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Home My WebLink About16793-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy gl6902 THIS CERTIFIES that the building ..... a,d.d.l.t.i.o.n. ................................... 1200 Indian Neck Road Peconic Location of Property/:/~s~ ~V'o: ........................................................ Street Hamlet County Tax Map No. 1000 Section 86 . . ·Block 4 .Lot 3 Subdivision X . .Filed Map No. X .Lot No. X conforms substantially to the Application for Building Permit l~eretofore filed in this office dated ..... .M,a.r.c.h..2~. J .9.8.8... pursuant to which Building Permit No. 16793z dated . . . ?l.a.rg.h..I .13..I .9.8.8 ........... was issued, aud conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... An addition to an existing one-family dwelling. ' The certificate is issued to BRUCIg & B/~RBAR/k G'EORGI (owner,~~ of the aforesaid building. Suffolk County Department of Health Approval ............ .~/A ........... UNDERWRITERS CERTIFICATE NO ................. lq/3. PLUMBERS CERTIFICATION DATED: Rev. i/81 TOWN OF SO~THOLD BUILDING D£PARTMENT TOW~ HALL SOUTHOLD, N, Y. BUILDING PERMIT CT'HIS PERMIT MUST BE KEPT ON TIlE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N*_ 16793 z Date I{ .. Permission is hereby granted to: .... c~.~.~_~.....~.., ................... .~......~.....':L,.....u.,.~..t. ~ .............. ~o~' at premises located at .]..~.~..~...~..~.,e~....~. ........ .~.~e~,. .............................. ............................................................................ County Tax Map No. 1000 Section .....~..,,~..('~.. ..........Block ...... ..~....~. ........ Lot No....~...,.~'.. ............ pursuant to application dated .......~.~ .~.......~.. .......................... , 19.,~..~., and approved by the I~uilding Inspector. Building In,~ector Rev. 6/30/80 ..... ~3LDG. 12 E p~l"~ TOWN OF ~;OUi'~OLD APPLICATION FOR CERTIFICATE OF OCCUPANCY FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 Instructions A. This application must be filled in typewriter OR ink, and submitted m ",,-,------ to the Building Inspec- tot 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.Approvat 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: I. Accurate survey of property 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- Lion required to prepare a certificate. C. Fees: Additions $25.00 POOLS $25 . 00 ALTERATION $25.00 1. Certificateofoccupancy New Dwelling~$25.QO, Accessory.!$lO.00 Business $50,00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancv $ 5 00, over 5 years $10/.00/ 4.Vacant Land C.O. $ 20 O0 ' 5.Updated C.O. $ 50100 Date ..~../..~./...(~..~. ........ e Construction ~' N w ' . ..... Old or Pre-existing Building .. ~... Vacant Land ........ Location of Property . . ./...~...~.. .... ~.~!...~...../~...~C.~,.... t..~.[. I.~.~ ............ House No. Street Ham/et Owner or Owners of Property ..G~..~.../...~..~.....~...~....I~..~ County Tax Map No. 1000 Section ............... Block ............ Lot ................ Subdivision ~ ~ ................................. Filed Map No ................... '~'~.... Health Dept. Approval ........................ 'Labor Dept. Approval ........................ Request for Temporary Certificate - · ........... Final Certificate ... Construction on above described bu,ldi~mi~e~ets all applicr~o~od~ TOWN OF $OUTtIOLD OVIUCE OF BUILDING INSPECTOR ILO. BOX 728 TOWN ItALL SOUTIIOLD, N.Y. 11971 TEL. 765-1802 To Whom This May Concern, We are unable to complete your Certificate of Occupancy because .of the follo~ing reasons. /5/ An application for Certificate of Occupancy is not on file. /~/ No Underwriters Certificate on file. /~'~ Thc? check i:;(~ut(]it.:d/not on file.) ~,0~ /~/ No Ileal. th Dept. Approval on file. /5/ No final inspection has beeu made. Please contact our office on this matter. Thank you for your cooperation. Dui ld in~ Dept. **~/~/ Uo Plnmbcr solder Certificate on file. ( all permits involving plumbing being issued after April 1,1984 ) TOWN OF SOUTIIOLD OFIqCE OF BUILDING INSPECTOR P.O. BOX 728 TOWN IIALL SOUTIIOLD, N.Y. 11971 TEL. 765-1802 To Whom This May Concern, We are unable r.o complete your Certificate of Occupancy because of the followin9' reasons. /_--/ An application for Certificate of Occupancy is not on file. /_--/ No Underwriters Certificate on file. /~'~ The check i:;(euL!'!at.~.d/nut on file.) $~,~3 /-/ No Health Dept. Approval on file. /-~/ No final inspection has beeu made. ?]e~se contact our office on this matter. Thank you for your cooperation. lhlildir, c] PermJ. t ~ J..k ~ .~ ~ Z Building Dept. *~/~/ No Plnmber Solder Certificate on file. ( all permits involving plumbing being issued after April 1,1984 ) FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & ,PLUMBING INSULATION PER N. STATE ENERGY CQDE FINAL ADDITIONAL COMMENTS: ! .~/,¢ ,,,, ,./..: . %, '--o...c._A ~.~ge~ .Al ,~ce,~ ~ / 765-181)2 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULJ~TION FRAMING [~INAL ~r,., 8 DATE INSPECTOR 'FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N,Y, 11971 TEL.: 765-1803 Examined. ~/~..Ovkc~. Approved .~.0M.&..I.I .... , 19 .~.~. Permit No..).