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Home My WebLink About14186-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z13804 Date Augu. st 28 .,1985 THIS CERTIFIES that tile building ...... d.~ ~ .k..a.c~ d..i.t.i, qn... .......................... Location of Property .... l 7 5 ............ ?.v. ~.,. J(d.... l~ 5 ................. .P.e.q 9 P.~.q ..... House No. Street ~ Hamlet County Tax Map No. I000 Section .... 5.~ ...... Block ........ .2 ......Lot ...... ~. 4. ......... Subdivision ............. X ................. Fried Map No... )~ ..... Lot No ..... .X ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... 4 u J-~.. 1.6 .... , 19 ~ 5. pursuant to which Building Permit No .... 1.4. J .8.6.Z. ........... dated .......... A u F>~a ¢. a ......... 19q 5., 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 ......... .... D~.ck. art.c~ ~. [ ~..o.n. to..ex $~.¢.~r~g..d.~.e. ¢ ;t.5.n.g, .................................. The certificate is issued to ............. JAH~$..&..I~ gl~J~.I~. I).U?.~.~. ....................... (owner, ~ XeJq~} of the aforesaid building. Suffolk County Department of Health Approval ................. i~/. g ...................... UNDERWRITERS CERTIFICATE NO ......................... N/b ...................... Rev. 1/81 Building Inspector LVO~.M NO, ~B TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 14186 Z Permission is hereby granted to: ....... ~'"~'~~i ............ ..... zZ..~....~.p~?~.,...~: ............ ~ ....... .../Z~../.L~...~.~,,E~,,~,~...,.,.~:~..zz~-~ ,o ......... d~.~...f~Z ....... ~...~.~.~:...~.....~..~.~..~_ ................. ........ .,~z,~..~..r.,~.,~, ...... ~ ......... Z~.<..~.,..C....~,W........./.~.,.~ .............. at premises located o(......../..7.....~..'~.. ...... ..~..~...Z~.,.~.,..~..~, ........... ..~.C~),¢~./..~,,.7..~..'....'~Z...: ...... County Tox Map No. 1000 Section .....(~..LZ ....... Block ..~.~. ............ Lot No..~/...~... ........... pursuant to application dated ......... ~..'~.~..~.~.,...../...~... ................. , 19 ....... ..~..'C and approved by the Building Inspector. Fee $ ......... .(,~).... ......... Rev. 6/30/'80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall $outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application 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 features. 2. Final approval of Health Dept. of water supply and sewerage disposal-iS-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 Plann lng Board approval of comp leted site p lan req~ ireme~ts where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of pZ"operty showing all property lines, streets, buildings and unusum 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 o 00 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. '$5.00 Date ~' ~' ~ New Building ............. Old or Pre-existing Building .....~. ....... Vacant Land ............. Location of Property ..... ./~7~.- ............. ~ ............. . ............... Hou~ No. Street Ham/et Owner or Owners of Property ...~..~.'~'~. ,~.~..---..~. ,~.~. ,~.c¢-..AJ~. ,/.~,~. ,~. County Tax Map No. 1000 Section ... ¢~./~.~ ....... Block .. ~. ,2:-. ......... Lot..'.. ~,/~. ....... Subdivision ................................. Filed Map No ........... Lot No. PermitNo. /~/.~.~ .Z. Date of Permit ~/~.Z'/~.5." .Applicant ~..L,~'~'/~*¢¢zJ55;~b/ Health Dept. Approval ........................ Labor Dept. Approval ....................... . Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ . . .~..'.~.c.>.../..~.. ~.~. [ ) .......... Construction on above described building and permit'rr'~ets all a_~D_l~able codes and regulations. Mr, & Mrs, Glen Rasmussen 18 W, Spre~ue Drive Valley Stream, N.Y. 11580 FOUNDATION (Ist) FOUNDATION (2nd) ROUGH FRAME & PLUMBING 3. INSULATION PER N. Y. STATE ENERGY QODE OMM [',N I o FINAL ADDITIONAL COMMENTS: TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL Examined .~. ~.. ~ ..... 19~'~."' .-~. ~ i~ece±ved ........... , 1 9... ~iapprov.eda/ ~ · ~ \c~~ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tins application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 :ets 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 6r 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. r d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit ~hall be kept on the premises available for inspection throu~out the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy aall 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 ;uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or '~egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. 