HomeMy WebLinkAbout14226-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. Z..I.6.?. 6. .......... Date .../}!~ p.t.e.m..b.e?.. !.6,..l. 9..8.7 ........
THIS CERTIFIES that the building... ~.d.d. ~..~.i.o.q ...................................
Location of Property 2025 MAIN RD. (FRANKLINVILLE .R.D.:! LA?.R.EL ...
Hou~ No. Street Ham/et
County Tax Map No~ 1000 Section . .1.2.5. ....... Block 0 I ...... Lot 0 3,
Subdivision ............................. '..Fi]ed Map No ......... Lot No .......... .** .
conforms substantially to the Application for Building Permit heretofore f'fled in this office dated
9, 985
Aug .. , pursuant to which Building Permit No.
dated .S.e. ?.c....~. :. ?.8..~ ............ wu issued, ~d conforms to ~li of the ~qui~ments
of the applicable provisinns of thc ~aw. The occupancy for which this certificate is issued is .........
D.e..c.k a.d.~iclon to exlstln§ dyelllng.
The cerUficate is issued to.....ROB~'RT..............B' & KATB~.~.~N..........K:.G~.RDTS (owner,
of the aforesaid bui]d~g.
Suffolk County Department of ~e~dth App~ov;d .... ~./..~ ............................... .. . .
UNDERWRITERS C~RTIFICATE NO ............ ~../.~ ...................................
~.UH~E~S CR~TTFTCATION DA~ED: N/A
Rw.l~l
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Buildln~ Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
N°''Z'I'6'I'7'7' '"'-....* Date Se2ce. mbe. r 16, 1987 THIS CERTIFIES that the building .... Ac ce.s.~l ¢ 1~¥ ..................................
Location of Property ....2.02.5. ¥.Ar.S.,Rp... (FRANKLINVILE RD.) LAUREL
House No. ' ...........
Street Hamlet
County Tax Map No. I000 Section ............ Block ............... Lot .
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building permit heretofore filed in this office dated
...................... pursuant to which Building Permit No 14 226 Z
dated ...S.e.p.c.:....................3' 1985 . wasissuad, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is .........
Accessory l~ar.a~e and storage building.
The certificate is issued to ROBERT lt. & RATIILEEI~ R. GERDTS
..................... .....................
of the aforesaid building.
Suffolk County Department of Health Approval ...I~ [b .........................
UNDERWRITERS CERTIFICATE NO ......... ~/.A ....................................
PLUItBERS CERTZFZCATTON DATED: N/A
Rw. 1/81
L~OR'M' NO. t
TOWN OF SO~THOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. ¥.
No
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLE'rtON OF THE WORK AUTHORIZED)
z ........
Permission is hereby granted to:-,
............
.......... ~....O.',.:.....Z~.L..z.~ .....................
,/~ . z~ .~ ....
,o ...:...~..~..v..~..~.~..z....~......z~:.~.....~..~.~..~.z~ ............. /~..C .C/.~..~...
............~' ~.z.~- ~,~-z.....~.~..:~.-"~t.~/~.~.~, ..... ~. ,.~ ~.. ~~z¢~. ~= ........ ~'
at premises located at ..... .~....O'.....~.'....~...~.. ....... ,~,/~/./~C......~..~...~..Z'~.~. ...........................................
....................................................................................................................... /,~,,z~/..f~.,,CK, t..: .--C.. ... . :~. . .~. . ; .~
County Tax Map No. 1000 Section ..., ./..~,....~-...'~.... Blcx:k .......~..../. ....... Lot No...~..~...~... .......
pursuant to applicotion dated ~y.(~....~.~......~... ................... , 19. ~.~...:'and approved by the
Building Inspector,
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
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-(S-9 form o~ 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~Coperty 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: Additions $25.00
1. Certificate of occupancy New Dwelling $25.00, Ac~sor~ Business $50.00
2. Certificate of occupancy on pre-existing dwelling $ 50.00 '
3. Copy of certificate of occupancy $ 5.'00, over 5 years $]0.00
4.Vacant Land C.O. $ 20.00
5,Updated C.O. $ 50.00 Date ......................
