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Home My WebLink About9365-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificafe Of Occupancy No..~ ~ .~ .5.3.3 ......... Date March .~ 19 THIS CERTIFIES that the building ...... g:. 997.~.~..~X ............................... Location of Property .... ? .0.9.55..FI.~.J:.n....R.o.a.d. ................... .E.~.~.$. ~.z?..5_9.n' .lx.T....Z..... House No. Street Ham/et County Tax Map No. 1000 Section . . .Q~.? ...... Block ....Qg. ......... Lot ..... .2~ .......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULy '15 19..~?pursuant to which Building Permit No ...... ~.~.G.~7, dated ...J.u..~..q~ ................. 19. ~.~, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... i¢or a storage shed The certificate is issued to ]]ester E. & Lillian Wallace (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE NO. Rev. 1/81 Building Inspector (THIS PERMIT MUST BE KEPT ON THE PREMIS£$ UNTIL FULL COMPLETION OF THE WORK ~,UTHORIZED) 9365 Z Permission is hereby granted to: Building Inspector. Fee ~: .~ff~) 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 submitted in duplicate 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" tand uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspectipn 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 or land use 3. Copy of certificate of occupancy $1.00 $5.00 V/// Date ..... ~ . , New Building ............. Old or Pre-existing Building(X) ........... ~/Vacant Land Location of Property . ~,~.¢~.-~, .~. .......... 1~.~"~. ~..~.z-./2.,~¢-~,~...L. ~,,~: ........... ~.-.. House No. Street Ham/et Owner or Owners of Property . ..... ... County Tax Map 'lqpO..~ Section .... ~-).4:~.I ...... Block ...... 0~½~ ...... Lot .... :-.)-Jr! ........ No. Subdivision ............. 'i~.: ................. Filed Map No... ...... N~ . .Lot No, Permit No.q.~..~... Date of Permit 7~.~'/:7.~.Applicant . .t-....~...~..~.......~ff.~.~/.~¢~.~..~.~ Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. Underwriters Approval ........................ Planning Board Approval .................. ~ ,. ~ Request for Temporary Certificate ..................... Final Certificate ................. * Fee Submitted $ ............................. Construction on above described building arid per,,m~:meets all appl~cable~codes and regulations. Applicant . Rev, 10-10-78 OF SOUT OLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-I 802 - Applicant Dear ,~_~ ~OGJ)Jc~q~ : This is to advise o ' ~ ' · · ~ . ~ y u that ~he 3ob under Bulldlng rermlt No. ~% issued to ' n~,%\p] fo~--~--~~%j~q,-~q.~¢, is completed and a zmnal inspection has~ has ~o~~ been done. In order to comol~te ~ ~ . oh_s file, it is necessary that a Certificate of Occupancy be issued. Please fill out the enclosed form(s), return same to the above office with a check for $5.00 payable to the Town of Southotd. Please indicate to whom the Certificate of Occupancy is to be mailed, and arrange with this office for an inspection date. Thank you for your prompt attention. Very truly yours, Victor Lessard Administrator VL:ec Enclosures TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ................... Examined , 19 ........ Application No ................................. T.?. Approved ...................... , ................ , 19... Permit No..~..~'~ Disapproved a/c .~ ~,di~~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. 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, 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 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 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, 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 con}rector, electrician, plumber or builder. Name of owner of premises/....L..f:5/2;.:....:!..../.::./.:?4./.~.~.C ...... ............................................................... 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 ............................................. Other Trode's License No ............................................... X /IV Location of land on which proposed work will be done. Mop No.: ................... z ...... .~ .......... Lot No. -.~4 ................... Street and Number ...!..'...~...6..,: ....... ;..'..L./...:.-,::.L..>.;:~....~.:.~ ....... ~..~.~./.,,h~¢:?¢'.~.:. .............. .r'.':~:~.-/,.~.~.~./..~?- ........... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy i 'i ~ ,' ~ 2./.~;) .~// , · ,,' ~' ,~',~'*'7~" ~-~-e ~'~, (, 7'"'~*'?,~ ~' b. Intended use and occupancy ............................. .~,, ............................................................................................... 3. Nature of work (check which applicable): New Building,, ..... Addition .................. Alteration ................ Repair .................. Removal .................. Demolitior ..................... Other Work ......................... ' ........................... '~ ~'d::/ ~ [ ~ ~ (D~scription) 4. Estimated Cost ....... z~........~.....:~¢,,,,,,,,,,,,,,,~. ..................... Fee .......................................................................................... (to be paid on filing this application) 5. [f 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 ................................ Deptl~ .................... 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 ............. ~...~. ................. Rear ....... ~ .................. Depth .....~.. ............. Height ....... ~.~ ....... Number of Stories .......................................................................................... ; .......................... 9. Size of lot: Front .......... .~...~.~.~...~. .............................. P, ear ..... I....~...~/.:.~..~. ................... Depth ...~.~..J.-....'7...~ZT... ........ 10. Date of Purchase ........... ./...~..~....~- .......................... Name of Former Owner ...x~/~ ........ ..F..~..~,...7'..,~'...~¢ ............. 11. Zone or use district in which premises are situated ........... ~....~....~.../....~...-~...'ZT.I,~..~,, ................................................ 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. Nome of Owner of premises ..L.,.,(,~../~'/.~..c~. .................... Address~.~........~..~..,~... ........ Phone No...~..~..~..~ ...... Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frorn property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot, )~'~ ~-/'d?~--"~ ~ I,-~-~' 1r'~'/~, STATE OF NEW YORK, I~ c COL)~TY OF.~ .............................. ~ "'.-'.,,~ ........ ..~...,..~,...~..../...<~,. ........ ~[~:..~,~'.~...~......; ............................. being duly sworn, deposes and s~ys that he is th? opplicam (Name of individual signing contracf) 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 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 thor the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this , ,o ...... ..... dayof ......... .................. , Notary Publi~ ................................................. County ......... · .~...-~...~......~...... ~~..~.....'~.. ........ ~,~/~"~, ~)~ (Signature of applicant) / ~'~ARY E. DAWSON NOT/~y/I~UBLtC, State of New York Ne.L~'2.4643721, Suffolk Cot~t~ Term Expires MarCh 30, ~g/~! FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hail Southold, N.Y, 11971 APPLICATION FOR CERTIFICATE OF OccuPANcY Instructions This application must be filled in typewriter OR ink, and subr~itted in duplicate to the Building Inspec- tor with the foilowing; 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 disposaI-(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 approva~ 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 peoperty showing all property lines, streets, buildings and unusual natural or topographic features. 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. New Building ....... Location of Property Fees: 1. Certificate of occupan~v.. $5.00 2 Cer't [,cate of occupancy on*p~e-existing dwelling or land use 3. Copy b,f~certificate of occup andy,, $1.00 Owner or Owners of Property County Tax Map No. 1000 Section Subd v s on .......... ': ...... ~I Permit No ........... Date of Permit $5.00 Date ..... Building(X) .. ......... =/Vacant Land ........ Street Ham/et Health Dept. Approval ........... ~ ...... Underwriters Approval ....................... Request for Temporary Certificate .......... ,royal ...................... ,.. )royal ...... ~ .. ~ .Fina~ Certificate ................. * Fee Submitted $ .......................... 4;~ 0 Construction on above described building and permit me, ts all ap~c. able~co.des and regulations. Applicant .: ..... / ................. ,.? ................................ Rev. 10-10-78