HomeMy WebLinkAbout17703-z FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 218230 Date AUGUST 1, 1989
THIS CERTIFIES that the building ADDITION
Location of Property 2835 MILL RD. PECONIC
House No. Street Hamlet
County Tax Map No. 1000 Section 067 Block 04 Lot 21.3
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated DEC. 14, 1988 pursuant to which
Building Permit No. 177032 dated DEC. 16, 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 OPEN PORCH TO AN EXISTING ONE FAMILY DWELLING.
The certificate is issued to GEORGE E. ~ BERNADETTE M. ALDCROFT
(owner, )
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
7
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1 ng In a for
Rev. 1/81
MHat NO. f
TOWN OF SOUTHOLD
' BUILDING DEPARTMENT
70WN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED) -
N O ~ 177 0 3 Z Date ...~..JV,R.S:~?'~::!!~-... ~ 19..4..4
Permission ~s hereby granted to:,,~
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to . ~~.~...s?-~.......
ct premises located at .'~.8..~?.y~... ` (.~rS.~f... ~.~r~:!r~S..,~ .
lc.. ~f~:s!?.gR ~e~~
County Tox Map No 1000 Section 4~.7 Block .~i.~...... Lot No .~:.t:3
pursuant to appl~catian dated .~..~,R-.C9:!:~~... ~.7 19.57 and approved by the
Building Inspector
Fee $ .
Building Inspector
Rev 6/30/80
a~ g
3~ TOUN OP SOUTUOI,D
u tl ~ ~ ~ BUILDING DCPART:i1;tIT
1 ~V ~ a - TOl7N QALL BtDO DEPT.
TOWN OF SOUTHOW
SOUTUOLD, tiCN YOt2K 1197
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCIIPANCY '
/~j' 9.
DATE.
HEN CONSTRUCTION ...v...OLD OR PRE-E%ISTItiC BUILDINC......VACAti'C LALiD..._....
Location of Property... " " '
UOUSE N0. STREET -I UAriLET
~2- ~j p
Ovncr or Ovncrs of Property...- ~ `=/G-~7Gc.- ~H-[-.~r'~f~~~~~/C - /-L.C(~Ga/4'J~%
County Taz Hap Na_ I00Q Section B1ocR Lot .::Z~.`.---
Subdivi~ioa./ Filed Hap .__.....Lot._.~~.//...._. /
Pcrnxt tio. 1.!~U7._.Dace of Pcrmic /:'~~~',/~~-Applicant .~I'~~cS 1/~'O!'7r`'.IfJN
LlcaLth Dept. Approval Underwriters Approval•......_.....-
Plann ink Board Approval
Reduest for Temporary C~prtificate ...._..'Final Certificate
Ul f
°ec Subaictcd: $...s~~--___.......
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APPLICANT. ......f_
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FORM NO 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y 11971
p TEL.:765-1802
Examined L~RV~~w.u4~. ~ Ir ,19~. Apphcatron No
Approved e~C.~. ~ ~ 19~ Permrt No 1 7 7 ~ ~ ~ _
Disapproved a/c L I ~ i ~a ~.J L~~,
E
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r ~(I Q~
l.i l` R
BLCG. DEPT
(Building Inspector) TOWN OF SOUTHOLD
APPLICATION FOR BUILDING PERMIT
Date +.rJ.G c.. ~3 . J , 19
INSTRUCTIONS
a This applicatron must be completely filled in by typewnter or m ink and submitted m tnphcate to the Build
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 str~_
' or areas, and giving a detailed descnptron of layout of property must be drawn on the diagram which rs part of this ap
canon
c The work covered by thrs application may not be commenced before rssuance of Building Permrt
d Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant Such peA
shall be kept on the premrses 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 Occupa~
shall have been granted by the Building Inspector
APPLICATION IS HEREBY MADE to the Building Department for the rssuance of a Building Pernut pursuant to
Burldmg Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinance•
Regulations, for the construction of burldings, addrtrons or alteratrons, or for removal or demolrtron, as herein descnb
The applicant agrees to comply wrth all applicable laws, ordinances, building code, housing code, and regulations, anc
admit authonzed inspectors on premrses and m burldmgs for necessary inspectrons
,,,C[[}}y~~ (Srgnature of a/ppt~ ant, ofname,~f
a
orp~VO/ra~t/ion)
M~~ .34Si.r.~a~./ ./~.o,aC. ~C'Cpni G~ I~~
(Marling address of applicant)
State w//nether applicant rs owner, lessee, agent, azchitect, engineer, general contractor, electncran, plumber or bud<
L.G1f~Le~"
Name of owner of premrses ~ae~+~~ l
r. .~ar.rf? n~~ ~f~ ~~~~C~'0?`T
(as on the tax roll or latest deed)
If applicant rs a corporatron, srgl ature of duly authorrzed officer
(Name and title of cgrporate officer)
Budder's Iacense No. .3.Z Gr2 f - .
