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Home My WebLink About17477-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPanCY No Z17552 Date NOVEMBER 30, 1988 THIS CERTIFIES that the building Location of Propert~ 270 GOLDIN LANE House No. County Tax Map No. 1000 Section 135 subdivision FOUNDATION SOUTHOLD Street Hamlet Block 02 Lot 21 Filed Map Mo. Lo% confdrms substantially to the Application for Building Permit heretofore filed in this office dated SEPT. 19, 1988 pursuant to which Building Permit No. 17477Z dated OCT. 3~ 1988 was issued, and conforms to all of the requirements of the applicable provisions of the lawl The occupancy for which this certificate is issued is FOUNDATION UNDER AN EXISTING ONE FAMILY DWELLING (SUMMER COTTAGE) The certificate is issued to STANLEY K. & ANN T. KEMPNER (owner, of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Building Inspector Rev. 1/81 FORM NO. O TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HAiL SOUTHOLD, Flo Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: /~ I / / .... Y.~..~....~..~....~ .................. ..... , at premises located at .,...~.,~..O.......,~.~......~.....~ ................. ~ .................... Caunfy Tax Mop No. 1000 Section ...... Z.."~.~...... Block ...... ..O...."~m.. ...... Lot No ..... ..'~..1 .............. pursuant to application dated .... ..~.~.~...../...~ ....... , 19.,~.z~., and approved by the Building Inspector. Rev. 6/30/80 ,,, BLDG. DEPT, TOWN OF SQUTHQLD FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 ,PPLICATION 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 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~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. C. Fees: Additions $25.00 POOLS $25.00 ALTERATION $25.00 1. Certificate of occupancy New Dwelling $25.00, Accessory ,$10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ IO0.00 3. Copy of certificate of occupanc¥ $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date ....................... NewCOns truction Old or Pre-existing Building Vacant Land Location of Property ...... 2-."70 ......................<~o.~, p~ · . Z. ,~va: ................................ . . · House No, Street Ham/et Owner or Owners of Property ~'7-~Mz'~r Y J~. ¢ /~w~ -~. .z./' County Tax Map No. 1000 Section / Block ~' Lot.., ................................... u Map No ........... Lot No .............. PermitNo ....../V.¢,77...z DateofPermit/0/3/~¢ .Applicant 5'7-,~vz~ry 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 per_m~~pl~a~le codes and regulations. Applicant . . ,,~./.-~. . Rev. 10-10-7e /~.~ ~5 ~ 3 :~ '~ TOWN OF $OUTLIOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTIIOLD, 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. /_--/~ An application for Certificate of Occupancy is not on file. ~~ /~1 No Underwriters Certificate on file. /7 The check is(outdated/ng~ ou file;) /~/ No Bealth Dept. Approval on file. /~/ No final inspection has beeu made. Please contact our office on this matter. Thank you for your Duilding Permit t~ Building Dept. cooperation. No Plumber solder Certificate on file. all permits involving plumbing being issued after April 1,1984 ) FOUNDATYON (ls)~ FOUNDATION I2nd) ROUGH FRAME & .PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDYTIONA'L COMMENTS: bi Z APPROVED AS NOTED DATE: , L_.. iNT AT NOT~F¥ 765-1802 9 AM TO 4 FOR THE F~LLOWING REQUIRED 1~) FOUNDATION J~ FOR POURED col' [ETE ~ ROUGH - & PLUMBING ~, iNSULATION "iTl. FINAL ? :1 C.O. ,.~ BE SHALL MEET oALL OF THE N.Y. 1'HE & ENERGY ~ STATE £ CODES. RESPI~ISIBLE FOR I ERRORS 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION AND [ ] INSULATION FRAMING ~F~AL 765.1802 BUILDING DEPT. INSPECTION [~FOUNDATION 1ST [ ] [~FOUNDATION 2ND [ [ ] FRAMING REMARKS: ROUGH PLBG. ] INSULATION [ ] FINAL DATE SEP 2 I 1988 BLDG. DEFT, TOWN OF $OUTHOLO FORM NO. 1 TOWN OF SOUTHOLD bUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved~.~.. · · .O~. · . . . .~..., 19~..~. Permit No. ].7.~.77...~. BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK ...................... SEPTIC FORM ................ NOTIFY . . MAIL TO: Disapproved a/c ................................ (Building Inspector) APPLICATION FOR BUILDING PERNIIT INSTRUCTIONS Date .... ~. :../?. ..... 19 ~.~. 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 lhyout 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 building 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, a,d. ditions 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 regulations, and to admit authorized inspectors on premises and in building for necessary '~ t// ' ' '"" " .../.4.qy... qro · . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............ ........................................................................... Name of owner of premises . .~..TS~.M.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 .... .1:. ! .~..~..'7. J.~. 1. Location of land on which proposed work will be done ........... ' 270 ~;'oz.D/,/ /~,,,/~-~ (gO. ~oz /'n~) ...~.q.o.-C.//.o..~>.,,' ,A/ ~... ........... ................................................ House Number Street Hmnlet County Tax Map No. 1000 Section . . . ] ~ g' Block 12. ~ ]. Subdivision..~.,,e'. jv~.o~..~.r..fl. ?.~'.~.t.o. ~?..~.~.~.~.fl..~.a?.~.l.,,q.... Filed Map No .... 71 O (a Lot / o (Name) 2. State existing use and occupancy of premises and intemtcd use and occupancy of proposed construction: a. Existing use and occupancy ,,~u~-/,¢ ~. ~'~a 7".r.~. ¢~ b' Intended use and occupancy ~ ~,/,/Pt~'~ ~'~o~ ' 8. 10. Date of Purchase .... /.??.q.. 11. Zone or use district in which prem 12. Does proposed construction violat. 13. Willlot be regraded ...... 14. Name of Owner of premises Name of Architect ............ Name of Contractor .4t~,~. ~.q..,} 15.Is this property locat~ *If yes, Southold Town Locate clearly and distinctly property lines. Give street and interior or ct Nature ofxvork (check ~vhich appliicable): New Building .... ' · · Addition .......... Alteration R pair R al k .~!~. .......... ....... D liti Otb W e .... . .... emovI .. ·, ........ cmo on ........ ! ...... er or ~l] ~~t..~..~5 (Description) Estimate'd Cost .......... ~} i°- I'~ ..................... Fee . ...."'~'.. ................. (tq be paid on filing this application) Ii[ dwelling, number of dwelling u4its ..... I ........ Number of dwell ng itmits on each floor ........ If business, commercia, l or mixed c ccupancy, specify natutre and extent of each ty/pe of use ............ ; ........ Dimensions of existing structures, fany' Front . ~.o ~oor 36 l-t~;,,t~t ~' ~' -, _ . ' ' · ~ ................ ~ ......... Depth .. ~..o,. --~.= ......... t,, ....... ~umoc r of Stones. /-'r ; ........ Dm~enmons of same structure w,th alterat OhS or addP; .... ~-~* '~ o t i - - , ......... Depth , 9,,o t,., .... ' .......... · ....... ................ txe~gn~ ...... Zo. .............. Nu m be f o f St erie s . ./. ~,.. ~,...~.~..~.e¢~ .~.,. Dimensions of entire new constru, :ion: Front ....... .3.0.: .... Rear...,~'. ! ....... Depth.. ~..o. ' Height .... .'2 f. ....... Numbe: of Stories ... ,~r~.~ ~ ........ . ' ........ Size of lot: Front ... lop .' .I ....... Rear .. .l~..a,.~.~.' ' I ....................... ...................... :.. Depth .~ly~/.3..~..~.a..e).~,~.~... [ ................ Name of Former Owne~ W.~4. r.$.4~.. .scs are situated ......... r. : any zoning law, ordinance or regulation: . ~../~ ......................... ................. Will excess fill be rembved from premises: /Yes No 4~. ~ ff.g~,°t<gtt.. Address/.4q"~ $~e~,a~t~ ........... ~ ..... ~.,. Phone ............... Address ............ 4 ...... Phone No ........ ; ....... ¥~'$q ~ .......... Address 'ff'. 5~'~ Vqq~u,~ ./[ql~.~.~.~ ~.. r, Phone No ..9~.-. ~.~...~. ~. ?~. fl within 300 feet of a tidal wetland? *YES .... NO...~';~. ~rustees Permit may be required, PLOT DIAGRAM all N ildings, whether existing or proposed, and[indicate all set-back dimensions from block nu nber or description according to deed, and s mw street names and indicate whether lot. ' STATE OF NEW YORK, COUNTY OF fl/t $.$fl:. q ..... S.S ...... $'T'~I'~/~'~X ' [(" '[<'~?' ?'~'~6 ................ being duly sworn, deposes and says that he above named!Name of individual signing contract) is the applicant fie is tile ......d. (Contractor agent corporate officer etcl) .................. of said owner or owners, and is duly authorized to perform or have performed tile !said work and to make and file this application; that all statements contained in this application are true to the best ofh!s knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. ' Sworn to before me this ! ....................... day ........................ 19 Notary PuN c . - /f~.~$~ o CHRIgTIN~ M', R~P~q~ ...... 2.'/~'.' . ............. County Notary Public, State of New York ~ ,/~ %//) .... · No. 4888125 ..... "~ . /14¢7~11/~ Qualified in Nassau County ~ornmt~:,~on Expires March ~0, 19..,.,~ (Signature of applicant)