7. Dimensions o£existing structures, if any: Front ............... Rear ........ i ...... Depth ............... Height Number of Stories ' Dimensions of same structure with alterations or additions: Front .... ' Rear Depth ' Height Number of gtories 8. Dimensions of entire new construction: Front ............... Rear ..... i .. Depth Height Number of Stories ' 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 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 ................ :... Phone No ................ Name of Architect Address Phone No Name 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, mad show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ~OUNTY OF ................. S.S (Name of individual signing contract) above named. ....... being duly sworn, dePoses and says that he is the applicant He is the ................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the ~aid work and to make and file this application; that all statements contained in this application are true to the best of hig 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 .......... f..~..(~.., ....... dayof .... ~ ......... 19~.~. ~ [ ..... ~!' V // ,/ J : . Notary Public .... ~....~.,.. ~ .g<...U(.~ .... County f SUFFOLK CO. HEALTH DEPT. APPROVAL · H.S. NO. "~4! /¥'O, - - .... I STATEMENT OF INTENT '~'~4<~ ' ' I THE WATER SUPPLY AND SEWAGE DISPOSAL - (L .-.,.-~ -' SYSTEMS FOR THIS RESIDENCE WILL _~ . ~ ,'.i.%,/.. / ......... CONFORM TO THE STANDARDS OF THE , ; .... ,- ,,, / ,.,,'... .t ;, . · , . ; SUFFOLK CO. D/PT. OF HEALTH SERVICES. -~.o o. dC./ ~,' ~ "- < ' (SI ~' "; · ,/ ~' '/'? APPLICANT ; / SUFFOLK COUNTY DEPT. OF' HEALTH ' ': "4ao / , /' SERVICES - FOR APPROVAL OF ,~,~ ~"~ // CONSTRUCTION ONLY -~- ' DATE: ~-~ -~.. ~/,~' ' '"-~~:~0~ ' ~"" / APPROVED:H' S. REF. NO.. 14 ' SO' E'~f I ~,~,'; / I,'./ SUFFOLK CO. TAX MAP OESIGNATION: /~)~/7'/,O/(/,4/. ~,~ ;1~ ; ,/ OIST. SECT. laLOCK PCL. OWNERS ADDRESS: I ~s . , o:~:~~z ~ rna~ I , -O~ o=..~ SADLk..E'' ' : :__ '. O~ 2_A_ (~ .~/.~_zr.. TEST HOLE STAMP · --.. Gti~:/~;i ' i:~.L 7 . SEAL Co~4-*' ""-' ''*F'ak: ,' ........ ~ RODERICK VAN TUYL. P.C. LICEN~D LAND SURV ORS GRE~RT NEW YORK " SUFFOLK CO. HEALTH DE:fir. · ~/r.., H.S. NO. 14-,~O- '~'~/~'-'~[~/~,~ ~.~, ~ ~.J ~ ~ , STATEMENT~INTENT "-' ~ ~((. ~'~ THE WATER S~Y AND ~A~ DI~AL , /~ ~"'~ -- , (~C~' '--~/~)~ / 1 (~<_~.~ ~ .. SYSTEMS FOR T~S REliaNCE -~ c ~ C~F~M TO THE STA~R~ '?/ /~6~'~ /~S- N / ~FFOLK COUNTY ~. ~ ,/~ALTH '~ · ,~.~ ~, ,~ / SEEVICES - FOR APPROVAL OF .... ',/ CO~TRUCT ~N ~LY , , , ~RS ~E~: "-J " J /' ' TEL. __ ~ I ..... - , ..... ~ -, ~ ~~1~. ~.~,~ -z~ ~ .... A~-,~E:~,~:~, ~ u~.~ z.,-l~ ~ ~, ¢*'~ ¢--' 7_, FLlJtd '-:_k'.~ LANE--- _ ............ ~ r~_~n /~ ~ND~C - JULY B, 1985 L~ ..... '~ ::~;" ¢./-~ '- ..1. &") '~l'~ ~ ~'~A~~ DF LiCEWD LAND S~Y~S ~E~T ~W Y~ APPROVED AS NOTED FEE: ~"" '" '-- NOTI~ ~utLDING OEPARTMENT AT 765-1802 ~ Af~ TO 4 PM FOR Tile ~ATE CO~~T~C~ON & ~NERGY ~OES, NOT ~5~S~LE ~R m~SIGN ~R CONSTRUC~ON ~RS. OCCUPANCY USE iS WITHOUT 17 -O'~