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Home My WebLink About9421-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.Z. 1.2. ?.9.8. .......... Date ..... .~ ?.v.e.m..b.e.r..~..0 ...............19 86 THIS CERTIFIES that the building . .fi. c..c.e.a s. 97Y.. b..u3.1.d' J, .nE.. ........................ Location of Property ...6.0.0.. ?.a.v.e..c .v.e.s. ~...L.a.n.e. .................. [4.~?. ~. ~- ?.u.c.k. .......... House No. Street Hamlet County Tax Map No. I000 Section .... l.q0. .....Block ....3 ........... Lot ....... .~ ......... Subdivision .~. ~.l.t.a.~..~.e..~.~..t:.~.t.e.s. ........... Flied Map No.0 9.~.~ ..... Lot No...4..0 ......... conforms substantially to the Application for Building Permit heretofore fried in this office dated ·..fi. u. g...2. 2. ..........,197.. 7. pursuant to which Building Permit No. 9 z, 21 2 dated .. fl.u. 5....2.2. ................. 197.7.., 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 ......... The certificate is issued to .. B.a. 1. D .h. )~.....8,. fi.q .p9.1-..F..~.e.e.rqa..n ............................ (owner, ~uy~ ~ of the aforesaid building. Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO !.I/fi. Building Inspector Rev. 1/81 FORI~I NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N? 9~21 Z Date August 22 19...~. Permission is hereby granted to: ....~.~k.~..~ ..................................... ............. N~.~.~...~ .............. .,,~,.~. Build new accessory building at premises ~"~'~*~'~ ~'* Lot ($07) Salt Aire Est Wavecrest La l~attituck pursuant to <3pplic<3tion dated ..................... ~.g.......2..2. .................. , 19..?..~., ~nd approved by the Building Inspector. Fee $.!..0..'...0..O. ............ Building Inspector FOflM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall ~[outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitte~licc, t~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 natu ra~ or topbgraphic featu res. 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. Su bm it Ptann lng Board app royal of comp leted site p lan requirements where app l icable. B. 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. Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling land 3. Copy of certificate of occupancy $1.00 --Pre-Existing C.O. $15.00 Vacant land C,O. $ 5.00 Date New Building .... ~ ....... Old or Pre-existing Building , ~ ........ Vacant Land ............. Location of Property . .~??, .... House No. Street Ham/et Owner or Owners of Property /~L~ County Tax Map No. 1000 Section .. ~ ........ Block ............... Lot ................ Subdivision .5.~.c.T.~! .~.. ~?.~..~.~. ................. Filed Map No..o.O..~.~. .... Lot No.. ~o. ......... ......... Permit No. ~'~/Z. / ~ Date of Permit . . .~...Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... I Certificate ~ Request for Temporary Certificate ..................... Fina ....................... Fee Submitted $ ..~ .o o Construction on above described building and permit meets all applicable codes and regulations. Applicant ,~-~...~..~'~' "..~.'.,?. .............. v-. ...................... Rev. 10-10-78 FOR~ NC), IL TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ......................... ~ ............ , 19 ........ Approved , ~I ~ '' : ~2y .................................. , 19 ........ Permit No ..................................... Disapproved a/c / ~ ~.~... "~" ~ ..... ~'~'" ~ ........................... (Build}~ Inspec~r) .... .~ APPLICATION FOR BUILDING PERMIT ~ ........ : ....... ...... ...... 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, 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 or7,,5 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 contractor, electrician, plumber or builder. Name of owner of premises....~....R..~...P.~. ...~.. ...~.~..~..~...~.. ...................... 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 Trade's License No ............................................... Mo Location of land on which proposed work will be done. ~ ~...~-~ ................................... LOt J'~O ......................... Street and Number ....~...~...V.~..~/~........~.. ........................................... ,./~.../~....~......7~.......~. ....................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use end occupancy ................................................................................................................................ b. intended use and occupancy 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .............. (Description) ............................................................ Fee .......................................................................................... 4. Estimated Cost ~ [ 0 ~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Numbcr of dwelling units on each floor ............................ If garage, number of cars .............................................................................................................................. 6. If business, commercial or mixed occupancy, spec,fy nature and extent of each b'pe of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear Height ........................ Number of Stories ...... ~ ................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................Height ............................ l'lumber of Stories ................................ S'i y# 8. Dimensions of entire new construction: Front ......... /7 ...................... Rear ............................ Depth .g .................... Height Number of Stories .......................................................................................................... 10. Date of Purchase ......... ../.?..¢....~. ................................... Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ I3. Will lot be regraded ....../~..q ................. Will excess fill be removed from premises: ( ) Yes (/~No Name of Architect ........................................................... Address ................................ Phone No ....................... I'..!ome of Contractor ....................................................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-back dimensions from propcrty fines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot ~TATE OF NEW YORK, .S.S cOU T ............................... ...~.~....~.....~~. ............................. being duly sworn, deposes and says that he is the apphcon, (Name of individual signing contract) above named. (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 applicction are true to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this