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Home My WebLink About10213-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No...~.1~.~1 ~ ......... Date .... .D~.q e..m.b.e?.. THIS CERTIFIES that the buildhag ................................................ Location of Property ...~0. 7.0..H .i.a.~.~.~..h.8. . .I~...h., ................ .~.o.u.~.h.o~..d?...N.o?... ..... House No. Street Hamlet County Tax Map No. 1000 Section . . .7.8 ....... Block ..... 3 ......... Lot .... ~.0.: .2 ......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore Fried in this office dated May 6, ?9 10213 Z blOV, · 2.8, ........... , 19. ~'~pursuant to which Building Permit No. 1Q507.7~ ............. May 16 79 dated . l~ocember./. .............. 19.. 7~;vas i~sued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Addition to Dwelling - Wood B~rning Stove The certificate is issued to Joseph H, Kollen (o wner, ~ of the aforesaid building. Suffolk County Department of Health Approval . ~/.R. ..................................... UNDERWRITERS CERTIFICATE NO....N/.R. ........................................... Building Inspector Rev 4/79 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 10507 Z Permission is hereby granted to: ~ ........ ~.~.~z...~...~.~¥./.~.~. ............ ..... ,=,:~.~ ~.. z':/~ r_ AJ....-:......./~....-...~ ................... ,o....~..~.z~.~ ...... ~.o.o.~ ...... ~:~..~,~..¢...~.~.,~.~.~.....,~ .... ~/..:~..z~..c~ ........ ~.,./..~...~,~./~.~.,..~....._...,.._._.._......z.,~,.~__ ................................. · / pursuant to application doted/~..(~.~.,~,~.~.....~....~...., 19.7...~.., and approved by the Building Inspector· ....... ~-,.;.~.;;;.;.; ......................... 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 featu res. 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date ..... ~,],QT/~.e ............. New Building ............. Old or Pre-existing BulldOg ... ,1~ ....... Vacant Land ............. Location of Property].01.0...]~;;[~,W81;~A [1~.. ~a~ ~ .t.~ .,~p~. g.l.d. ........................... House No, Street Ham/et Joeep~ ~ KO~ Owner or Owners of Property ............................................................ 0?8 · 5 050-~. County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision.i. ~.~.~.~..,~. . .~. ~.g?..~.~.~....~/??.e.z'3 ~-;4..;?9.Filed~ Map No...~ ...... Lot No ..... Permit No.. ~9~.~... Date of Permit .~.~.Applicant Jeseph h Kollen Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ........ ~..5 ................... Construction on above described building and permit ~eets all applicabl/e~codes and regulations. Applicant ........... Rev. 10-10-78 FIELD ~S~PEC T ION FOUNDATION (Ist) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY COpE FINAL C 0~q~F~?TS ~_ ADDITIONA~ COMMENTS: TOWN OF $OUTHOLD OFFICE OF BUILDI2~G INSPECTOR TOWN HALL SOUTHOLD, N. Y. 11971 TEL. 765-1802 October 10, 1980 : Joseph H. Kollen Hiawatha's Path Southold, New York Dear Sir: This is to notify you that Building Permit No. issued. May 4, 1979 to same will expire on November 4, ~60 " 1 021 3Z If more tLme is required to complete the Certificate of Occupancy, you may apply, six (6) month extension. Job and obtain a by letter, for a If the work is not completed and the Certificate of Occupancy not issued after the six (6) month extension period, you are than required to apply for a new building permit. Very truly yours, GEORGE H~ FISHER ~ Sr. Building Inspector GHF/mw FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT Examined ........... J ...., 19 ... / / / ,,,/,. / / Approved ....... ¢ .'.: ...... 19... Permit No .......... Disapproved a/c ......................... ................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date..~.-...¢.%.-~..~., TOWN HALL . ' ,"'"' SOUTHOLD~N.Y. 11971 ~/7/~. ~J~ Applicatinn Noel ................ INSTRUCTIONS a. This application must be completely ffled in by typewriter or in ink and submitted in triplicate 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 issue 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 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 buildings for necessary inspections. ( 'gna~e of applicant, or name, if a corporation) · .I.~./2~ ~,~7b).~.'A. ~,qT)l' ...... $ ¢.t4 T/~o. ¢~.~ ...... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..... ..'~.O ._5 .e {D .[, .... Iv[ ..... ~5:7o. [ I e. t-J ................................... (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 ..... (~5 ................... Plumber's License No ....... I.&/ ............... & Electrician's License No ........~ ............ Other Trade's License No .......... .~. .......... ·, ' ' 1. Location o.f.,land on which proposed work will be done .................................................. C_ · ..I.:.t.;.~.~/.4, T'Pt ,o..~... ff,.9:l'.t~ ....................... : .......... '..,.3'.q,c.T./-J.,,.q~. ................... House Number Street Hamlet County Tax Map No. 1000 Section . .?..~ .... 7 ........ Block. ~. Lot .... 0.'7'0'.. ~ ..... Subdivision .... 4-~.c~.G i-I. ,~Zv.~..1/¥'.~ .7. i .-?~'{ )' ....... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... /~./?.4 .t.49&~'./,t..T./.,9.q .............................................. b. Intended use and occupancy ......... ,,9.. L.'~. g ~7. ~'o.~' ............................................. 3. Nature of work (check which applicablel: New Building .......... Addition ....... Alteration . . -Oihe/' 7olk ..... Repair .............. Removal .............. Demolition ........... i : . '..v.a... ~ . (Description) 4. Estimated Cost ........... ~J~ ....................... Fee ........ .'.. z . (to be paid 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, specify nature and extent of each type of use 7. Dimensions of existing structures, if any: Front...~ ? ......... Rear .... ~6~'(.. . . . Depth . ;' :.c . Height .... '." .......... Number of Stories .... g ......................... Dimensions of same structure with alterations or additions: Front .... ).