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Home My WebLink About16913-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No....z.-.1.7..07.8 ....... Oate..~..u.ly. 12, 1988 THIS CERTIFIES that the building ....... A..gp.I.~ ~..O.N ................................ Location of Property .... 3. ! .9.0..~ .o.r.t.h...S.e.a..D..r ive Or ient, N.Y. House No. ' ..... '~'t/e~i ....................... ~lJ~/el County Tax Map No. 1000 Section 15 .Block 1 ..... Lot 5 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated Apr±l 6, 1988 pursuant to which Building Permit No. 16913 Z dated .... .Ap.r.i. 1...2.2?.. ! .9.8.8. ........ 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 ......... D~CK ADDITION TO EXISTING ONE FAMILY DWELLING The certificate is issued to ..... H.A..R.Ry..&.. JEANNE MART IN (owner, ~,~z-z~Y~X~J( of the aforesaid building. Suffolk County Department of Health Approval ........... ~ ./.A ............................ UNDERWRITERS CERTIFICATE NO ................... ~[.A ............................ PLUMBERS CERTIFICATION DATED: N/A Rev. 1/81 FO~.M NO. ,a TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N916c)l 3 Z Dote...../~. ;~ ~":././~.. ........................................ . , Permission is herebyoranted to: / // ., ? ...................... 7:~ ....... .; .............. ,o .~~~.....~.~.~~.....~~~ ....................... ....... .......... ....... ~ ~,= ~ ~ ~ ..~z~....~.~....~ ............ ............... ........ .... ......... County Tax Mop No. 1000 Section,.. ........... /'~.. ........ Block ............... ,/..... Lot No .............. .~........'~. pursuant to application dated ........... .~../.~. .................................. , 1~...'.~.., and opprov~ by the Building Inspector. Fee $..~... ~ ,~/~' '~/,~ Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted m mmmmmmmmm 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 P~anning Board approval of completed site plan requirements where applicabte. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic featu res. 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,S25.00, Accessory iS10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 5 0.0 0 3. Copy of certificate of occupancy $ 5.00, over 5 years $i0.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date ... Newcons%~uction ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ... ?/?.~. ..... .~..o.<~.~'....~.~... ~)..4~.~.~. ...................... ...~..z-~..~. ..... House No. Street Hamlet Owner or Owners of Property .... ¢~'-'-~rr'f'~/- · .r. '/~'¢"f;~7' ' 'f-' County Tax Map No. 1000 Section.. ~../.~. ....... Block. / Lot Subdivision. ~/;¢~.~..~.c~'.~..~. .~...~./'.'..~.% ....... Filed Map No ........... Lot No .............. Permit ,o.../~.~./.-¢~... Date of Permit ~/~.~.~.~.~.....Applicant .. /~d~c¢''-~ .~-..~..~. ...... 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 perm~it meets all applicable codes and regulations. Applicant,....x~.~J~kt~.../~....~ .: ...................... Rev. 10.10-78 ¢0 )7o7g' 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [~J]/FINAL REMARKS: ~ ~ INSPECTOR TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, 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. __/Z/~No Underwriters Certificate on file. /--4/ The check is(outdated/not on /Z/ No Health Dept. Approval on file. /5/ No final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. _~uilding Permit # ..~ ~_~ ~ ~_~ 2, Z Building Dept. *~*/~/ No Plumber Solder Certificate on file. ( all permits involving plumbing being issued after April 1,1984 ) 765-1802 BUILDING DEPT. INSPECTION FOUNDATION lIST []ROUGH PLBG. FOUNDATION 2ND []INSULATION FRAMING []FINAL DATE INSPECTOR 7GS.'1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [~J/FINAL DATE ~//~/~ INSPECTOR DUNDA TION ( 1 s t ) DUNDATION ( 2nd ) )UGH FRAME & .PLUMBING ~SULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: Robert A. Born Home Improvements Indian Neck Lane Peconic, NY 1195.8 ~-~ ~-~ l 734-5916 Robert A. Born Home Improvements Indian Neck Lane Peconic, NY 11958 734-5916 TEL.: 765-1803 Examined '~. ,..'~. ......... 19 ~' , Approved .~...2~. ....... i, 19 ~.'~Permit N~.~%f.~../. Disapproved a/c ..................................... APPLICATION FOR BUILDING PER~I~ 3 SETS OF _P]~ANS .... ,:o,,,,,,,,,o. t s,.,RVE¥ TOWN OF SOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC FORM ............. TOWN HALL NOTIFY SOUTHOLD, N.Y. 11971 CALL '~3.~r.-.~J~ ....... MAIL TO: INSTRUCTIONS :.~ ,, ,1, ~ ','~1~ .t ~ m~;o o,,.~io,tlan must he comnleteht;filled in bv typewriter or in ink and st/bmitlea~'lt~$~l~tilla~ig. Inspe,ctor, with 3 se;s~f pl'a'~,"aVc~t-e~p"lot pl~ i0'sdal~e~ ~e'~e accordin~t;schedule. . COtne.~,l~ IJ~ · h plat alan ahowinm loc~tlon~f~tottalad,of buildings on premises, relaQoflsl~ip ~tl~l~l!hing pr_em_ises_.pf p.~b~c streets or areas, and giving a d~t~fl6dt~s6'vlptioaJl[ l'hyo? of l~roperty must be drawn ~l~n~c~f ~i~ l~lnl'his appli- ~ ~ .... ~v o~vere&,~ ~nhl~.