~o.?.~..~..~. Disapproved a/c ............................... ....-/~ ................................ .... (Building Inspector) APPLICATION FOR BUILDING PERMIT P./t~. BOA~ OF UEALTNq.~-:".'. 3 SETS OFpt', PLANS. SURVEY . A'. ..... CHECK . .0~ NOTIFY CAL~ ' ' ' ~;,L' '~LZJ~ .... MAIL TO: INSTRUCTIONS a. Tins 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 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, additions or alterations, or f~rr~re~,~val or demo~tion, as herein described. The applicant agrees to comply with all applicable laws, ordinances, buildir[g/b~djl4, housing/Co, e, an~ r~fgulations, and to admit authorized inspectors on premises and in building for necessa~i~r~. ~ / ! ~ .../..4..aT:.. (Maihng address of applicant) State whether a.p~plicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...~t.~ ...L.CM~\,.n~..~..~..'vO~(~ .............................................. .................... Name of owner of premises . .~.~...Q~.~..~..~...~..~..~.~\ .l~... i.~...~..G,.¢~. X.~.~.~. .... .~...(..~..~,.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) ALL CONTRACTOR'S I~UST BE SUFFOLK COUNTY LICENSED Builder's License No ........... Plumber's License No ''~ , ........... ,7 ........... Electricians License o ...... ~... ...... ~.2'"'~' Other Trade's License No..../.~'Z~.(;?. · z/'/.T7 .~....&". · I. Location of land on which propose~d~work will be done ............. >.~. ................................ ............ /.~ .o.~ .......... 1.~ r. a~...~.~ ~ ...... .vn.~.~...~. ...................... House Number Street Hamlet County Tax Map No. 1000 Section ~.4 Block .~. Lot. Subdivision .............................. ; ...... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises arkd intended use and occupancy of proposed construction: a. Existing use and occupancy..~KT.-~ ~....~.k~.~'.~.....~....~..~...L//...~. ............................. b. Intended use and occupancy .............................. 3. Nature of:~_~k. (~h c~ka~which applic ,~..' N~Se_w~.Build~i_ng ..... ' ..... Additio0..., ......... Altera~on .......... · · · ! .. '' ., OS, herWork~9~J.~.~.. Repmr ~O Rem,~~ Demol,t~on~.~¢.~ ~.~ kSc3'e~-ItCr~ (Descriphon) 4. Estimated Cost ............ ~.(~.(~ .................. Fee ...................................... '~ /. ' (to be paid on filing this application) 5. If dwelling, num~ber of dwelling flnits ........ ' ....... Number of dwelling units on each floor ................ If garage nuinber of cars : //"~. ~. ? 6. If business, commercial or mixed, occupancy, specify jnature and exten~"6f each type of use ...~ .... ............. 7. Dimensions ~f~e~isting structurei, if any: Front....%~.. ....... Rear ....~.~ ....... Depth..,~..~ ......... Height ...~..~:~n. ~1 ........Number of Stories ..... ~ ............................................... Dimensions of same structure wi~h alterations or additions: Front ....~./~./.~[..~- ..... Rear .................. Depth .................... ;. Height ........... Number of Stories ...................... "8. Dimensions of entire t~ew construction: Front... ~.' i . Rear ............... Depth ............... Height .............. ~,Iqumber of Stories .......... /.?i~. ..................... ~. ~. z ............. 9. Size of lot: Front ... [.~.Q)... i .......... Rear ................. Depth . .2~.~..,_~. .............. 10. Date of Purchase ........... ~ ................. Na~e of Former Owner ............................. 11. Zone or use district in which premises are situated ...... ~ ............................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ...~j(.~ ......................... Will lot be regraded .... /~[.~ · i .................. Will excess fill be removed from premises: 13. Name of Owner of premises ~.~V~~-/~ .... Yes No Address . .~¥g '~! .g_,_,~...~(.~..-~.~,. Phone No. ~.3.q..~'~..t. ~... 14. Name of Architect .. ~. ........................ Address ................... Phone No ................ . Name of Contractor .Gf~7~...t-~%q. ........... Address .I.q-.~.] .¢~. ~ ..%%, Phone No...~..¢.1.1.[ ..... 15. Is this property located ~ithin 300 feet of a tidal wetland? *Yes ..... No ..... · If yes, Southold Town TruStees Permit may be required. PLOT DIAGRA~ Locate clearly and distinctly ~l ~uildings, whether existing or proposed, and. indicate ~1 set-back dimensions from proper~y Hnes. Give street and block number or descHption according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, Si.S COUNTY OF ................. .............................. : ................... being duly sworn, deposes and says that he is the applicant (Name of individual signifig contract) above named. He is the .................................................................................. (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 tiffs application; that all statements contained in this application are true to the best of his 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 ............... .o~ ....... day of .;. Notary Public ..... ~..'~. '.. '~' .~..~/.t~t~, ..... HELEN K. DE rOE i NOTARY PUSUC, State of New Ye*t No. 4707878, Suffolk Ceunly l::: 0 Term Expires Msrch 30,19~/ (Signature of applicant)