HomeMy WebLinkAbout17624-zFORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 219408 Date OCT. 2, 1990
THIS CERTIFIES that the building ADDITION
Location of Property I30 CLEAVES POINT RD. EAST MARION
House No. Street Hamlet
County Tax Map No. 1000 Section 38 Block 02 Lot 32
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Perm~.t heretofore
filed in this office dated NOV. 10, 1988 pursuant to which
Building Permit No. I7624Z dated NOV. 21, 1988
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 ADDITION, INCLUDING DECK TO EXISTING ONE FAMILY DWELLING
The certificate is issued to MR. & MRS. 70HN R. EDLER
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N089193 AUGUST 30, 1989
PLUMBERS CERTIFICATION DATED N/A
Building Inspector
Rev. 1/81
tows xo. s
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MU5T BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N4 ~J1.7b24 Z Date ......~.......a:( •~~
Permission ~s hereby granted•ta•
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to ~%'Nv4XJ~::!~.~....a.^.'~...~4-44:$~:~'P`.!? t ..?tt:1.~X~ :................4!~`.4Y~:~....~........ ..
at premises located at . 1..~~'4? ............:................. '. ~+s]l. ...... ...... ....~9r.1.r,-dx1... ..
County Tox Map No 1000 Section .~.°~$ .... Block .......Q ~-..... Lot No ...3
pursuant to opplrcation dated ~o-'4~'Y!;l~+r ! a... 19a g ., and approved by the
6u~lding Inspector.
Fee $.. ~ ~
rC ~~!~•- .... .. ................. .
Buil g Inspector
Rev 6/30180
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FOUIIDATION (1st)
FOUNDATI01d (2nd)
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INSULATION PER N. Y.
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Survcyocl Mctic{i 2/, /96.2.
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FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1802
Examined . AlQ"~'!~1~f..
Approved f,~.r}~,10.w~~i.
Disapproved a/c .. . .
..?~., 19~~.
~~ ., 19g8 . Permit No ... ... . .
BOARD
3 SETS
SURVEY
CHECK
SEPTIC
NOTIFY
CALL
MAIL
~~GC.Y .. ,• .. ....... .
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
OF HEALTH ............
OF PLANS ............
.....................
......................
FORM ................
.....................
T0:
het, /I,~ja/,~Y
Date ! "..:~/ ~ .., 1~~
a. This application must be completely filled in by typewriter pr in ink and submitted to the Building Inspector, with
sets of plans, accurate plat 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 stree
or areas, and giving a detazled description of layout of property must be drawn on the diagram which is part of this appl
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 perm
shall be kept on the premises available for inspection throughout the work.
e. No building shall be occupied or used m whole or m part for any purpose whatever until a Certificate of Occupanc
shall have been granted by the Buulding Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Pennit pursuant to th
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descnbe~
The applicant agrees to comply with all applicable laws, ordinances, budding code, housing code, and regulations, and t
admit authorized inspectors on premises and m building for necess/ary~inspec ns 1
(Signature of applicant, or name, if a corporanon)
.. ....... ........ ../fJ 1 ~. ~f.
(Mailing address of ap cant) •
State whether applicant %is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises U~o/!-•. i • i~ „ i~N "' . • . • • • ... • • • ... • • • • • • • • .. • .
%% (as on the tax roll or latest deed)
If app/li~ca-nt-i~s a rporat~n, s~nature of„duly authorized officer
(Name and title of c?orporate officer)
Builder's License No . `. J v .y ~ .~ ~ • •
Plumber's License No . ....................
Electrician's License No. ....... ..
Other Trade's License No . ................ .. .
Location of land on which proposed work will be done
House Number Street
c~~2T t~ '''~ "'
..... .........
Hamlet
County Tax Map No 1000 Sectior, Q 3g .. Block .. ~ ?-- .... Lot . ~
.....
Subdivision ~~~~ ~J
/~iGf'l'LedZ---. .. .Filed Map No aQ.3~ ... Lot .~.
(Name)
2 State eeisting use and occupancy of premises anpd intended use and occupancy of proposed construction
a. Existing use and occu anc ~ •'ti---•-m • • • • •
... .. ..... ....... ........... ..
b. Intended use and occupancy .. U. W2 .~'-_-~-• • • • • • • • • • ........ • ................ .
3 Nature of work (check which applicable) New Budding .... ~.. .. Addition ~• • • • Alteration ..... .
...........
Repair .... .... .. Removal ... .... .. Demolition ... ...... .Other Work
(Descnption
4 Estimated Cost .. al.,.Q-f1'-4) ... .......... ..... .Fee ... ...... .... .... .... ......
(to be paid on filing this application)
5. If dwelling, number of dwelling units .. .. ..... Number of dwelling units on each floor .......... .
If garage, number of cars .. .. .. h.~ ... ........... .... .... .. ....... ........ .
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............. .
7. Dimensions of existing structures, if any Front ... jU. { . ..... Rear ..~.jf ........ Depth ..3~,-~.... .
Height ... ~. Number of Stones ....... ~_ . ... .... .f .... ....... ............... .
Dimensions of s me structure with alterations or additions Front ~.Q .... ..... Rear ..''j..EJ ........ .
Depth ...3 Lt ...... ....... Height . ....~'- Number of Stones .. ,~~
8. Dimensions of entire new construction Front ...` .... .... Rear .... /.5 ..... Depth ~......... .
...
Height ...~7,~.-......... Number of Stones . ... .~ ........... .. ............... .... .
9. Size of lot. Front ....~:4( ..........::.: Rear ... ~t!!.. .... ..... Depth .~ ~~~,-~ ....... .
10. Date of Purchase ... .... .. .. ... ..Name of Former Owner ..... .. ..... ........ .
I 1 Zone or use district in which premises are situated . ...................... • ...... .. .... .
12. Does proposed construction violate any zoning law, ordinance or regulation ..... ~ .................... .
13. Will lot be regraded ... ,~: V .. .. ..... ,~pp W~ill excess Gll be removed from premises Yes (f
14. Name of Owner of premises ~LY..~ CA Yt .fly .~~{:4tkdress . Gtrx[T..~?~r'L:-!~~.. Phone No. ~/~~.if~ ~/..
Name of Architect ...... ....... ...Address ... ... ... ..Phone No.........
Name of Contractor j1!-~. f~k~...... ..Address ~i4:~...... .Phone No. ,7.1.1.-~'(od. ~
IS.Is this property located within ~00 feet of a tidal wetland? *YESy7~ .NO.
*If yes, Southold Town Trustees Permit may be required. 1~u~C~EA4JZ~
_ PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro
property lines. Give street and block numbez or descnption according to deed, and show street names and indicate wheth
intenor or corner lot.
STATE OF NEtiV YORK, S.S
COUNTY OF ........... .. .
• • • • • • • • • • • • • - • • • • • • • ... .... , being duly sworn, deposes and says that he is the applica
(Name of individual signing contract)
above named
He is the
(Contractor, agent, corporate officer, etcJ
of said owner or owners, and is duly authorized to perform ar have performed the said work and to make and file tl
application; that all statements contained m this application are true to the best of his knowledge and belief, and that t!
work wdl be perfoired m the manner set forth in the apphcation filed therewith.
Sworn to before me this
........ ~0. ........day of . .. ~CZY... .
Notary Public, .... .. ~. lJQ.Ue~-.
HELEN K OE VOE
NoT~trr eusln; inn ~t Neiv Yak
Na d?67878, Sulfalk Cawdy
Tarn ~~ rarn 30. L.,~1
..., 19 d~
County , ,.,...~___. ! .:~.
(Signature of apphcas