-/ ........ Rear ..... Depth ......... ¥9,, .......... Height ...................... Nmnber of Stories ' . . 8. Dimensions of entire new construction: Front . .. )~ .q, ......... Rear ...~ .q ......... Depth .' !.*. . Height ...... '7 ........ Number of Stories ........ /. ................... Size of lot: Front .... t~ .5':q .............. Rear ... d.V.'~, ............... Depth .... .: ~'. ,' ..... Date of Purchase .. /.~/. 75 ................... .AName 93f Fon_%~rQwner . Zone or use district in which premises are situated...~etA, e.~-- ~J,~X6e,_.av ........ Does proposed construction violate any zoning law. ordinance or regulation: ...... ,ZV, ..... :.. Will lot be regraded ...... dM. O .................. Will excess fill be removed from premises: Yes (,_No_-. Name of Owner of premises . .37. c~ ~.~.../J'../$-.~'./.~-~-~-~-~-~-~-~-~-~ddress ~'~WJ,,9 3", .&r,/,,o.,.. c~F./Phone No. '76' Name of Architect ............ !'. ......'I .... i . . Address .... '~ y.. !., pt;. ~:~ ..... Phone No. Name of Contractor .......... ~l ......". ....~'... Address .................. Phone No .......... 10. ,1 1. 12. 13. 14. 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. '3 /)/)7 .,~ I } ~/5' I,~,~,~ ,9~f,,'T--., STATE OF NEW YORK. S.S ............. r..' ................... being duly sworn, deposes and says that he is the applicant ~ame/of individual signing contract) above name~ He is the ...... O. ~.Zt~t~ ............................................................ (Contractor, agent, corporate officer, etc. of said owner or owners, ~d is duly author~ed to perform or have perfo~ed the said work and to m~e and file ~is app~cation; that ~1 statements contained ~ this application are true to the best of his knowledge and belief; and that the work will be perfomed in the m~ner set forth ~ the application filed therewith. Sworn to before me, this ~ ........... ....................... Notaw Public,~**~t,~ sc,,~tt~ [~t ' County ...... ...... ..,//:..: ................ C ..... i~" ['~ ....... ~ ~0 ~ / (Signature of applic~t) FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 (Buildin~Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No...~..~..~..7 ..... Date .... /1>:,,)..f'/. ...... 19.~. a. This application must be completely filled in by typewriter or in ink and submitted in triplicate 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 layodt 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 issue 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 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 buildings for necessary inspections. ........ . ............... (Signature of applicant, or name, if a corporation) ,i · ..... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· (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. ~'.~-. ~(... ~?'....,¥-A~...~. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No .... 1. Location of land on which proposed work will be done... ~./. ~...,z-/,r_~/_..~,~/,~a:, . ;x.-~/~r.. ................... .... :..,7:...>:..' ......................................... House Number Street Hamlet County Tax Map No. 1000 Section .................. Block .................. Lot ................... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~L,~/~ t///~ ]d/~ ,qd... ~ ~...lq... ~.d ~.O/.~jt~',,~_...: ~ ~. ~.d ~.e' ......... b. Intended use and occupancy../,//.J.. ~.J,~. ~, ~.~./~.Z/..~...~..~..~...~.~.,(..~.,,/~d~...~./.~..~. .......... 3. Nature of work (check which applicable): New Building .......... Additionb.~ ....... Alteration ..... Repair .............. Removal .............. Demolition .............. Other Work ...... (Description) 4. Estimated Cost....~..~...~...~?. '~. ~'f'7..~ ............. Fee../~...~-...o~.~ ............... (to be paid 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, specify nature and extent of each type of use ............ 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ..... Height ............... Number of Stories .......................................... Dimensions of same structure with alterations or additions: Front ................. Rear ....... Depth ...................... Height ...................... Number of Stories .............. 8. Dimensions of entire new construction: Front ............... Rear .............. Depth .... Height ............... Number of Stories ..................................... 9. Size of lot: Front ...................... Rear ...................... Depth . . 10. Date of Purchase ............................. lq, arj~e of Former Owner ................ 1 1. Zone or use district in which premises are situated .... ~,,,~... ~ ~ ............................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ....~. O. ............ 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address ................... Phone No ............. 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. 8{3P1~OI,t~ ....... ............ ,~l~[.'l'J~. KO~hI~lgl~l ....................... being duly sworn, deposes and says that he is the applicant (Name of individual signing 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 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 performed in the manner set forth in the application filed therewith. Sworn to before me this ......... .2.8..~'h. .......... day of .... .N.o.v...~j~l~...~. ....... ,19'/.9.. N~y Pu_blic, .~ .~ .............................. County (Signature of applicant) O0 3.5 9.1 T~SF HOlE sand I~ ~rovl~ coarse sand water - H/A WA THA'S el:l?? =19.7 fesf ho well//t ~. ~.26 (vOC~t) john ~/ Myers P~. 45595 ' L4ND I~ '~ ',' '. -'.'rE O;PJPE NEAREST WATER MAIN- 3000~t JOSEPH H. KOLLEN ~ ANITA KOLLEN THE ~TLE GUARANTEE CO. RIVERHEAD SAVINGS BANK dOSEPH H. KOLLEN a ANITA KOLLEN SU~- O~K cOUNTY HEALTH A s_S 2 2 Chief of Cc. neral ZerviceS SOUTHOLD 'd". ~ -.... - SOUTHOLD ' ' ,-. ,, LAND SuR¥'E'r'O~'S ,.., . Gr;~, ~,":,,~, ".STRANDER AVENUE ~'vERHEAD, NEW YORK SEPI~ 15,1976 I" = 50' 76-800