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Home My WebLink About9382-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate O[ Occupancy No ....Z.!373.9. ....... Date .......... .~.u.~ .~.~.~. ?..2 ........... ,19 .~.5. THIS CERTIFIES that the building ..... a. ?.o.e.8.@ .o?~.: ............................... Location of Property ..... ~.~.5 .............. .O.a.k...8.~.. ............... .0.~.~.~..h.o.~.~.e. ...... House No. Street Hamlet County Tax Map No. 1000 Section ...... .~.3.6., .Block ......... fl. ..... Lot ......... 2.~. ...... Subdivision..~u, ge~e..~;~gh..'~.~ ............. Filed Map No...~.5. ,6., ,Lot No....~.O.&.~.? ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated August q 1977.. pursuant to which Building Permit No. 9382Z dated ..... A~g~S.~. fl. ............. 19 ?.7., 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 ......... Accessory building in rearyard area. The certificate is issued to .......... lvLh-RIE. &..J. 0~P~H. ~:Q~]~ ......................... of the aforesaid building, Suffolk County Department of Health Approval N/A UNDERWRITERS CERTIFICATE NO ...... N/A Building Inspector Rev. 1/81 SouTHOLD, N..Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL PULL COMPLETION OF THE WORK AUTHORIZED) 9382 Z Permi~{~ is"hereby granted to: ......... ~ ............... ,~: ~ , . Ot premises located at ....... ~..~...~......~..~-~:~ / ................. ~...~/ ~ ................... Building Inspector. Fee $...:~. ............... FORM NO. 6 TOWN OF SOUTHOLD Buiiding Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A, This aealication must be filled in typewriter OR ink, and subr~itted in duplicate to the Build(ng Inspec- tor '.vm~ the foHow[ng; for new buildings or new use: 7. Final sun;e,/ of property with accurate location of all buildings, property Pines, streets, and unu~al n~L]r~l or tooograoh~c features. 2.Final eoorcv81 of Heaith Dept. of water suooiv and sewerage d sposal--(S-9 form or equal). 3.ACDrO','31 O[ electrical installation from ~oa~d'of Fire Unde~riters. 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,Submk Planning Board approve of completed site plan requirements ,,,/here applicable. B. For existing buiMings (prior to April 1957), Non-conforming uses, or bu~Mincs and "pre-existing" ~and uses: - ].Accurat~ ~n/ey of peoperty showing all proaerty Fines, ~reets, buildings and unusual natur~( or tooo~rephic features. ' 2.Sworn statement of owner or previous owner as to use, occupanc~ and condition of buildings. 3. Dale oi anv housing code or safety inspection of buildings or premisas, or other pertinent informa- ticn required to prepare a ce~ifica[e. / C. Fees: ~. C¢~ificat¢ of occupancy $5.00 2. Cartel;cate of occupancy on pre-existing dwe(ling or land use 85,00 3. Copv of certificate of occupancy $1.00 Date .. New 8ui[dic0 ............. Old or Pre-existing Building(Z) ......... = /Vacant Land -. ............ Subdiwsion ................................. Filed Map No ........... Lot No. He.]hh DepL Approval ........................ Labor Dep[ Approval ...................... ,.. Ucde~,vrhers Approval ........................ Planning Board Approval .................. , ,., Request for Temporary Certificate ..................... Final Certificate' .... ~ ......... . Construction on above describ,~d buddm,, ~nd ~*r~i*' ..... " . , , ,~ ~ . u ~, pc ,,, · ~,,~ a. app~,caole~codes and regulations. ........................... . TOWN OF $0UTT~0LD OYFICE OF BUILDING INSPECT~ OR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11371 TEL. 765-I 802 o , K E 1)~~~ 0 -- ~PPlicant . This is to advise you ~hat t~ Permit No..~'~. issued to -~ a f~ ins-~e~ Z~~ ~s comp_s~ea End r ~ ~ ..... ~-o f / n~ ndt~ been done. om .... h_s file is 0 ~..cy be ~ssued. enclosed ~ ~ F-~s~ fill out the ---c~ WiZh a check fop $5.00 payable to the Town of Southo!d. lnezcate to whom the Certificate of Occupancy is to be mailed, and arpange with this office fop an inspection date. Thank you fop youm prompt attention. VL:ec Enclosures Very truly yours, Victor Lessard Adminis ~r~ tot ......................................... , ............................. .g.~_o_ ~_~ .__d_._??_ ............. FOB, M NO. 1 TOWN OF SOU?HOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, Examined ...~....-~....'..../.~ ............ , 19..~.....7 Approved ....... ~.~..~.../. ............. , 19:.~.~.!.. Permit No....~'...~-.~.~.~.~ ........ D' isapproved a/c ....(/-. ............. ;.;T; ................................................................... Application No. ~:/~/c:'~ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date ..... ~.....~ .................... , a. This application must be completely filled in by typewriter or 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 o 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. (S~gnature of applicont, or name, if a corporotion) ..... ........................ o (Add, tess of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, elect~ian, plumber or builder. (Name and title of corporate officer) Builder's License No ....... :x~.../~ ........................ /5/ Plumber's License No ................................................. Electrician's License No ............................................. Other Zrade's License No ............................................... : Location of land on which proposed wo~will be~tane M p No ~'~:~:-~-~ ~/~ Lot N ..~...~.. 1. Street and Number ~.~.~.~.~...~.'..~: ....... 2. State existing use and occupancy of premises an.d i~n.:ended use and~,~?f]y,/~f proposed construction: a. Exisiting use and occupancy ..... ~¢'/~r...~~...~. -~~ ~ ///2~ .................... b Intended use and occupancy ..,~..~¢:~/~C~.....~.~?~..~....~...~~...~..~.~.~:~~..z~..--Z~. 3. Nature of work (check which applicable): New Baiidln .~.~.,.... Addition .................. ,~lterotion ................ Repair .................. Removal .................. Demolitior- .................... Other Work ................................................ .-. /~, / ~ (Description) 4. Estimated Cost ....................... ..~.....~-.~.. ....................... Fee ../~....%. ..................................................................... (to be paid on filing this application) 5. If dwellir}g, 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 ................................Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ De th .... Hei ht Number 9~, Stories .............................. P ............................ g ~ z__~ 4~ r._~__~// //1 ~/~" 8. Dimensions of entire new construction: Front ........ ...(~........, ................ Rear ............................ Depth ./.,CM ....... ~ .... Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front .... ,~--~....~..J~.~-..~. .......... Rear .......................................... Depth 10. Date of Purchase ...................................... ~. ............ N,9~e,e,e~f Former Owner ........................................................ 11. Zone or uae 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. Narne of Owner of premises .................................................... 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 from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner Iol. STA'TE OF NEW YORK, COUNTY OF ................................ ....... ..~.....~.....~.../...~'~.......~.,,,~..,~./g~..(~ .................................. being duly sworn, deposes and says that he is the applicon~ (Name of individual signing contract) above named. He is the ........... .~..~,4¢..~..~..~ ........................................................................................................................................ (Contractor, agent, corporate officer, etc.) of said owne~ 'o~ 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 ~nd belief; and that the work wilt be performed in the m~nner set forth in the application filed therewith. Sworn to before me this ~ ........ ..... o, ...... .............. , Notary Pub c, ~,.~. ......... ~ .........................Coun~ ............ f~.,~.....~~ ......................... "27~ ..... ~ ~, ) ..... (Signature of ~cant) / ~ E OAWSON NOTARY ~LIC. 'State el ~ew ~ork No. 52-464372], Suffolk Term Expires March ~0,