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Home My WebLink About14248-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ......... .Z.1.5.8.3..0.. Date June 9, 1987 THIS CERTIFIES that the building addition to existing dwelling. 3450 ......... L~'s'Ii&' 1~66d .......................... Location of ProDertv 2900 Indian Neck Lane Peconic County Tax Map No. 1000 Section 98 . .Block 1 .Lot 2.4 Subdivision ....... E..a.s.L..H..L.l.1. ............. Filed Map No....6.0.4..4 .Lot No. 2.12 conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .A.ug.u.s..t..7.,..1..~.8.5. , pursuant to which Building Permit No. 14248Z dated ...... .S.o~.~..e.m.b.o.r...9.,..1. ? .8.5.. 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 ......... .... ~0.~J,~ipn .So..e.x.i..s.~.i.n.g. 9.n.e. r .f.a.rqi. %y..d.w.e..~.X.i.n3: ........................... The certificate is issued to ..... CLEMENTINE JANE ZUREK ............... /oYn;;,'~ 'rd~'~ ..................... of the aforesaid building. Suffolk County Department of Health Approval ............... .N./.A. ............... UNDERWRITERS CERTIFICATE NO ................... PENDING . PLUMBERS CERTIFICATION DATED: 1/2/87 Building Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 14248 Z Permission is hereby granted to: ......... ........ to .. .~ ....... ~. .......... ~ ................. at premises located at ~.~'~c~.~.~.~"~.c¥:~.~..~.~.?~~~~`~L~:~z~. County Tax Map No. 1000 Sectio~ ................... Block ...................... Lot No ........................ to application dated .... ~.~..~......~. .................. , 19...~..~.., and approved by the pursuant Building Inspector. Building In~ector Rev. 6/30/80 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions _~ (~/10/~q This app!ication must be filled in Wpewriter OR ink, and submitted m ~,=asama to the Building In,eh- tot 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. 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 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. Updated C.O. $15.00 $15.00 ~~~--../~J? Da '. ....... ~.. New C on s t rhc t i on ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Proper ty~,~2u~;~.~l~,/o/.o. "~.(/JJ'.~o~. ~?~.~. ~'~ ~..~.~. ~.. ~.~'.o,. ~.~.~. ~.~.~.~ ......... Street Ham/et Owner or Owners of Property____ , ./Z. [~ ~..~./~..~. .........~.~.../~..~:~. ............... County Tax Map No. 1000 Section . .Q~...~.,~/ ....... Block ...~...( ........ Lot.. ~-..f~. .......... Subdivision ,~/~.. ~.~ .(~.~J~ / .... I.~.t. / 1 ........ Filed Map No. ~. Permit No. I. ~ Date of Permit 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 permit meets all applicable codes and regulations. .............. Rev. 10-10-78 TOWN OF $OUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL $OUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No. / g/ ~ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber s~ign~ure) Sworn to before me this Notary Public,~~ County Notary Public Qualified in 8uffolfc County ~'" Commission Expires December ~. 1 ~/ COMMENTS FIELD ,INSPECTION FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & FLUMBING INSULATION STATE C,ODE FINAL PER N. Y. ENERGY ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: ~?"~~ DAT_ / ,,/'--' INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FRAMING REMARKS: [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION :)ND [ ] INSULATION [ ] FINAL TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y, 11971 TEL. 765-1802 To Whom This May Concern, We are unable to complete your Certificate of Occupancy because,of the following reasons, /Z/ An application for Certificate of Occupancy is not on file. __~_~ No Underwriters Certificate on file. /Z/ The check is(outdated/not on file.) /~/ No Health Dept. Approval on file, /~/ No final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. __Building Permit # / q ~-~ ..~ Z Building Dept. ***~ No Plumber Solder Certificate on file. ( all permits involving plumbing being issued after April 1,1984 ) TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL $OUTHOLD, N.Y. 11971 To Whom This May Concern, We are unable to complete your Certificate of Occupancy because,of the following reasons. /5/ An'application for Certificate of Occupancy is not on file. _,~_~. No Underwriters Certificate on file. /Z/ The check is(outdated/not on file.) /Z/ No Health Dept. Approval on file. /Z/ No final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. __Building Permit # -! _L~_.~. L/ ~ Z Building Dept. ***~ No Plumber Solder Certificate on file. ( all permits i ~ nvolving plumbing bein~ issued after April 1,1984 ) 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-180'3 Examined..