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Home My WebLink About6557-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildin§ Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building ..... .A.C.q E..S.S.O.R.Y...S.H.~ .D .......................... Location of Property .... 3.3. 7. .6..W.~. c..k.h.a.m...Ay,e.n.u..e ............ .If. qt..t .~.t.u.c..k.,. fi.: .X: ....... House No. Street Hamlet County Tax Map No. 1000 Section .... 1.0.7. ..... Block .... .0.9. ........Lot .... 1.5 ............ Subdivision Amd. M/o Mattituck Heights .Filed Map No. 1184 .Lot No. 9 & l0 conforms substantially to the Application for Buriding Permit heretofore fried in this office dated M..~?..9.: . [9.7.3. .......... , . pursuant to which Building Permit No... 6.5.5. 7.. Z. ............. May 9, 1987 dated .............................. was ~ssued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is msued is ......... ACCESSORY SHED FRANK RAYNOR The cert, ficate is issued to .......................................................... (owner , 7~v~ Ya~blOt~ X of the aforesaid building. Suffolk County Department of Health Approval N /a UNDERWRITERS CERTIFICATE NO .................................................. PLUMBERS CERTIFICATION DATED: N/A Rev. 1/81 Burid~ng Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWI'4 CLERK'S OFFICE SOUTH'OLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6557 Z Permission is hereby granted to: .......... .~.-~..~.~...!.~ .............. ~..~.~.~.~ ........ .......................... ~.~..~....~...~..¢..~.~... ............ at premises located at ...................... ,~.~t.~.../~. .......... ..~.../...~.../.~..../-/...~...../~.. ......... .~.....~..~..~ .......................... .................................................................................... ~.&.~r.~..c....~... .................................... pursuant to application dated .................................... ..~........~...~....~/~.., 19..'Z....~.., and approved by the Building Inspector. Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y, 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Co Instructions This application must be filled in typewriter OR ink, and submitted m~ 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 features. 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 property showing all property lines, streets, buildings and unusual natural or topograph ~c 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 $25,00 -- BUSINESS $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 5.Updatecl C.O. $ 50.00 Date .......................... NewConstruct-ion ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property . ~-,~.. ~,~....~...~ ?./.Z ./fi'..,¢~,...,<~..¢~.~..../?.-j~...~/~,/.~.'?-'..~../.CT. .................. Owner or Owners of Property ,v',~-- County Tax Map No. 1000 Section ./'..o, .-~ ........ Block . ¢), .o..~. ........ Lot. Subdivision ..'~..~../~. <z.-~.~,,~../.~, ./.~.~/.~..~..3-._,- ........ Filed Map No./../, .~. ~....Lot No... ?'.?/..O ..... Permit No.~. ?..~?..2~... Date3%f Permit..~./. ?-,~...Applicant. , ./~.~. ~.<v¥~.¥ ,<', .~,-'~/2'. ,-'~..~.~ ........... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval . .~ ............ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $. / ~ ~ Construction on above descmbed building and permit meets ali applicable codes and regulations. Applicant..~ .~...~'~....~'. ............................. Rev 10-10-78 ~ /~ ~;~ ~'~'~; ~ ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT ~ ~ ~ ~-~ ~ TOWN CLERK'S OFFICE ...... SOUTHOLD, N. Y. Ex, mined ......................... ~....., ~.~~ , ~lic,tion No..~:.~( ....... ........... ........... ............. : ........................ ...... ................. ' AFPMCATION FOR BUILDING PERMIT ....................... INSTRUCTIONS a. This apphcatmn must be completely fdled ~n by typewriter or ~n mk and submitted m trlphcate to the Budding Inspector, w 3 sets of plans, accurate plot plan to scale Fee according to schedule. b. Plot plan showing location of lot and of buddings on premises, relationship to adjoining premises or public streets or areas, , Owing a detculed description of layout of property must be drawn on diagram whmh ~s part of th~s apphcation. c. The work covered by th~s apphcat~on may not be commenced before ~ssuance of Budding Permit. d. Upon approval of this apphcation, the Budding Inspector wdl issue a Budding Permit to the apphcant. Such permit,shall be kept the premises avadable for mspectmn throughout the work e. No building shall be occupied or used m whole or m part for any purpose whatever untd a Certificate of Occupancy shall have b granted by the Budding Inspector APPLICATION IS HEREBY MADE to the Budding Department for the ~ssuance of a Budding Permit pursuant to the Budding Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances or Regulations, for the construct~o buddings, additions or alterations, or for removal or demoht~on, as hereto described The apphcant agrees to comply with all apphcable ordinances, braiding code, housing code, and regulations, and to admit authorized inspectors on premises and m buddings for necessary mspect~c {Address of apphcant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bull, ........... ............................................................................................................................................................ Name of owner of premises ....... ..~.../~.~....,~'..~.'....~..:...~...~..~,~....o..~ .......................