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Home My WebLink About13845-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. z14720 Date July 29~ 86 THIS CERTIFIES that the building .., a..d.d.i.t..i.o.n..t.o., ?.x.i.s..t.i.n.g., .o.n.e..f..a.m.i.l.y...d.w.e. 1..1.lng Location of Property 500 West Lake Road Southold, New York House No. Street Hamlet County Tax Map No. 1000 Section 90 .Block i .... Lot 24 Subdivision...M/.o. Cedar Beach Park .Filed Map No. 90 .... LotNo. 120 conforms substantially to the Application for Building Permit heretofore filed in this office dated i977 1384sz Apr i 1 2, . pursuant to which Building Permit No. dated . J.P.r..i.1..S,: ................. 19..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 ......... Add~itign to exis. ting one family dwelling Herbert Greenfield & Marcelle Greenfield The certificate is issued to ........................................................... [owner, ~. ~;~x of the aforesaid building. N/A Suffolk County Department of Health Approval .......................................... N759930 UNDERWRITERS CERTIFICATE NO Plumbers Certification Dated__ , fiune g7~ ,1.986 ' Building Inspector Rev. 1/81 FO~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y, BUILDING F ERJ~,IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WOP, K AUTHORIZED) N~ 13845 Z Permission is hereby granted to: ....... /.x.~..x.....n4..~.~ ........................ ,~~.~,...~./..z.z~..., ...... ,o.~...~...~..'/..~.L.~..'.,.'~ ....... ~ ........ ..~..~-r.~...~....'~, ............... ~ .~.v.r. :;. _-..--. ;~.. ~....v~..~. ...... ~,~ .. ~.~.,... ~L~ .'~ ..................................... otpremis. Io2,edo, ...... ~......~.~....~'...~.....~....~ '-' .... i~~.~ ........... County Tax Map No. lO00 Sect)<r~...,..~..,cJ...D.. .... Block ........ ~ ............ Lot No .......c~.....~. ........... pursuant to application dated ...... ~ ........................ , 19..~..~.., and approved by the Building Inspector. Fee $....~... · .~...?.. :.?....~.. Building Inspector Rev, 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall $outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions in duplicate This application must be filled in typewriter OR ink, and submitted v to ~he 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 approvat 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 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- 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 New Building ............. Old or Pre-existing Building $15.00 Date..J ".~..~. · · · .~.~. ~. ~ .~. ~. · · Vacant Land Location of Property ....... · ~. House No. Street Hamlet Ow.erorOwnarso Property ........... County Tax Map No. 1000 Section ....~a ........ Block ...... I ........ Lot....~.~, ......... S. bd ivi;on. ~.~..o[..~.~ .~-., .~. ..... ?..~,..~....~.~. ...Filed Map No ........ otNo. ~P PermitNo. [~.~. DateofPermit~t.,..~tl.?~CApplicant J~.v.~ '~' ~[~./~ ....... 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 regula.tions. Ap pl ica n'~~ . ,~ ..................... Rev. 10.1e-78 ~IELD INSPECTION COMMENTS FOUNDATION (1st} FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N. STATE ENERGY QODE FINAL ADDITIONAL COMMENTS THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ exa~nia~on. ~ 5uly 14, 19~ and found to be ~n co:t pliattt~ with the retI~t(re.tenl.~ qf ~hls Board. DRYERS 34 33 OVENS DISH WASHERS I EXHAUST FANS 1.2 5 F . OILERS ~is cedificote m~t not ~ oltered in any monner~ retbrn to the oHi~ of the Board if incorr~. Inspedbrs may be identified by their TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No.'~'/f]~[VD Owner ~/~ (~r~,~ (please print) (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber' s signature) Sworn to befor~ m~ ~his Notary P.ublic, ;~/~, f~/~ .County 7GS-X802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION ZND [/] ~JI~TION [ ] FRAMING [~'~FINAL REMARKS: ...... ~) ~ 'FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL,: 765-1803 Approved(~.. [.0 .... , 19~..~. Permit No. /...~. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received . .~. INSTRUCTIONS a. This 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 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 buiIding 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 regulatiofis, and to admit authorized inspectors on premises and in building for necessary inspect., //,~ ~ ~/~ (Signature of applicant,, or name, ff a corporation) .