'he applicant agrees to comply with all applicable laws, ordinances, building code,~housing code, and regulations, and to dmit authorized inspectors on premises and in bttilding for necessary inspections. // (Signature df applicant, ~)r name, if a corporation) ..... ./~ ~.' ~ ~. ~?..~-.//.~ ~.~..~..~, (Mailing address of applicant) Itate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· .//.o~. ~.~/e~. ~.~ ~. ~..~. ~ ~..~....(?.%~.~ 0.~../,.~.~..;.~.~. ~..~!,.'~ d. ~.) .... ~me of owner of premises ..... .~. a .~.~.~....~.... i~..O, my..*.~d... ~(.O.~..*.a...& .P..~.~.V. .......... (as on fhe tax roll or latest deed) f 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 ...................... · Location of land on which proposed work, will be done .................................................. ,~../7.~....~:.-.~.o~....~..~d~./.~..~.~ ..... ~.~.~.~..~.,.~....,...~.~..~o~ ................... House Num her Street Hamlet County Tax Map No. 1000 Section ....O.~.~.: .O.O. ...... Block .... .O.2.~.~..O ........ Lot .... ~../.5/.'..O.O. ·O ...... 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 ..................................................................... b. Intended use and occupancy ...... /~C{d../A)~)~.~. O.. d.~.C.h~..(../.Z..X .2..~.).O.~....F~.~.C .O..~..~14,~. l.~.' Q o~ ..... Nature of work (check which ~pplicable): New Building ..... ' .....'.~ .ddition... ~ .... Alteration .......... Repair ............ Removal .............. Demolition ............ Other Work ............... ' . (D C,,,,4 ~ : , ~ escription) Estnnated Cost...' '. .......................... Fee ..... :e'O ~-~Sff~Jn.~: .~w~ ~' (to be paid on filing this application) If ~i~m[~{~llin} ~mti ............... [~b~r of d: ~llini ~its o~ ~a~[ toor ................ If [ara~: n~b~r of oari .... ; .................................................................... 9~sio:l of ~is[in] ltruol.~, if any: ~rom ............... [~a .............. 9~th ............... Height ............... Number of Sto~s ......................................................... 9~ensiom of sam~ struot.r~ Wia alt:mtloni or ad~itio~l: [ru:t ............... [~ar .................. Depth .................. !... Height ...................... Dimensions of entire new construction: Front ............... Rear .... g .................... urn- ....f ,,,o ....................... 9. Size 6flor: Front ......... ~ ............ Rear ............... 10. Date of Purchase .......... ................... Name of Forme 11. Zone' or use district in which p~emises are situated ................. 12. Does proposed construction viblate any zoning law, ordinance or regula 13.Will lot be regraded ...... ,,. ·..l .............. Will excess fill 14.Name of Owner of Address Name of Architect ..... ,. · .i · .---7 ..............Address ....... Name of Contractor...~).~'~..)~.~ .~;r3~.e'.~. ...... Address PLOT DIAGRAM Locate clearly and distinctly all buildings whether existing or propos property llnes. Give street and block number or description according to de~, interior or comer lot. STATE OF NEW YORK, COUNTY OF ................. S.S ........ O. ..... .~..q.s.sRO ............ (Name of individual sig~~ dng contract) above named. being duly s' is the ......... .............................. (Contractor, agent, corporate o: of said owner or owners, ~d is doly author~ed to perform or have perfo~ application; that all statements contained ~ this application are true to the work will be perfo~ed in the m~n~r set forth in the application filed then Sworn to before me this ........ · .~.~ .......... /~ay of .... ~ .......... , ~ /.~ ,..~.~ ..~ ~ , amber of Stories ...................... ............... Depth ............... ....... Depth ...................... : Owner ............................. ion: ................................ be re~0o,ved from premises: Yes No ............ Phone No ................ ~d, ~d, indicate fll set-back d~ensions from ~d show street nmos and indicate whe~er am, deposes and says that he is the applicant ricer, etc. ) reed the said work and to m~e and file this best of his knowledge and belief; and that the dth. '~"' ~ (S~gnature o; appll~ant~ I11- b'- q,/L ' ~ /~t__ , ~,/ (,l Unauthori~Jtoratton ' · ~7 ~ ~8~ of th:s survey map ..... ~ ~ valid copy.