NewC°nstructi°n ...... Old or Pre-existing Building ............ Vacant Land .............
House No. Street Ham/et
Owner or Owners of Property .~.~.~...~.. ! ~.~..g;...~..~..~...'~.. .......
0.[.
County Tax Map No. 1000 Section ............. Block ............ Lot ...............
Subdi¥ision ................................. Filed Map No ........... Lot No ..............
Permit No. I .~:~..Z;. Date of Permit ~]~-~..Applicant .............................. I I I '
Health Dept. Approval ........ [~.~ ............ Labor Dept. Approval ...... ~[ ..............
Underwriters Approval ...... ~..~ .......... Planning Board Approval .... ~ ~:~ ..............
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $. ~0.~. ........................
Construction on above described building and permit meets all applicable codes and regulations.
Applicant...~..~'~. ~ ...................
,.,. ,0.:0.78 .4 z/¢ / 77
FORM NO. 6
TOWN OF SOUTHOLD
Ruilding Department
Town Hall
Southold, N.Y. 1197i
765- 1802
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-la-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~perty 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~
ees /' 'Add. itl°ns $25 0
C. F : ~ md~d~itio.
1. Certificate of occupancy new Dwelling $25.00, Accessory ,~]0.00 Business $50.00
2, Certificate of occupancy on pre-existing dwelling $ 5 0-. 0 0
3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00
4.Vacant Land C.O. $ 20.00 .~[[.~.!.~.~7
5.Updated C.O. $ 50.00 Date .................
NewC°nstruction ...... Old or Pre-existing Building ............ Vacant Land .............
Location of Property ~.~A)~W .~. ~.%..L~.....~..~'~...r~. t~)~_).
House No. Street Ham/et
Owner or Owners of Property . J~.~..~.,..
County Tax Map No. 1000 Section .... J.~.~. ...... Block ..... (~[ ....... Lot ........ ~ ......
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No. ~ ,~. 6.~. Date of Permit '.q. !~JJ~ ,~, .Applicant., ~J~O~J~"~... ~....~. ~ J~.-r,.~ .....
Health Dept Approval I~ Labor Dept Approval J~ t~
Underwriters Approval . · · .~.~ ............... Planning Board Approval ..... J~..~ ............
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $. ~.. :~. ~. .......................
Construction on above described building and permit meets all applicable codes and regulations.
Applicant . .~ ........................
Rev. I0-10-78
FIELD INS?ECTI~N ~ COMMENTS
FOUNDATION
FOUNDATION (2nd)
2.
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
q~DE
FINAL
ADDITIONAL COMMENTS:
Memorandum from ....
BUILDING INSPECTOR'S OFFICE
TOWN OF SOUTHOLD
TOWN HALL, SOUTHOLD, N. Y. 11971
765-1802
p gv.o AS No'r"o
i~-1~802 ~' AM Tq 4i PM FOR THE'
~-r~LLoW.,I NG ,NSPECTION~S. ', ~
· , ~UND4~IgN,-. ~WO REQ~ RD
:FOR ~O~RED tCONdREtE ~
2. RQUGH - FRAMI'NG~& iPLU~B ~G~
~ BEf COMpL~E FOR~C, O-; : ~
~ALL CONS~B~C~IQ~ ISHALL .MEET:
,THE RFQU(REME~TS 0F THE :N, Y,
;CQDES. ~oT fRESPONSiB~E J POR
DESIGN O~JCONSTRUCTION ~R~ORS.
' FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1802
)isapproved a/c ...... ........ :~ ........ ~... ...... .~.
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Re(
INSTRUCTIONS
a. This 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-
:ation.
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
,hall 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
~hall 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
5uilding 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 building for necessary inspections.
(Signature of applicant, or name, if a corporation)
... .ff..
(Mailing ac[dress of applicant)
~tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
i- .............................. ...... ; ...........................................
~qame of owner of premises . .~f.)..~..~.'[7....~....~.. !..~..q~..~ .L~.~..~'.t~. ~ ~..~ -~-~ ........
(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 ......................