~.~..~...~.., 19 ~ .~. Approved . .~-~h .~A~...~., 19~. .h. Permit No.. [ t.~.~..q..~..~. Disapproved a]c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS TOWN OF SOUTHOLD R~ceived ........... ,19... a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ~ts 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 r 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 luilding 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. '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 in~ectionscrp~: /t~ /] ,~ (Signature of applic~ff[t, or name, }f~ corporation) '. (Mailing address of applicant) t / ~.5~ ltate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~Iame of owner of premises~:-~ .~.~,~L~/~-~~. ................................................... (as on the 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 ..... I.~..~..7..¢ ........ Electrician's License No .... [...~.'..~. 7 .......... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section -~.~.'~ ........ Block ..l ............... Lot.~3.¢ ............. Subdivision/~.~..O~..~.~T.... ]~.~. I.] ............... Filed Map No..(q...~..L[ .~ ..... Lot .0..O~. ,..O. l .~... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . t~...~ ... ~..~: C~ .... ,~.~.~ ./. ~/ ..... ~)Ltoe. I.I.I. ,~ ....................... ·. ............... 10. I1. 12. 13. 14. 3. Nat re of work (check ~hlch ~ppllcable): New Building ................. Repair .............. l~emoval....~.' ...... Demolition ......... ~--- Other Work ............... 4..Estimated Cost ....................... Fee . ~ .................................... · ' ~' (to be paid on filing this application) 5. welling; number of d~vellifig units . .~. ........... Number of dwelling units on each floor..q ............. If garage, number of cars .~.c~ ~,, ........................... ; .................................... 6. If business, commercial or mixled occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structuies, if any: Front ...... ~-.~-! ..... Rear ...~.! ....... Depth . .~.q f ......... HeiglSt ..... Number of Stories . f ....................... D~mans~ons of same structure w~th. alterations or additions: Front .,~4/. ........... Rear .~.q./. ............ Depth ~1~.' ............ !... Height ...................... Number of Stories../. ................... Dimensions of entire new construction: Front ... i.~. ! ........ Rear .. l..X~..~ ........ Depth .. ,~.. ~. ......... Height ......... ., ......... ? of ~.one ., ................................................... Size of lot: Front~afJ.I .~.,.c/6,. ~.~.( ~.~,.q~. 0.¥. tR"e~°. ! ............... Depth [ ~.~., Date.ofPurchase ..[.ct~'.~ ...................... Name of Former Owner ,,'~f~r~(...~.0.~....'~.tlt...f.~... Zone or use district in ' which premises are situated ................................................... Does~proposed construction violate any zoning law, ordinance or regulation: ................................ Will 10t be regraded ... &/..~. i .......... z ......... Will excess fill be removed from premises: ~ No Nam~ of Owner of premisest~?e'~ Ct) ~.o¢. ~>. ~/.e~J~. Addres§~.o.~l~.q ~..~/e¢ .L..~.~'.~. ~,_.~.. Phone No..7.,.~ q' .~.. Name of Architect ........ J .................. Address ................... Phone No ................ Name of Contractorr~hi [. [[~ v.*.~ rJ. $ ............. Address--V'o. .09% ?.~.q. --q .[ ..... Phone Noir'(,) ~. f~.: $.el.q .[.. PLOT DIAGRAM Locat~ clearly and distinctly all buildings, whether existing or proposed, and~ indicate all set-back dimensions from property lines. Give street and bloc number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ........... S.S being duly sworn, deposes and says that he is the applicant (Name of individual sighing contract) above named. He is the. ............................................................. ~ ............................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d~ :ly authorized to perform or have performed the said work and to make and file this application; that all statements con lained in this application are true to the~best of his knowledge and belief; and that the work will be performed in the man~ ~r set forth in the application filed therewith. Sworn to before me this , : ............. 7..~'.. ...... day if.. ~ ....... 19 ..~.~ Notary Public, . ..... ~ .i ~.~t'~(~.~.~ .~f.~w.. County / ....... x~ OCCUPANCY OR USE 1.5 UNLAWFUL.. FOR PO;:i:~D ' ~,~/'~'~ 2, ROUGH :~A~i: '~ & PLUMBING 3. INSULATION 4. FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIp. I=MENTS OF THE N.Y STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR ,~I~SIG~~ OR '?ONS"r~,( ~r:'t~,:~,::I:tBC'~