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Home My WebLink About14544-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y, Certificate Of Occupancy THIS CERTIFIES that the building Addition Location of Property ..... .1.4.5., .T.e.e.~e.. Trail Southold House No. ' ............ County Tax Map No. 1000 Section 087 .Block 02 ...... Lot 032 S,,ha~,,;o~,~ Nunnakoma Waters .Filed Map No.5.1.2.6. .... Lot No. 19 conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... N..9.v..' .1.2. .......19 .8.5. pursuant to which Building Permit No. 1. 4. 5. .4 .4 .~ ............... dated . .F.O.b.-..1..4 .................. 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 ......... ....... Acl~i~iVr~ .~9..e~.J~ .t~_.n.g..d.w.e.1..1 .i.n.q: ......................... ;,: .......... The certificate is issued to ROBERT AND RUTH KASSNER of the aforesaid building. Suffolk County Department of Health Approval ....... N/.A ............................... p.e. ndi n.g. UNDERWRITERS CERTIFICATE NO ............................................... PLUMBERS CERTIFICATE June 20, 1986 Building Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o 1~5~ Z Permission ~s hereb/granted to: . . ... . l;9 ................. at premises located at ..... /,.~,,,~),,,,'~,, ....... /,~-~,/,,~,,,~,,. ,~,~,.~ ..... ~ .......................................... County Tax Mop No, 1000 Section "~'" '~'"7 ..... Block .,~,,,,,~,, ........ Lot No. ,~,.3s~, ......... 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 .... IIIU)G. 0~7'.'~ i A. This applicatioq must be filled in typewriter OR ink, and submitted m~ 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 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 similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Su bm it Plan n lng Board app royal of comp leted site p lan requ irements where app licable, 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. Data of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 $15.00 Date. ~ .'7. ~ .-..~...~' ............ New Building ............. Old or Pm-existing Building ............ Vacant Land .... ......... Location of Property . ,~."~..,-~. ........ . .~.C.. ,~,~, ,~., House No. Street Ham/et Owner or Owners of Property~;) ]~ 'TL ....... ~! ~t.~"~ .~..~..~. ..................... County*ax Uap No. 000 Section ...¢3.7. ....... B,ock . ......... cot...0. ....... Subdivision .~.~./~../~'. ~./~..~¢~. ~)~. ¢./¢.5. .... Filed Map No5.'~/¢,~ ~...Lot No, ./.~ ......... Permit NoJ .~, ?', ,~,,,~,. Date of PermitX//,/2//~.~.AppJicant .~.,~,¢, ,~.~'. o ,'~, .': ,/.-~,~,'~, S.~ ......... Health Dept, Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate .. ................... Fee Submitted $ ~..; ......................... Construction on above described building an~ permit meets all app~.licable codes and regulations. ' Applicant ........................ TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL $OUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Permit No. ;~l~'~F~ Owner~O~'~' k~ /V~ (please print) ¥~0~1 (please print) I certify that the Solder used in the water supply system contains less than 2/10 of 1% lead. umber' s s i-g-n~re) Sworn to before me this ~ day of Notary Public, County Notary Public ]'65-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: ~'~,,'u-/~/. / DATE INSPECTOR 7GS-'" 802 BUILDING DEPT,, INSPECTION [ '1 FOUNDATION '~ST [~ ROUGH PLBG. [ ] FOUNDATION 2ND [~.?NSULATION ~FRAMING [ ] FINAL REMARKS: ~ ~~ ~~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. FOUNDATION 2ND [~ ]j~.N~ULATION FRAMING ~ FINAL DA~ INSPECTOR FIELD INdirECTION C OMMI*2N'I ~ ~- FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME &~ PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 'FORM NO, 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Disapproved a/c ........... ~.~ ......... ~.. · (Building Inspector) APPLICATION FOR BUILDING PERI~/IIT .BLDG, DEPT. TOWN OF' ~OUTI"IO_ b Received ........... ,19... Date ............... , 1 INSTRUCTIONS a. Tins 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 layou.t 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 commeficed 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, ordinancesAbuilding code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessar~ Inspections. ~ (Signature of applicant, or n[,fne, if a corporation) ' (Mailing address of applicant) State whether applicant is owner, lessee, agent, archi/~ect, engineer, 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... ! ./..~. .................. 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 o~cupancy of proposed construction: a. Existing use and occupancy .... ~ ~-~' ........................ b. Intended use and occupancy ..... ?. 3. Nature of work (check which applicable): New Building ..... ' ..... Addition . .... Ali~ration ......... ~ Repair ....... '.~ ....... Removal .............. Demolition ...... .-. ..... '... Other Work .............. (Description) (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number welling unit on each floor '. ~ .............. If garage, number of cars ' ' . ........................ .. 6. If business, commercial or mixed occupancy, specify nervure and extent of ~ch ~yp!e of use ..: :......~; ) ......... 7. Dimensions of existing structures, if any Front.. ~ .~. ......... Rear .~.~.' ....... ~.. Depth. 5. ~O.. ........ Height .... ~ ......... Number of Stories ... ~_ ...................... : ........................... Dimensions of same structure with alterations or additions: Front . ~ .~ ~ i. .. Rear . .7 q-.) Depth . ~ ~ ................. Height ...~.~ ................ Number~of Stones ...~.~ ......... - 8. Dimensions of entire new construction' Front ~' .~ Rear ~ -~ ~ r~,~,,~ Height .) ~ Number of Stories . ~ . 10. Date of Purchase . . I .'.-'..~.~ :-. ~ .~ ."2. ~ .......... Name of Former Owner i .... ~.-n-. ........... ' ...... 11. Zone or use district in which premises are situated... ~,...-.. ) ...... ' .......... ~ ', ................... ~.. 12. Does proposed construction violate any zoning law, ordinance or regulation: .I.~ .6 ......................... 13. Will lot be regraded . .t~ .e .~:_..,.....t .~..,,., ......... Will ex.c~ fill be removed from premises: Yes ~ame of Architect ~ 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 shov' street names and indicate whether interior or corner lot. ~ o ~ ~ ~ o'T SI'ATE OF NEW YORK, S.S COUNTY OF ................. · ' ................................................ being duly sworn, depoges and says that he is the applicant (Name of individual signing contract) above named. He is the ' ~ (Contractor, agent, corporate officer, etc.)I of said owner or owners, and is d~ly authorized to perform or have performed the s~id work and to make and file this application; that all statements contained in this application are true to the best of hislknowledge 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 Public, . ......... .~.~ ........... County . NOTARY PUBLIC, State of New Yodt '* i (~ignature of app!i~ant) .~ e7 BOW ROAD LOT eo S. 88° I1' O0 "E. LOT 19 N, 88° II '00" W. LOT 20 15 116.22' 'z.~'I ~/~ ~.~ ~ 80. O0 LOT 0 O, ~S'7 40. ?~ CERTIFIED TO ; ROBERT G. KASSNER RUTH Z. KASSNER Prepared in accordance wit~ the minimum ~andc~rds for title sur~eys as estabIi~hed by L. L A. L.S. and approved and adopted ~ ~ ~ 1be ~w York Stete ~ /PE~ SURVEYORS (516) 765 - 5020 P.O. BOX 909 MAIN ROAD SOUTHOLD ~N,Y. 11973 N.Y.S. LIC. NO. 49618 ENGINEERS , P.C, SURVEY OF LOT 19 OF NUNNAKOMA WATERS" ' MAP FILED JUL. 9 , 1968 FILE N0.5126 AT SOUTHOLD TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. lO00 87 02 32 SCALE I" = 30' MAY 2~ , 1986 86 -294 ~c [) 0 £, o /