House Num her Street Hamlet
County Tax Map No. 1000 Section .... .[.c~..~. ........ Block ......... [ ........ Lot ....... '2 ..........
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 ...... ~. UO..~.I..;~...~.f:)/hq [t~.~... ~.[~.~ ......................
b. Intended use and occupancy ..... ~ [~ ~ . ~a~. ~.~/..,~.~..a.~~~.~ .~. ~
3'. - Nature'~0f WOrk (check whJ~ch applicable): New Building ....~.'.' .... 'Addition .......... Alteration ..........
Repmr ............. i Removal .............. Demolition ... i ..... .~e.. Other Wolk..
' i "~¢*~ '~0'*'"O_._ -- /.~ (Description)
'"'~ 4. Estimr'~a ~o~t ~J~. ~ .t~g~/P ...................... Fee~,~. Z$ ~.'~./_'~.. ~..b~'..~. -~ ..
· ! *' i (to be paid on filing this application)
5. If dwelling, number of dwelilnglunits ............. Number of dw!lling units on each fl. oor ...............
If ga age number of cars i ~ ....... ~ .........
6. If business, commerciai or mix!d occupancy, specify nature and extent of each type of use ....................
7. Dimensions of existing structures, if any: Front ............... Reari .............. Depth ..............
Height ............... Number of Stories .................... [ ..................................
Dimensions of same structure with alterations or additions: Front .... ~ ............ Rear .................
Depth ................... i. · · Height ...................... Number of Stories .....................
.... 8. Dimefisions qf entire new constrUction: Front ....~ ........ Rear ,...~ ......... Depth ... i~ .......
He~ht . .Ii5 vl~. ....... N, mber of Stories ....... [.?.1,.O..¢~. .....i
9. S~ze of lot. Front ...... ,. ~..! ............. Rear ...[.~.o.~. ...... : ....... Depth . .~[O~.. 1~.~! ..........
D teofPur h se [ [~l i .1~ r ~:>
10.. a c a .... ~I..BO.. ~. ............... Nam~,ofFormer~Owner .~-3~.TxF.t-[ .....
11. Zone or use district in which p~emises are situated '/~ i ....
12. Does proposed construction viqlate any zoning law, ordinance Or regulation: .., .~M.Q ..........................
13. Will lot be regraded ........ ... JMO .............. Will excess fill be removed from premises: Yes
14. Name. of Owner of premises ~, >~.~1'. 14 .~¢-g-.1}'l~Address~:~>l~:~: t ~t~4-.~.t~-~7-UPhone No..o~:l.~.'~ .~p~ .fl'..
Name of Architect ..... .5~1- ~. ................ Address ....... ! ............ Phone No ................
Name' of Contractor .... I,~ ~J ~. ............... Address ....... i ............ Phone No ................
PLOT DIAGRAM
Locate clearly and distinctly ail buildings, whether existing or proposed, and, indicate all set-baak dimensions from
lines. Give street and bloc]
corner lot.
STATE OF NEW YORK, S.S
COUNTY OF ................
number or description according to deer
, and show street names and indicate whether
(Name ' being duly s om, deposes
of individual signing contract)
above named.
and says that he is the applicant
He is the ; '
i (Contractor, agent, corporate officer, etc.)
of smd owner or owners, and ~s d~ly authorized to perform or have performed the smd work and to make and file this
application; that all statements contained in this application are true to the best of his knowledge and belief; and that the
work will be performed in the man~er set forth in the application filed therewith.
Sworn to before me this ~ j
........ ! ...... ./..,., .....day 9~' ' · ·..,~'A'~-----~r. ............ ,19
Notary Public, .... i ......... County
~ [s~ Ilin~ ~. lt..l~ ! (Signature of applicant)
6LDG, DEPT.
TOWN OF SOUTHOLD
formefly
5¢ho°l
Aroo ' 5'1,099
Route
YOUNG & YOUNG
400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK
SURVEY FOR:
.,~OBERT H G£RDT$ 8 t(ATHLEEN
L~LIREL
SOUTHOLD
SUFFOLK CO., N.Y.