¢.. .... (Mailing address of applicant) I State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....~. J~.-..~..t:.~...~'..~ .~.. ~ .~...~..,l~. ~...K[~---./Cl..N/... II~.X~ ......... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate office, r) / 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.~. ~t~/.~.l.~..~...'~ .M..'~..~. O.~.LltA~....~..~. ........ .... 94 ................ ............. House Nmnber Street Hamlet Couuty Tax Map No. 1000 Section ......... q. ~.. .... Block ..... / ............ Lot...~...~/ .......... Subdivision. ~t~.|~..~..'~ld.~.,. ~/;70~..~1,,~..~g Filed Ivlap No....'~. ........ Lot...~.~.. ........ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing nsc and occupancy .... .P. ~{/~-4~.1.~...~. ................................................... b. Intended use and occupancy . . . l~.t~t5 h ~..I,~.~_~ ................................................ 3. Nature of work (check which applicable): New Building ..... ' ..... Addition ./-~.. ....... Alteration .~.. ....... Repair .~--AZ.. L' ' ' ~'~' · '~ .... Removal .............. Demolition .............. Other Work ............... j . ' (Description) 4. EstimatedCost..[ffQ/.Q~.~ .......................... Fee "' (to be paid on filing this application) 5. If dwelling, number of dwelling umts .... t:>kl.~, .... 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 type of use .... :.... ........ 7. Dunenslons of emmng structures, if any: Front.. ,~>..t~ ....... Rear ... ~ ........ Depth.. ~. ....... Height ... IA' ....... ' Nu'mber of Stories ... ~;2.1Ot~. ............................................... Dimensions of same structure with alterations or additions: Front .. ~.~, .-.~ ......... Rear .... qf.~'.-. ~ ........ Depth .. ~-,~. 5.~.". ........ ;... Height ...... ~ .*.~..aL:?. ........Number of Stories...~J~.~.~2;> .............. 8. Dimensions of entire new congtruction Front .. ,~ .~. ..... Rear .... :~.~-: .~. ...... Depth ~ ~ . .. mb Height .... -~. ....... Nu er of Stories .................................................. 9, Sl~e of lot: Front ...... L.~ ............ Rear ......... ~ ........... Depth., .I.~.C:~. .............. 10. Date of Purchase . .~?~.'~... !.'~? ."/.~ ............. Name_of Former Owner ~... ~.lg.~I~g,~*~ ......... 11. Zen/or use district in which plremises are situated ....... t~...2. ~..~.-~ ................................. 12. Does'proposed construction violate any zoning law, ordinance or regulation: ............................. 13. Will 10t be regraded .'... t~1~.! .................... Will excess fill be removed from premises: Yest/ No 14.Name of Owner of premises l~4 . .~f,'~g~..M.P..I~.;I~.2_;.. Address . ~.~.17-3~.. M.~... Phone No~-4~'."/~?'. ~ ~.... Name of Architectf~t~,,,,,,~l~. J~. :2. Address .~UiX'A4. ,l?~:?(r~l'7.... Phone No.~-&d. · Name of Contracto'lr-'.~...l~..~.l*.?.lP.~.~.?.?.~..'7~... ?.. Address . '.~i~..'~. ff..~J?..r'... ,. Phone No.'Z?.'. .~...~.~...~'..o... 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 show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF ................. ...~[~,lf~..r~.~t. .~...~L,,l,~,~..f~.. ................. being duly sworn, deposes and says that,he is the applicant (Name of individual signing contract) /bore named. He is the .: ..... ~..~..1~..KI..~... 'i ............................. :' ..................................... (Contractor, agent, corporate officer; etc.) of said owner or owners, and is duly authorized to perform or have performed the said 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 w, ork:will be performed in the manner set forth in the application filed therewith. Sworn to before me this ...'. .... '...~./;~ ........ day ~f....~<1.~.,~. , , Notary Public, . ........ HELEN iX. DE VOE NOTARY PU[]LIC, State of New Yor~I No. 4707878, Suffolk Coun%~i Term Exp*ra iVlarcli 30, 19~ i M~F~ , . , ~ ~, , : :,, : , ,, . ,,. , : . - ,. . ~ ~ , . ;, ~ : J l Ill i- - ...... -1i. ,,, 1 ,,., ,, ,';,,,',~,.~ ,.:',' .. ,;-~.,:,,,~,, ~.. ,,,:~.. ,,~,.,'L';,,.,,..,,. ~,'~.:..{.':.~,., [.,,:, ,. ,,~:'...,. ,.,,: : :., ,. :,,,.,~',...,..... '. ,-. '.,i , ,,~., .. ' , ,., ,