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Home My WebLink About17560-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z17695 Date JANUARY 20, 1989 THIS CERTIFIES that the buildin~ Location of Propert~ 455 VILLAGE LANE House No. County Tax Map No. 1000 Section 25 Subdivision ALTERATION ORIENT Street Hamlet Block 02 Lot 03 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCT. 19, 1988 pursuant to which Building Permit No. 17560Z dated OCT. 26~ 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 ALTERATION TO EXISTING ONE FAMILY DWELLING. The certificate is issued to TOM & SUSAN MADIGAN (owner, of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A '~~ '~ding Inspector Rev. 1/81 FOB,M[ NO. f~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PEBMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No ,0i'[560 Z County Tax Map No. 1000 Section ........... .~....'~...... Block ....... ~ ........... Lot No ....... .,,~,,. ............ pursuant to application dated ............... /....~.//...~.. ........................ , 190~.~.., and approved by the / Building Inspector. Fee $....~..~.~.. Rev. 6/30/80 TOWN OF SOUTHOLD BUILDINC DEPARTMENT TOWN HALL SOUTHOLD, NEW YORK 765 - 1802 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY / NEW CONSTRUCTION ...~....0LD OR PRE-EXISTING BUILDING ...... VACANT LAND ........ Location of Property ......................................... HOUSE NO. ~TREET H~HLET Owner or Owners of Property ........... County Tax ~ ,o. ,000 ,,~,~o..~.. ~o~, .a .... ~o, ..~. .... ~ealth Dopt. ~pproval .................. ~nder~riters ~pproval .............. Planning Board Approval ................ Request for Temporary Certificate ....... Final Certificate Fee Submitted: $ ............ [. .. APPLICANT .................................... rev. 10/14/88 FOUNDATION (1st) FOUNDATION 2. f2nd) ROUGH FRAME & .PLUMBING 3. INSULATION PER N. STATE ENERGY CODE FINAL ADDITIO~A'L COMMENTS: - TOWN 0 , FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ...... . ...... SEPTIC FORM NOTIFY C--'7~'~r°X~ CALL ............ MAIL TO: p~ Examined.../..~ ....~. .... , 19 ffz~ Approved..../y~. .... ~:.., 19 ~. Permit No../Z.'~. ~..~./ Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT / Date ....... ~..., / INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Buildihg 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 l~.yout of properW 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~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 inspections. ......... .................. (Signature o£ applicant, or name, if a corporanon) .-~-. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, ral con.~trfi lectrician, plumber or builder. Name of owner ofp[emises If applicant is a corporation, signature of duly authorized officer. ...... ~.............. ~..% ...... '~.~=a~ ~ .~;f.~. ........ . (Name and title of corporate of£fc~r) Builder's License No..../~77~...~.../'~.~7'. ...... (as on the tax roll or latest deed) Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done ....' ....... ................. ....................... :...75-.. .................. House Number Hamlet County Tax Map No. I000 Section . .7~...~... Block .~. Lot.. ~ (Name) State existing nsc and occupancy of premises and intended use~and occupancy of proposed construction: k( h! ' 3. Nature ofwor checkw tic ,app cable): New Building .......... Addition .......... Alteration .. Repair .............. Removal .... ' ........ Demolition .............. Other Wor~ q. 'li~ .... [i{ ::, ·. (to be paid, od filing' th'ia applid~hon),[ $ If dwelling number of dwelling units Number ' · ' ............... of dwelling units on each floor If garage number of cars , ............... . 6 If business ' ' TM ......................................................... 7' D ....... , commercial or mixed occupancy, specify nature and extent of each type of use .................... ........... · mmnsmns of existing structflres if any: Front Rear Height...............Nfim~erofStories ............................. Depth.~ ............. Dimensions of same : .......................................... I ............. structure !with alterations or additions: Front Rear Depth i Iteight ..................... : ........... .................. I .... Number of StoNes I ~ ' ' ' 8. Dimensions of entire new con~trnction: Front ............................................. Rear Depth ' Iteight ............... N~mber Of Stories ........... . 9. Size of lot: Front .... ! 'J. ...................................... 10. Date of Purchase i .......... ~qear....; .... ~.;.. ..... ~. ..... Depth ...................... 11. Zone or use d~stnct m winch premises are situated .......................................... i. ' 12. Does proposed construction violate any zoning law, ordinance or re u ti : ......... 13. Will lot be regraded . . . ,~,.,, g,!,a,on ., ~. ..... . ................ · '.2_ ' ...... ~., ........ WIll excess ifil ce removeu ~rom premises: Yes No 14. Name of Owner of premises . ,T.~..~...~..~.~, .a-.~... Address .<:,/.~..~..~¥'~..~.~..~.~ Phone No.~.~.~.',~ N ' amc of Architect ........ I ...... Name of Contractor .~-:.t,,~. ~..,.~.,..J~'~.~:~'' i'' ..... ,xrlrl~ ~v,.x'gAddress ................... 9q~,.~.44~m,~x,~.t_,Ooot'~z,,e~.,Phone No ...... ; ....... ,.. ~If. yes, Southold Town Trustees Permit may be required. "i PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back d~nensions from property Hnes. Give street and bloc number or description according to deed, and show street names and indicate whether interior or corner lot. NEW YORK, I ~S.S ~F .... . ............. [ STATE COUNTY OF ............................(Name of individual sighing .................... contract) being duly sworn, deposes and says that he is the applicant above named, i ., ftc is the i (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or lmve performed the said work and to make and file this application; that all statements contpined in this application are true to the best of his knowledge and belief; and,~hat the work will be performed in the manne!r set forth in the application filed therewith. Sworn to before me this ...................... day o£ ................... 19... Notary Public .... ~....~.. .... ./Q..Z ......... ?..~-r-. County HELEN & I)E YOE · ' · ~em~ ~.xp res M,~rch ~0,