Plurnber's Lrcense No
Electncran's Lrcense No I
i
Other Trade's Lrcense No
1 Locatron of land on whch proposed work wrll be done
.~~x'3S /`-lr//~ ~acoHic J; /V.l`~.- //958
House Number Street Hamlet
County Tax hlap No 1000 Section .Q ~i..7- - Block ~ - Lot -z/.~ . -
Subdrvrsron Frled Map No Lot
(Name)
2 State exrstmg use and occupancy of premrses and intended use and occupancy of proposed construction
a. Exrsting use and occupancy ~fir.v7 ~~C, , , ,~,.y~ r~V ~lriG~~e~j E , - , , , .
b Intended use and occupancy ,,$',~,,•i~V
,jC.. ,~,.•.,;,~y0 ..ccs~dvc,/~~.4~ . .
J
3 Nature of work (check which applicable) New Building Addition . Alteratton .
Repair .Removal Demolition .Other Work .
~j (Descnption)
4 Estimated Cost ..,(J•`fi,~'C~p,DQ Fee
(to be pard on filing this application)
5. If dwelling, number of dwelling units . Number of dwelling units on each floor .
If garage, number of cars .
6 If business, commercial or mixed occupancy, specffy nature and extent of each type of use .
7 Dunens~ons of existing structures, if any. Front ...Rear Depth . .
Height ..........Number of Stones .
Dunens s cif sa tructute with alterations or additions Front Rear . .
g ~ ~ ~ ...Height Number~of Stones .
Hei ht nstruchon Front ...1.~ .Rear .1.`~ Depth . ~.S
8. Dunensrons of en ire new c umber of Stones " .
9 Size of lot Front Rear . Depth .
10 Date of Purchase .....Name of Former Owner .
11 Zone or use distrrct in w ich
premises are situated . . .
12. Does proposed construction violate any zoning law, ordtnance or regulation .
13 Will lot be regraded SIP... .Will excess fill be removed from premises: Yes
14 Name of Owner of premises j~~ ..d4~~~'4 i~~ .Address ~unG. /~w~!~.. Phone No...7. G~ir-?,-~~~.`
Name of Architect ..Address . ...............Phone No.............. .
Name of Contractor .~c. ~R,t' lN.~-~/?~,(~~'~ . .Address j~{/Jl~..c.,~eGOH<,r~. Phone No..'7~..~:
s~717, _
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dunensions frog
property fines Give street and block number or descnptron according to deed, and show street names and indicate wheth_
intenor or comer lot.
STATE OF NE YORK, S S
COUNTY OF
ffl~QL.~,S . ' ~ TFiq i1-~P ;P a~ , , , , , being duly sworn, deposes and says that he is the applicar
(Name of mdrndual signing contract)
above named.
Hersthe .
( ontractor agent, corporate officer, etc )
of said owner or owners, and is duly authonze o perform or have performed the said work and to make and file th
application, that all statements co~tamed m this application are true to the best of his knowledge and belief; and that tt
work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this ~
.....~~.:c:l. .......day~QOf ~!Y;,c,Last.J 19
Notary Public . ........,4~c~~-~ County
Notary Puti
eAc, Sl~eo~f
N
wYOrk,,,) (Signature of applican
No. 4822683, Suffolk CourMy /a"
Term ENOtre8 ONGUnhar 71 1 n
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