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No ..................................................... OLher Trade's License No ................................................... 1. Location of land on which proposed work will be done. Map No .............................................. Lot No ...................... Street and Number .... .~......3[,,?...~.'.....~..,,/.,.~,~..,,~,.~.....~1....,,~...J~,..~. ................ ,,,'~,~-..Z..Z'.&4.,,(~,..~. ......................................... MunicipaliW 2, State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~ /C-/f/v) / L ~' Z~) [1/~.; Z-L / )L[ ~,- b. Intended use and occupancy ...................... ..~...~...../~..,~.. ........ ../~...!;~./'..¢. ......... ...~,...?..t..~./. ...... ..~'...L...~........~..~..~'.~ ..... o 10. 11. 12. 13. 14. Nature of work (check which applicable): New Building,..... ....... ~' .......... Addition ..................... Alteration ............... Repai~ ......................... Removal ......................... Demolition ........................ Other Work .................................... , ~ 0.~...~ (Description) Estimated Cost ................... .~...~... ................. Fee ........ .~.. ..................................................................................... {to be paid on hhng this apphcaBon) If dwelling, number of dwelling units .......... ! ...... Number of dwelling units on each floor ......................................... If garage, number of cars ............................................................................................................................................ If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................................... Dimensions of existing structures, ~f any: Front .....................Rear ........................... Depth ................................... Height ........................................................... Number of Stories ............................................................................. Dimensions of same structure with alterations or additions: Front .......................... Rear ......................................... Depth ............................................. Height .................. .. ...................... Number of Stories ........................................ Oime,~sions of entire new construction: Front ............ ........ Rear ............................ Depth ...... ./...?.. .................... Height ........................... ./ ....... ._..~ ...... Number of Stories .............. ._ ......................................................................... Size of lot: Front ............... .~...~.~.~.. ............. Rear ................... ../...~....~.. ............ Depth .............. ...,~....C.....O.. .................... Date of Purchase ........../.~.....~...~....-~.. ........ Name of Former Owner ............... ../~.....~.....~?.~. ...................................... Zone or use district in which premises are situated .................................................................................................... Does proposed construction violate any zoning law, ordinance or regulation: ........................................................... Will lot be regraded ................................... Will excess fill be removed from premises: [ ] Yes [ ] No Name of Owner of premises ........ ~ ........-~-- ~_ __..~...../).....~.../~....~..,.~..~. ......................................... ..~..~...~.....~.. ..... ..z~....7.,7.~....~.,.,[ ...... (Address) (Phone No.) Name of Architect .................................................................................................................................................... (Address) (Phone No.) Name of Contractor .................................................................................................................................................. (Address) (Phone No.) PLOT DIAGRAM Locate clearly and dmtinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro, property lines. Give street and block number or description according to deed, and show street names and indicate wheti er interior or corner lot. ~0~0 COUNTY OF He ~s the ~..., --. ft ,.~ be,ny duly sworn, deposes and says that he ,s the apphcant above name (Contractor, agent, corporate officer, etc.) of said owne* or owner~, and Is duly authorized to ~rform or have performed the said work and to make and fda this apphcat~on; that statements ccntame~h ~his ~phcaBon are true to the best of his knowledge and behef, and that the work wdl be performed m the man set forth m the application fded therew,th ~ TERRI LEE E~K ~ ~ ...... da of ~ ~ Notary Pubhc, ~~~~ch 30, .]~Upty ............................................... fSt~tature of a~hcant] FOI~I~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OmCE SOUTHOLD, N. Y. .......................... :~.~..,~ ..... ~9.7,.~.. (-- ~ 77 ~___ E×om ned ............................ Pem,t No ..................................... Approved O ,opproved ........... ...... .......... Z .......................... Application No. ~ '~ ~ 7 (Budding Inspector) APPLICATION FOR BUILDING PERMIT ate ........................ .... INSTRUCTIONS a Th~s apphcat~on must be completely hued in by typewriter or ~n ~nk and submitted m triphcate to the Budding Inspector, w 3 sets of plans, accurate plot plan to scale. Fee accordmg to schedule b. Plot plan showing location of lot and of buddings on premises, relationship to adjoining premises or pubhc streets or areas, a gwmg a detaded description of layout of property must be drawn on d~agram which ~s part of th~s apphcat~on. c, The work covered by th~s apphcat~on may not be commenced before ~ssuance of Budding Permit. d. Upon approval of this apphcatlon, the Budding Inspector wdl ~ssue a Budding Permit to the apphcant Such permit ,shall be kept the premises avadable for inspection throughout the work e. No but~dmg shall be occupied or used m who~e or ~n part for any purpose whatever unbl a Certificate of Occupancy shal~ have b granted by the Budding Inspector APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Budding Permit pursuant to the Budding Zc Ord)nance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances or Regulations, for the construct)o[ buddings, additions or alterations, or for removal or demohtlon, as here~n described The apphcant agrees to comply w~th all apphcable la, ordinances, budding code, housing code, and regulations, and to adm(t author[zed ~nspectors on prermses and In bumldmgs for necessary inspect)o~ (Address of apphcantl State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build~ Name of owner of premises /~ ~ A'~ /%/0 ~......~.. If applicant is a corporate, signature of duly authorized officer. ~Name and title of corporate officer) Budder's L~cense No .......................................................... Plumber's License No ......................................................... E~ectrician's License No ..................................................... Other Trade's License No ................................................... 1. Location of land on which proposed work will be dor~e. Map No............. ............. ~ .................... Lot No ........................ Street and Number ................~...~..~.. ,~. ......... .~./.,~.~..~,~ ............................... ~ .~~.c~ .................................. : Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existin~e and occupancy / /E-?~'~/z- ~'' ~)(~// /~'/ / /",..~.. ...................................... b. Intended use and occupancy ..................... ;,~.,,~....~./..~' ......... !.~.~.~././. .......... .~...~..?..'..../. ...... ..~...~.......~,.,..~,.~..,~.:.~....F~,. ......... .- - Natare of work (check which applicable): New Building .......... L... Addition Alteration .... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... c' ~ '~ (Description) / 4. Estmmated Cost ..................... . .,~../7... ................ Fee .......... ~.. .................................................................................... (to be pa~d on hhng this apphcat~on) 5. If dwelling, number of dwelling units ........... l ..... Number of dwelling units on each floor ...................................... If garage, number of cars ............................................................................................................................................ 6. If business, commercial or mixed occuDancv, specify nature and extent of each tvpe 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 ............. [..~Q ....... Rear ............................ Depth ....... {..~. .................. Height ................ '. ........... :~.. ................ Number of Stories ....................................................................................... 9. Size of lot: Front ................~....~...~'.. ............ Rear .................... /....~....~.. ........... Depth ............... 10. Date of Purchase .......... ./.2...~...?..~. ........ Name of Former Owner ................ .~...ct~..._~...~m~... ...................................... 11. Zone or use district in which premises are situated ................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .......................................................... 13. Will lot be regraded ................................... Will excess fill be removed from premises: [ ] Yes [ ] No 14. Name of Owner of premises ......... ~ .........~...~)...',..,.A../L.../.~. .......................................... 2..~.~....~. ...... .z~..Z.7...5~ ...... (Address) {Phone No.) Name of Architect .................................................................................................................................................... (Address) {Phone No.) Name of Contractor .................................................................... i~l'~') .................................... i~l~'~'[q~i ............. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro property lines. Give street and block number or description according to deed, and show street names and indicate whet er interior or corner lot. STATE OF NEW YORK, _.~FFFt9~ '~.I SS COUNTY OF ........................ ............. /.~..(.. /~ h/ !.~ ......... ~ ~).~ ~!.(../~ be,ny duly sworn, deposes and says that he Is the applicant above nam. (Name of mdtvtdual szgmng contract) He ,s the ~ ~, A / ~i.~ ..................................................................................................................... (Contractor, agent, corporate officer; etc. } of said owner or owners, and ~s duly authorized to ~rform or have performed the sa~d work and to make and file th~s ap~hcation; tha, statements contained m th~s ap~hcaBon are true to the best of h~s knowledfle and behef; and that the work wdl be performed m the mm set forth m the apohcat~on fded therewith No 52616829,5- ~ Notary Pubhc ....... quahhed mn So,folk Coun'~ ~m~,~"[~;;~* '~.G;7~ 'g~.' ' 5 '*~ ' . . County ($~gnature of apphcant)