~ot be commenced before zsm~ce~mg re~. ~ ~'~';[~;a[of ~i~~'8~lding Inspector w~l issued a ~d~P~ff ?'the app~c~L ~uch pc=it ~ be kept on the ~emises available f~ ~pection ~rou~out the work. ' ' ' e. No bufld~g s[all be occupie~ ~'~d in whole or in p~t for any purpo~ What~vet ~ntQ a Ce~ificate'of Occup~cy ~1 have been granted by ~e Building Inspector. ..... ~ . ~. ~PLICATION IS HEREBY MADE to the Bufld~g Dep~tment for the issmnce of a B~ding Pemit pumu~t to the Building Zone Ordin~ce of the Town of Southold, Suffolk CounW, New York, ~d 'oOeP a~i~,~s, o~ces or Regulations, for the constmcQon of buUd~gs, additions or alterations, or for removal or demolition, as here~ described. ~e applicant agrees to comply with all appQcable laws, ordinances, bufld~g code, hous~g code, and reg~ations, ~d to admit authorized ~spectom on premises and ~ build~g for necesm~ insp~ons. ..... &: ..... -. ................. (Signature of applicant, or name, if a corporation) . ~. ~.. ~.. ~.,Z...//~. ..... (Mailing address of applic~t) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............. ~.~,'~.,,e .......................................... Name of owner of premises... ,~'~... H,~'/(7.. '~' ~' ' ~ J~'~J~6/. ,~,...~".../~..~.t'/~'.a4/. ..................... · (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 MUST BE SUFFOLK f.~UNTY Builder's License No ........ I'~ ~' ~"'~' ' ' ' Plumber's License No ......................... LICENSED Electrician's License No ....................... Other Trade's License No..~ ~ ............... Location of land on which proposed work will be done .................................................. ........ .3../. ....... ......... ............. House Number Street Hamlet County Tax Map No. 1000 Section ...... /.~. ......... Block ...... / ........... Lot.."~[ ...... ??... ... ~ ~,,J~.rex 4~- C~,.q~. .... ¢¢.t (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....~..~....'~'..'-~ .-: -~.~.~.:.. ~.. ~.'.".~..-~-. :.".~.~..".< .................. b. Intended use and occupancy ...o~.....~?[~)...' ~.~...~./)-....~...e~..~..~.,~'.~/.: .~).~....~-. ,/-~,:~../~,~.~...- ......... 3. Nature of work (check which applicable): New Building Addition.., ......... Alteration ~,~.~,... Repair .............. Removal .............. Demolition ...... ;... Other Work ....... ' ........ (Description) 4. Estimated Cost . . .~. Y~ .. ,o~. ........................... Fee ..................................... ' (to be paid on filing this application) 5, If dwelling, number of dwelling units ...... f ..... "... Number of dwelling units on each floor ................ If garage, number of cars ....... / .................................... ............................. 6. If business, commercial or mixed occupancy, specify nature and extent of each ty~e of use ..................... 7. Dimensions of existing structures, if any: Front .... .ff~.'....,,-..:Rear,. ...... ......,%~ ....... Deph.......,..,,. Dimensiofis of same structure with alterations or additions: Front -- ~--' Rear Depth ...................... Height ........... : .......... Number eli Stories ...................... Dimensions of entire new construction: Front Rear ~ Depth Height Number of Stories 9 Size of lot: Front Rear ' jDepth 10 Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated .... ~..~.~(9 ............... ! ............................ 12 0p 1 gl di [ .A~.~v.~, . ~ . · Doespr osed construction rio ate any zonin aw, or nance or regulation: ............................ 13. ' · ' ~ · Will lot be regraded ....... .~.~.W ............ . ..... Will excess fill be removed from prem,ses: Yes 14. Name of Owner of premises ~r,~..e~../~£?./t~.. Address J~..~..C~.` .,?-:~..~..~,.'f,! .... Phone No ................ Name of Architect ........................... Address ...~.¢.~.e L.c.~.....~.Y) .... Phone No ............ Name of Contractor . ~0~¢~...~,.. ~.o?..~( ....... Address . .~.,yg~,~.,g..,~ .e~. ~ Phone No. ?,~.F." 15, Is this property located within 300 feet of a tidal we~a~?..*Yes~.... ..... No · If yes, Southoid Town Trustees Permit maybe required. PLO~r DIAGRA~ Locate clearly and distinctly ali buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. 'Give street and block number or description according to deed, and sho{v street names and indicate whether inter, or or corner lot, OCCUP , C¥ OR USE IS UN WFUt WITHOUT CERTIFICATE OF OCCUPANCY STATE OF NEW YORK, S.S COUNTY OF ................. .A,P/PRO)/ED AS NOTED DATE: ~ B.P. # ~ FEE: ~8Y: NOTIFY BLIIL~)I~IG DEPART~EI~IT AT 765-1802 9 AM TO 4 PM' FOR THE FOLLOWING INSPECTIONS: 1, FOUNDATION . TWO REQUIRED ~ I'OUREO CONCRETE 2. ROUGH. FRAMING & IN,.UMBINQ 3. INSULATION 4. FINAL. CON~?RUCTION MUST BE ¢OMI~q'E FOR C.O. ALL CONSTffiJCI1ON ~NALL MEger THE REOUIREM~ OF ~ N.Y. STA~Ei 'CONS~UCrlO~ & ENERGY CODES. N~ nE~ ~ DESIGN OR C~TR~ ~ being duly sworn deposes and says that heis the applicant (Name of individual signing contract) above named. ". He is the ...................................................................... ~ ............... (Contractor, agent, corporate officer, etd.) of said owner or owners, and is duly authorized to perform or have performed the isaid work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be p~rformed in the manner set forth in the application filed therewith. Sworn to before me this ............. ..... .......... HELEN K. ~)E VOE NOTARY PU6LIC, State of New York . No. 4707878 Suffolk County,S' ~erm ~p res ~i~,c~ ~0, IS_ ,- / (Signature of applicant)