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Home My WebLink About5624-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF O~JumANCY No ~-23062 Date JUNE 24, 1994 THIS CERTIFIES that the building Location of Property 1125 MA~ON DRIV~ House No. County Tax Map No. 1000 Section 104 Subdivision ACCESSORY ~u'z'CHOGU'~ N.Y. Street Hamlet 5 Lot 35 Lot No. Block Filed Map No. conforms substantially to the Application for Building Permit heretofore filed in this office dated O~TOBER 21, 1971 pursuant to which Building Permit No. 5624-Z dated NOVEMBER 12, 1971 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 ACCESSOR~ STOBA~E The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED EUGENE & DOLORES TRAVERS N/A e/& Rev. 1/81 //~Jl' '/~ d~ng Inspector TOWH OF $OUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. N? BUILDING PERMIT ~(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permissioo is hereby granted to: ................ 1~ ~.~..~..~,r~:ak~..V..~.~~ .... ............... ~tc~ .......................................... to ...... ~,~,~,.~t,. ~.. ~,~-,t~ .,t~,~ .............................. : .......................................................... at p'remises located at ........... ~4i1~'~11~"~1'~ ...................................................................................... ...................... ; .................................... ~t,~ ......... ~ ............... ~' ............................................ pursucm¢ to application dated ............................ ~....~ ..... ~ 19 ..... [/~ and approved by the Building Inspector. ~Fee $...~e.0~ ........... Building Inspector Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN t~LL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter OR ink and submitted to the buzlding inspector with the following: for new buzlding 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 from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installatzon from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 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. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: i. 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. Fees i. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buildinz - $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 New Construction ........... Old Or Pre-existing Building ................. Location of Property ......... House No. Street Hamlet Onwer or Owners of Property .................................................................. County Tax Map No 1000, Section ............. Block..C~.. ........... Lot ....................... Subdivision .................................... Filed Map ............ Lot ...................... Permit No.~4-~ .Date Of Permit//- ~ .Applicant. Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate ........... Fee Submitted: $. ~5~-r° FO]gM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. Approved ........................................ , 19 ........ Pemit No ..................................... Disapproved a/c ............... ~ ................................ ~ ..... APPLICATION FOR BUILDING PERMIT / uote .............. ~ ........ /c ................... , INSTRUCTIONS a. 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 ofproperty 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 the progress of 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 /V~ADE 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 cede, and regulations. ............................ - > ............... o (Address of app~i'cant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized offlcer. (Name and title of corporate officer) I. Location of land on which proposed work. will be done. /V~gp No.: ...................... ,~-'-'-~....~J.ot No....Z..~.. ...... .~;,. / Street and Number ......... .~..i'..~.~ ...... '~ .................. ~i~i~y 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .............................................................................................................................. b. Intended use and occupancy ............ ~ ......... ,.~.. ......................................................................................... 3. Nature of work (check which applicable): New Buirding .................. Addition .................. Alteration .................. Repair .................. ~Removal .................. Demolition ........... Other Work (Describe) ............... 4. ........................................ .................................... :: ................. (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, specif~/ 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 ............................ Num/ber of Stories ................. 7 ............... / 8. D mensonsqfentire new construct on Front,~ (?.. Rear ...... Z..~.. Death Z Height ............. ~::: _~:= -~%;!0s ...... .t.L.~..~...,°CG.....L)¢.C..L.....~...B.~ ................ ; ............................... 9. Size of lot: Front ...~....0. ...... ,...;...~... R~sa_r ........ ~'..~.. .................... Depth ........ /...~'..L~..:...:'m..../) / .............. 10. Date of Purchase ......... ~rl:~.....~...~..~...~ ......... Name of Former Owner ....~...~ 11. Zone or use district in which premises are situated .............................................. ~1'/~ ......................... · 12. DOes proposed construct on via ate an~ zoning aw, ordnance or reau at on:~ ./..~....~. 13. Name of Owner of premises ~...~ .Address ....................... ~. Phone No. ?..~.~?. Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contrqctor ........................... L..:; .................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clea~ly and distinctly all 'buildings, whether existing or proPosed, and indicate al set-back d mens OhS from property lines; Give.street and block number or description according to deed, and show street names and indicate whether interiOr Or comer lot. STATE OF NEW YORK, J¢ ¢ COUNTY OF ...... ........ .................. ~'~ ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) 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 sam work and to make and file this application; that oil statements contained Jn 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 befpre me this /~ .....__ Notary Publ'c, . ............... ./~.~ ..... County ........................... ~'i~i~~~"~ .......................... .~/~ / ~'/// , /~ RO~A S. LUCE