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Home My WebLink About3755-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23538 Date MARCH 10, 1995 THIS CERTIFIES that the buildin~ Location of propert~ 95 NAVY STREET House No. County Tax Map No. 1000 Section 26 Subdivision ADDITION & ALTERATION ORIENT, N.Y. Street Hamlet Block 1 Lot 12 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 27, 1967 .pursuant to which Building Permit No. 3755-Z dated DECEMBER 27, 1967 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 ADDITION & ALTERATIONS TO EXISTING DWELLING "COTTAGE" AS APPLIED FOR. The certificate is issued to GERALD D. & LOIS A. DOP~MAN (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 N/A N/A N/A Building Inspe~or FON,~J[ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.~ Y, BUILDING PERMIT (THIS PERMIT MUST BE KEP:I' ON THE PREMISES uNTIL- FULL COMPLETION OF THE WORK AUTHORIZED) NV 3755 Z Permission is hereby grant_ed to: ............... 0~.~.~ ................................................... of premises located at . ~.~.~...~.~I~.~.tl ............................................................. ~ ............................... ............................................. .~rl~t,..i..~.~.kl ........................... , ....... : ............................................ pursua~ to aPPlication dated ...................... L...it.~4,i'J.~.....~ ............ ~., 19..~.~,., and approved by the Buildigg Inspector. ~:ee *..:.~..'...qg ........... uuilding inspector ~ · BLDG. DEPT, j TOWN OF SOUTHOLD j Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FORCERTtFICATE OF OCCUPANCY A. Thi~ application must be filled jn by t~pewriter OR ink and submitted to the building inspector with the following: for new building or new use: 1. Final survey of property with accurate location of all buildinks, property lines, ~treets, and unusual natura~ or topographic features. 2. Final Approval from Heal th D~pt. of water supply and sewerage-disposal(S-9 form). ~ 3. Approval of electrical, installation ·from Board of Fire Underwriters. ;4. Sworn statement from plumber certifying that the solder used in system contains less than 2/1.0 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings · and installations, a certificate of Code Compliance from architect or engineer · responsible for the building. / 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: ~ 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. ~ If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swill~ing pool $25.00, Accessory building $25.00, Additions to accessory buildiug $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-exioting Buildin~ - $100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ..~Aq~y .... ,.2.~5 .................... ~ew Construction ........... Old Or Pre-ezisting Building...× .... Location of Property ..... ~.~ ................... Navy Street ........................... Or~ ............. House No. Street Hamlet Gerald D. Dorman and Lois A. Dorman )nwer or Owners of Property ........ ;OUnty Tax Map No i000, Section..~.0~... ~1~ 0100 ...Lot. 012000 ;ubdivision ............... . ......... Filed Map ........... Lot ...................... )ermit No ............. . ............ Applicant ............................. · .. Date Of Permit 'ealth Dept Approval ' ' ...................... Underwriters Approval ......................... [anning Board Approval ..................... equest for: Temporary Certificate ........... Final Certicat~...'.X ...... ee Submitted: $.. . ................... ro~ No. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ ,10 ........ Permit N~i..~.~.,..~. .... Application No..?..../..?....:~ ............ APPLICATION FOR BUILDING PERMIT Date P~-, ~ ~ 19~'? INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Pict 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 application. 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 ~'he progress of the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until o 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 and regulations. ............... ................ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi.neer, general contractor, electrician, plumber or builder. Name of owner of premises ..¢~!..,.....~..../~..~.4[..~/.). ....... /~...~.~../-.J..~..(~/. .......................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................Lot No.: ........................ Street and Number Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .....~.....~.J.~..~..~./.f~./.~. ...................................................................................................... b. Intended use and occupancy ............................................................................................................................. 3. Nature of work (check which applicable): New Building .................. Addition ........ ~ ......Alteration .....~. ........... Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ Estimated Cost ..... /~.3....~.. ............................................. 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 c~rs ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ................ ~ ........... 7. Dimensions of existing structures, if any: Front ....... ..4.?. ................ Rear ...... d,;s~. .................... Depth .....~.2 ........... Height ./..~..i ................. Number of Stories .... ~. .......................................................................................................... Dimensions of same structure with alterations or additions: Front ........ ."~.?..i ..................... Rear ..~.~.Z.'. .................. Depth .....~.}..'. .................... Height ............................ Number of Stories .....zr. ......................... 8. Dimensions of entire new construction: Front .................................... Rear .....02 .................... Depth / z ...... Height .... 4. ......... Nu,mber of Stories 9. Size of lot: Front .....~..~..*..T. ............ Rear .................................... Depth ......... L~P....*..¥. .......... 10. Date of Purchase ........................................................ Name of Former Owner Z-./~...~.~*./.~.~.t.~(f. ............................ 1 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ....... ~ ................................................. Name of Architect ...................................................... 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 ¥~RI~/] / ~ ¢ c COUNTY OF .~..'~/~.~..~.::',..M,® ..... .~.:'~.~.~ .......~...~,~;,-,.~.~. ................................ being duly sworn, deposes and says that he is the applicant (Name of individu~gni~.gpplication) above named. He is the ..... ~.:~W.,(*.Z.~ ....................................................................................................... ~ ........... (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and is duly authorized to perform or have performed the said work and to m~ke 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. Swam to before me t~, _ .... ...... ........... .............. Notary Public, ..~,.~...~......~}.~.~ ......County (Signat~e of applicant) NOTARy PUBLIC, 8[~[0 of New York Suffollc Cmnd~ .,7, 2-007242~ , Commlsslm~ !~x~irc~ i~Zarch 30,1~,.~