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Home My WebLink About11688-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z~6779 Date April 8, 1988 addition THIS CERTIFIES that the building ................................................ Locafion of Property The Peninsula Fishers Island House No. Steer Hamlet County Tax Map No. ]000 Section . .].0. ........ B]ock 4 ....... Lot ! I & 12 Subdivision. ?.l.a.n...o.f..P..e p.i.~, s..u.[.a. ......... Filed Map No..2.2.3. .... Lot No. 6. 7.., .6.8. ,. 6. .9.,.7.0. conforms substantially to the Application for Building Fermit heretofore t'dod in this office dated ..I eP....2.9. ,..1.9.8..2 ..... pursuant to which Building Permit No..1. [ .6.8.8.Z. ......... · dated . ?..ay..2.~..,..17.8..2 ............ 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 ......... .Add.~pp..t..o..e.x.i..s.t.i.n.~ dwelling. (seasonal) The certificate is issued to HERBERT A. AHLGREN AND WIFE (owner, of the aforesaid building. Suffolk County Department of Health Approval .... ~ ./.A ................................... UNDERWRITERS CERTIFICATE NO .... N/A PLUNBERS CERTIFICATION DATED: N/A Building Inspector FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 11 88 z Permission is hereby granted to: at premises located at .................................. ./.?~f:~..~:..,.~.....!,.~../...~..,~..r...~ ............................................... ....................................................... '/ ................................................... ~ ........................ '~ ...... '" ...... "' .......... County Tax Map No. 1000 Section ........... ./...~..~ ...... Block ............. ~.. .....Lot No ...... ./.../....~..,/,, .~ pursuant to *pplicotion dated ................................... .~....~..,,~....~..~.., 19...~.'....z7-, and approved by the Building Inspector. Fee ....................... Building Insl~ctor Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate 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 feature[ 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 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: 1. Certificate of occupancy $5.00 ~'~. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date .... .~./..Z,./.~./ ............. New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of PropertyHouse' ~,~..~. .~..~. .Z. .~. . .No. ' '~' ' '"~' ' .... . .~. [..S. , .~. . . .Street ~/'-'~" ~'~' ' ' Owner or Owners of Property ...................'~. ~'~'- 4:~'.. .~/. x~'/--"~ ............... .~---~-~, . ~ ~, ~- County Tax Map No. 1000 Section ...... /.~. ...... Block ..... ~ ....... Lot.. S ..... ' ~ U/~-~.~,,,~,,z/~ ..... No..~.?.~. .... LotNo. UDalVlSlOn ............... ' .................. I-ilea Map Permit No././~i~.~. ~.. Date of Permit './//~/~./~.,~ .Applicant ~..:¢~'~'.....~. i..~.../~.~.~... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ................... Planning Board Approval ........... Request for Temporary Certificate ..................... Final Certificate ..................... .. Fee Submi,ted $....,~..~.-~ .................... Construction on above described building and permit meets~3fl'applicable codes and regulations. ~3o3fflr o~ t~tm/Yot~ ~ mpplic~.~_....~..c~....~ ............... ..F/~D INSFECTION FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & ?LUMBING INSULATION ?ER N. STATE ENERGY ~ODE FINAL !DATE COMMENTS ADDITIONAL COMMENTS: I?ul) $ ')-w 4, ) Ikl,, J ~0 u'~ n~ 'OCCUPANCY RC~¥ED~ · USE IS UNL~ FEE: BY: WITHOUT CERTIFICATE 802 9 AM TO 4 PM FCR THE ~G IN~ TIONS: POURED CO ICRETE S ~ · - F~M G &~LUMBING r ,u L ATI ", ~L - ~O~T~ JCTION MUST . . ~ ,NSTR~CTION S~LL ,. ~ t, ~ UIREMENTS OF THE N.Y.' ~ ~o · NOT RESP~)NSIBLE F~ CONSTRUC 'ION. ERRO~ . ' " ' ~' .. 1 '0 $ $ 7~ '5o' V,/ ~$1g.o8, ,,07- ~T FORM NO. 1 ~. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Exam,n;d ......... Approved ..,.., mlt ? .Disappr.oved a/c ....... ~ ..................... .......... ..................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No.//. ~ ~ a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildin. 