HomeMy WebLinkAbout4023-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
NO. Z13864 Date S.e.p.t.~.mber t8 ., 198..5
THIS CERTIFIES that the building ....A.c.c.e.s..~ ?.r.y. ..................................
Location of Property ....~/.$. y.e.n..i.n.s, ql..a..R, qa..d. ( Pvt .. Rd. ) Fishers Island
~o. '"' 'g i ..........." ........... h.
County Tax Map No. 1000 Section ...0.1.q ..... :Block . 03 .Lot .0.15
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore Fded in this office dated
.... gl~,g~ ~ J;. 2,~3 ...... ,19 .6.8. pursuant to which Building Permit No..~.023 Z..
dated A~.g V ~ .~..3. 0 .................. 196. .8., was issued, and conforms to ail of the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is .........
.... JI. Qq~g.s. qv.y..b.q~.]..d.J..n.~. ( ba±t shed )
(owner, l~ll~Y~Kla~t) Loretta A.)
of the afores~d building.
N/A
Suffolk County Department of Health Approval ..........................................
N/A
UNDERWRITERS CERTIFICATE NO ..................................................
Building Inspector
Rw. 1/81
FO?RM N'O. ~
TOWN OF SOUTHOLD ~
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISE
COMPLETION OF THE WORK AUTHORIZED)
N? 4023 Z D~te ............
Permission is hereby granted to:
........... :...~[..¢....~...~'~..~..~.,~
UNTIL FULL
........................................... ~aher.~t..-~s.~mo~ ~..~¢.~-~ ........... '~ .........................................................
pursuan¢ to application dated .............................. ~: ...... ~........, 19..~, and app~-oved 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 submi~ed imlllllll~ to the Building Inspec-
tor with the following; for new buildings or new use:
1. Final survey of property with accurate location of all buildiBgs, property lines, streets, and unusual
natu raj 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 installat'on from Board of F're Underw~riters.
4. Commercial buildings, Industrial buildings, Multiple Reside0ces and similar buildings and installa-
tions, a certificate of Code compliance from the Architect dr Engineer responsible for the building.
5 Subm t Planning Board approval of completed siteplan requirements where appl!cable.
B. For existing buildings (prior to April 1957}, Non-conformin~ 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 features.
2. Sworn statement of owner or previous owner as to use, °Ccupjancy 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
3. Copy of certificate of occupancv $1.00
4.Vacant Land. C.O. $5.00
$15.o0
New Building × Old or Pre-existing Building .'. Vacant Land
Fishers Island
Location of Property ...................................................................
House No. Stre~ Hamlet
formerly, Marcel L. and ;Loretta A. Rioux
Owmer or Owners of Property . · .~o~. .... M~arte~ .van..Hen~m.1 ............................
County Tax Map No. 1000 Section ....... 0.1Q~PD.. Block .... 03.~1~) ...... Lot... 0~L56~,. ....
Subdivision ....... --- ...Filed Map No/, .%7.- ...... Lot No .... 77;' .......
Permit No...4.0.2.3,Z.... Date of Permit -- - .Applicant Maar~en y.a.q..E.e.q~e..1 ..........
Health Dept Approval Labor Dept Ai~proval ---
Underwriters Approval ........................ Planning Board, Approval ....... 777 ............
Request for Temporary Certificate... --- .Final Qertificate ......... X. ...........
Fee Submitted $ .5.: .0.0 ........................
Construction on above described building and permit meets all applic[able codes and regulations.
Maar te~, He~~ ..~, ~
Applicant.. ~ Y. :.. ~ . ~".~i¢~-¢~¢:7¢'~-~l~5f~c...~r~ ...........
Rev, 10-10-78 Phi 1 ip B ~ MattheWs, Attorney
FORM NO. 1
TOWN OP $O~JTHOLD
BUILDING DEPARTMENTi
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Disapproved a/ c ......... ~:...~.~......~ ....................
..............
(Buildin~ Inspector)
Application No....~...:.~..~..~ .........
APPLICATION FOR BUILDING PI~ERMIT
INSTRUCTIONS
o. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building
Inspector.
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 ~n the diagram which is part of this application.
c. The work covered by this application may not be commenced befor,b issuance of Building Permit.
d. Upon approval of this application, the Building Inspector wilt issueJa Building Permit to the applicant. Such permit
shall be kept on the premises available for inspection throughout the progress of the work.
e. No building shall be occupied or used in whole or in part for any pu?pose whatever until a Certificate of Occupancy
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the i~suonce of o 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 fbr removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, building code and regulations.
~-~ (Signature of~pplicant, or nome, it a corporation)
( ddress of applicant)
State whether applicant is owner, lessee, agent, architect, en.a.i'neer, general contractor, electrician, plumber or builder.
Name of owner of premises ,~.../~;~'~',~........~..~---':¢~.~(...i..,~~.~ ......................................
If ~pplicont is a corporate, signature of duly authorized officer. .
(Name and title of corporate officer)
1. Location of land on which proposed work will be dane. Mac~No.: ...~'...~...~. .................... Lot
Municipality
2. State existinguUSe~nd oi~u~ncy of ~_re~...~te~d. ed us~~nc~j:z~pos, ed/construction:
~' i~ii~d ~e°o~d°~c~ao~ '~ ~i~ "' ..... ~~'~'~
3. Nature of work (check which applicable): New Building ...~ ....... Addition .................. ,~'~'__ .,z//~61't. er°ti°n ~..., .............
Repair .................. Removal .................. Demolition .................. Other Work (Describe),4'.~.~.'~c....~
4. Estimated Cost ..... ~..~.~.~2,. ................................... Fee ..........................................................................................
(to be paid on filing this application)
5, If dwelling, number of dwelling units ....../,r~.. ................... Number of dwelling units on each floor ..~ ...................
If garage, number of cars ....f.,~... ........................................................................................................... ~..._: .............
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use
Dimensions of existing structures, if any: Frqnt ...~'.~... ..... Rear ...~.~...~....Z..: ............. Depth ....~.....~.. .......
Height ...... Z..~.. .......... Number of Stories .................................................................................................................
Dimensions of same structure with alterations or edditions: 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 ........................................................ Name of Former Owner ........................................................
1 ]. Zone or use district in which premises are situeted .....................................................................................................
]2. Does proposed construction violete any zoning law, ordinence or regulation? ............................................................
13. 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, tS S
COUNTY OF ................................ ~ ' '
................................................................................................. being duly sworn, deposes and says that he is the applicant
(Name of individual signing application)
abow~ 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 applicatio~ filed therewith. ~
Swam to before me this ~ //-~ ,/~,~,/ ,~"~ F
........................ doyo, ............................................ ........
Notary Public, . ........................................................... County (Signature of applicant)