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Home My WebLink About9280-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the bud&ng ....~.?.e?.8. a..r?r. ................................ Location of Property .... ~,? ?., .S. ,k.t~..k...~,a~e, .............O.u~.c.l? ,o.~??. .................. House No. Street Ham/et County Tax Map No. 1000 Section ...0.~.? ..... Block ..... ~. ......... Lot ..... fl. ........... Subdivision ............................ Filed Map No ......... Lot No .............. conforms substantially to the Application for Budding Permtt heretofore filed in this office dated ...... .J..l~. ?..2. ...... , 19 77. pursuant to which Building Permit No .... 928~Z, ............ dated ........................ June 2 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 ......... Accessary storage building The certificate ~s issued to ..... .g:.d..~?...v. ,., p.q . ................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. ~./.g: .................................... UNDERWRITERS CERTIFICATE NO .................................................. Rev. 1/81 ......... <...~..~,~. ~ .......... Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9280 Z Permission is hereby granted t_o: -, ...~aa...¥.....~,.e~a~ ......................................... ~ at premises Ibcated ~at ....... ~.~.,~..~ .................................................................................. , ..... :~':~ ................... : ..... ~.~ .......... ~e~.., ............................... :...: ............................ ~ .................... ~ ......... -/ -~; pu~on~ ~o opphcat~on-' ' ' dat~ ............................. ~ ....... ~ ....... , 19.~.., and ap~rov~ by the ,~ ~._- z Builaing In~e~or. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A0 Th~s application must be filled in typewriter OR ink, and subr~itted in duplicate to the Building Inspec- torw~th the following; for new buddings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. F~nal 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 c~rt~hcate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. Bo 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 mspecti,on of buildings or premises, or other pertinent informa- tion required to prepare a certihcate. Co Fees: 1. Certificate of occupancy $5.00 2. Cert~hcate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date ..... New Building ............. Old or Pre-existing Building(2¢) ......... = /Vacant Land ............ Location of Property . ~ I ~' ~'~L1 ~1 H~ /~ ~ ('b1 'T C House No. Street Ham/et Owner or Owners of Property ....... ,~./~-'~ . h ,]~, ~-?,. . ,V,., .~, ?.(.-~, f..~./,~,/, ............... County Tax Map No. lOOOSection ....... ,~.~... Block 3 Lot Subdivision ..... ~(. .......................... Filed Map No, . ..~. ...... Lot No...f~. ......... ........ .......... Health Dept, Approval ............ ~ ........ Labor Dept. Approval ......................... Underwriters Approval ........................ Planmng Board Approval .................. , ., Request for Temporary Certificate ..................... Final Certificate ~ Fee ~ubmitted $ ....... ~..~.'~.J.' '. .............. Construction on above described building and permit~ meets all app~cable~co_des and regulations. Rev. 10-10 78 Examined ............ ~...~.., Approved .............. ~ ............ , TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. 9 Application No .... .f.. ...................... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildir Inspector, with 3 set~ of plans, accurate plot plan to scale. Fee according to schedule. b Plot plan showing Iocahon of lot and of buildings on premises, relationship to adjoining premises or public streets t areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this applicatior 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 perm 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 Occupanc 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 th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances ~ Regulahons, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe~ The apphcont agrees to comply with all applicable laws, ordinances, building cede, housing code, and regulations, and t 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 buiide~ 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 ............................................... Locotion oflandonwhichpr..c~po~sedw~~e. Mop No.' .......... ,~.....4 ........ Lot No ~, 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 occupancy ................................................................................. 3. Nature of work (check which apphcable) New Building .......... Addition .................. Alteration .............. Repair ............... Removal ........... Demoht~or. ............ Other Work ................................................. ~ (Description) 4. Estimated Cost ? .Fee .... ~...~.. ............................................................................ (to be pa~d on filing this application) 5 If dwelhng, number of dwelling umts ...........................Number of dwelhng un~ts on each floor ......................... If garage, number of cars ................................................................................................................................... 6 If business, commercial or m~xed occupancy, specify nature and extent of each type of use ....................... 7 Dimensions of ex~stmg structures, if any' Front ....................... Rear ................................ Depth .................... Height ....................... Number of Stones ...................................................................................................... Dimensions of same structure w~th alterations or addmons Front .................................... Rear ...................... Depth .........................Height ................ Number of Stones ............................... 8 D~mens~ons of entire new construction' Front ................................... Rear ............................ Depth ..................... Height .................. Number of Stones ................................................................................................ 9 S~ze of lot Front ..................................................... Rear ......................................... Depth ............................... 10. Date of Purchase ..................................................... Name of Former Owner ....................................................... 11. Zone or use d~stnct in which premises are s~tuated ................................................................................. 12 Does proposed construction violate any zoning law, ordinance or regulation' . ...................................................... 13. W~II 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 d~stmctly all buildings, whether ex~stmg or proposed, and ~nd~cate all set-back dimensions fron property hnes Gwe street and block number or description according to deed, and show street names and ind~cat- whether interior or corner lot (Non. of indiwduol sigmng contracf) above named being duly sworn, deposes and says that he ~s the opphca.~ He is the .................................. ~ ......................................................................................... (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and ~s duly authorized to oerform or have performed the sa~d work and to make and fi th~s application; that ar[ statements contained ~n th~s apphcat~on are true to the best of his knowledge and belief; ar tk, a~ the work w~ll be performF'ci~in the manner set forth m the apphcat~on filed therewith Sworn to before~_),~me th~s ~~.-.k~ l ~ .................... of .... . ? . ............... ............................. ~__J/// (Signature of applicant) //