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Home My WebLink About8405-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-17203 Date AUGUST 18¢ 1988 THIS CERTIFIES that the building ADDITION Location of Property 170 JOCKEY CI~V~ DRIVE House No. Street County Tax Map No. 1000 Section 70 Block 5 Subdivision Filed Map No. ~U~OLD~ N.Y. H~let Lot 7.1 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 4~ 1976 pursuant to which Building Permit No. 8405-Z dated MARCH 4~ 1976 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 TO EXISTING ONE FAMILY DWELLING The certificate is issued to LESLIE J. HART (owner, X~) of the aforesaid buIlding. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-317520 - DECEMBER 21~ 1976 PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 Building Inspector FORM NO. 2 T0~N 0~ $0UTSOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CC~PLETIOIq OF THE WORk: AUTHORIZED) r~,~: ~ - 8405 ~--'-~; Pdrm~sslon is hereby z granted '~o:, %~ FORM NO. 6 TOWN OF SOUTHOLD Building Depai [i.ent Town Hall Southold, N,Y. 11971 765- I802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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. B. For existing buildings (prior to April 1957), Non-conforming 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 featu res. 2.Sworn statement of owner or previous owner as to use, occLtpancy 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. C. Fees: ~'~Additions $25.00~ POOLS $25.00 ALTERATION $25.00 1. Certificate of occupancy N~w Dwelling $25.Q0, Accessory ,$10.00 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.Updated C.O. $ 50.00 Date .......................... NewCons truction ...... Old or Pre-existing Building ............ Vacant Land ............. ~~r ~ Owaer or Owaers of Propertg ...r~..-..n .......................................... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No.~. ~ ?... Date of Permit ~.../t/7~.... ·Applicant .................................. Health Dept· Approva_~ ....................... Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construct,on on above descr,bed budding aNdA~,t me~e~all a~Dplicablej~q~es ~d r~gulations. Appl,cant . .~ ~~..~ .,~,....,~ ¢/~%~. ~, .................. R~.10-10.78 ~ ~,/ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST f ] ROUGH PLBG. FOUNDATION 2ND [ ~NSULATION FRAMING ~'] FINAL DATE INSTRUCTIONS a. This application must be completely filled in by typewriter o~ 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, relationsh p to adjoining premises or public streets areas, and giving a detailed description of ayout 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 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~DE to the Build ng 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 lows, 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) ..................................................... ........ ......... (Address of applicanT) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... ......... ............................... i ................ Nome of owner of premises ........ ~.Z4.z~'''' ......... ~J~.Z~,~'... ........................................................... If applicant is a corporate, signature of duly authorized officer. ..... ...... ~/ (Name and title of corporate offic~';~' Bu der's L cense No . ./..~...~. "' '~Lc~ ~ P umber's Lcense No.../~.e.~ ............... Electrician's License No .......... ~ ..... Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: ............................... ~. Lot No ..... ~.',e,..~: .... Street and Number .e~.~..,~'.l~...~r..~.t~r~,,~,/~., ....... ~'~.~..~..~.. ......m~_~l~.j~.;......l~...~;.k~.~...~o Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ...... b. Intended use and occupc~?~y ........... ~~. .................................................. ~ ........... ~ Nature of work (check which applicable): New Building.. ................. Addition ....~. ......... Alteration ............ ' ~'' ," .... ~ Repair .................. Removal .................. Demolition .................... Other Work ..................................................... L/~/O-d-O (Description) 4. £stimoted Cost ............ .~.,,,,~.~..,,~ ...................... Fee ............................................... (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 .......... ~1~' ................ Depth ...el~. .......... Height ....... ~i~..* ......... Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ............ ~.~...~. ............. Rear ..... ~L"~.~ ............. 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 .~,~/~.~.ql~......,~',,,~,~,~.~e., 11. Zone or use district in which premises are situated ...~r-~,~ ................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: s~e~...~..~r~X..~'~¥~.e~l~ 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 stree~ and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ~ COUNTY OF ....: ........................... .... ~llt~/,, .~'..~i~. ....... ~~..(.~1~ ................................ being duly sworn, deposes and says that he is the applicam (Name of individual signing contract~ abc;ve nbmed. He is the ....,~....O....~.....~.... ........ ~../.Ct.~l~ ......................................................................................................................... (Contractor, agent, corporate of.ricer, 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. Sworo_tcLbefore me this ^~_ ",,,, .... ....... day of .......... - ~//.,/ / - // (Signature of applicant) Ii0, ~.8l~u850. Su~4~kc0u~t,y ,Term Expires Ma~.~h 30. 19