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 street or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this app: cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of thxs apphcatton, the Budding Inspector will tssne a Budding Permit to th~ apphcant. Such peru. shall be lcept 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 Oceupan~ 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 Buildin~ Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descfibc~ The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit auth°rized inspect°rs °n premises and in buildings f0r~..~... ~ ...... (Signature of applicant, or name, if a corporation) (Mailing address of applicant) I I 362.. State whether applicant is owner, lessee, agent, architect, engineer, general contractor,, electrician, plumber or buildc~ ~0 ~ ~__1~. ........ '..' ........................................... Name of owner of premises . . .~. H.L.~.~';.~?). j .~..~..l~...~...~.:.~...fi.: . . ^~..~. yg.l?..E. .............................. (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 .......................... Plu/nber's License No ......................... Electrician s License No ....................... Otl~er Trade's License No ...................... 1. Location of land on which proposed work will be done ...... o..*q.....L~....~.~..~-..T~..g..~.g~4t ~.~9..I.~. .......... ltouse Number Street Hamlet County Tax Map No. 1000 Section ...... I.O....' ....... Block ...... .4. .......... Lot... I [. ~..l?.~ ..... Subdivision..~..1~..~..O.~...~.~.H ~. ~..~!,.)..t&... ~.~.~.~.~..1~....~..~..~iled Map No .... .'~.~.~ ....... Lot ~,.70 ~.'~ >~ ~.'1~. (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...~P.~..~. g.~....~...~..&~..z .?.~.g.Y.~?..~ ~.Y. .......................... b. Intended use and occupancy 3. NatUre of work (check which applicable): New Buildin~¢ .......... Addition . .~.~.X... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4. Estimated Cost ........ ~..ff~. · .<:~. ....................... Fee .... .~.l.~.: .~.O. .......................... (to be paid on filing this application) 5. If dwJlling, number of dwelling units ..... I .......... Number of dwelling units on each floor ................ If garage, number of cars ........................................................................ 6. If business, cor0merciai or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions' of existing structures, if any: Front .... .'~o...' ........ Rear ....'b-.~. ' ........ Depth ....'~. ! ........ lieight ..... t.~' ........ Number of Stories .... 9.-. ................................................... · Dimefisions of same structure with alterations or additions: Front ..... .41-.o.' .........Rear ....z-3.' ........... Depth ........ ~ .4-'. ........... Height ....... .2-~.I ............ Number of Stories...9-. .................. 8. Dimensions of entire new construction: Front ..... .~.l.' ....... Rear ...... I. Depth .I..'l- ........... Height . . .... %.%w ....... Number of Stories .... ~.. ................................................... 9. Size o£1ot: Front ....... -I. ~,: ............ Rear ...... .-I.~.' ............. Depth ...I.OO: .............. 10. Date of Purchase ....... I.cl.~. ! .................. Name of Former Owner . A.~.°.~I..~.O...I~..~..CQ~.~..~1. ....... I 1. Zone or use district in which premises are situated .... I~.. g.~.L~.v-..,,~T. M~.~ .................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..~.c,. ........................... 13. Will l~t be regraded ......... .Iq.~ ................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises . 14.a. gl~r~W'.,%..~.u.b.R~,l Address . .~..r-~f~..N.~.Clr., ,,I'~.¥,. Phone No. ~1~.-.~.%~ .".l~,Tt.el.. Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ............... PLOT DIAGRAM Locate clearly and distinctly all 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 show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF ................. .............. ~..~..: .~.%~.4..~...~-~... ........... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. (Contractor, agent, corporate officer, etc.) of said owner or owners, m~d is duly authored to perform or have perfo~ed the said work and to m~e and file this application; that all statements contained ~ th~ application are true to the best of his ~owledge and belief; and that the work will be perfo~ed in the m~ner set forth ~ the application filed therewith. Sworn to before me this :: . ; ':'.v Vcrt~ (S~ature of applic~t)