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Home My WebLink About10062-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building inspector Town Hall $outhold, N.Y. Certificate Of Occupancy No.. Z.113.45 ......... Date ... D~.aembe. n .13 ................. 19.82 THIS CERTIFIES that the building ................................................ Location of Property ... 199..Gill.et re, .I)v. ±v~.,.. E.. Ylaui~.n ......................... House No. Street Ham/et County Tax Map No. 1000 Section . .038 ....... Block . D.2 ........... Lot ...Q02 ........... Subdivision.. a'qau ±.o.n .Hah.ay. .............. Filed Map No. 2t3.38 .... Lot No... 3,L ........ conforms substantially to the Application for Building Permit heretofore flied in this office dated ·.. N.o.v. emb.e.v.. 17 ...... 19.7.8. pursuant to which Building Permit No..10062.Z ............. dated .... D~.cemb.e.n. 7 ............ 19 78. , 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 ......... .............. a..t. wo. c~v.. gar. age. ~.dd ±.t/.on .. ................................... The certificate is issued to .... Pre.d. eric/c .E ...C~agen ............ ...................... of the aforesaid building. Suffolk County Department of Health Approval ...~./. A. .................................... UNDERWRITERS CERTIFICATE NO .... .N./..g .......................................... Rev, 1/81 Building Inspector FOI~I~ NO. 2 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) ' 7 N? 10062 Z Date.............. , Building Inspector. Fee $../.: ........ : .......... FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hell $outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions A. This application must be filled in typewriter OR ink, and subn~itted 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 n2tura[ or topograohic 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 building~ 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 ~vhere applicable. 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 topograph lc 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. / C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date ..... New Building..~,,,~., ,~,..,, Old or Pre[existing Building(X) ........ =/Vacant Land'i ........... Hou~ No, ~treer Owner or Owners of Property .......... C tyT 1000S ti Blo k ' oun axMap No.. ec on ............... c ............... Lot ................ Subdivision .............. ~.~.~.~..~ ....... ,..Filed Map'No...: ....... Lot No. Health Dept. Approval ........................ Labor Dept. Approval ...................... Unde~riters Approval ........................ Planning Board Approval .................. Request for Temporary Certificate Final CertJficat~ Fee Submitted S ................ ~...~. ~'~ Construction on above described building and per~'i(meets all app~c~l~o~es and regulations. O TO~VN OF SOUT~OLD OFFICE OF BUILDING INSPECTOR ' P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 - Applicant Dear ~Y~h ¢o.~.~ : This is to advise you tha/t the job under Building Permit No /o ' a final' lnopec~ion ~,as /--~as no~ ~been done. In order to comp!ere . ~h_s file, it is necessary that a Certificate of Occupancy be issued. ?lease fill out the enclosed form(s), return same to the above office with a check for $5.00 payable to the Town of Southold. Please indicate to whom the Certificate of Occupancy is to be mai!ed~ 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 .......... ......... · APPLIC:ATION FOR BUILDING PERMIT Dote .................... , INSTRUCTIONS a. This application must be completely filled in by typewriter oe 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 o~ areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is port 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, o.r .for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, budding code, housing code, and regu arians, and to admit authorized inspectors on premises and ir~ buildings for necessary inspections. (Signature of applicant, or r~he, 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 ........... :.,.~.~ ......... '....,{':...,'~ .......... ~,,/,'./,.Ji.,.:i,(L.,/, ............................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ................7.~:.:.~ ........................... Plumber's License No ................................................. Electrician's License No ..................... ..~. ..................... Other Trode's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ./: '"' 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 end occupancy ................................................................................................................................ 3. N6ture o~ work (check which applicable): New Building.. ................. Addition .................. Alteration ................. Repair .................. Removal Demolition .................... Other Work ,,',, ,) . ..................................................................... 4. Estimated Cost ............................................................ ~ee . (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, sp§cify nature and extent of each ~pe of use ............................ 7. Dimensions of existing structures, if any: Front .....~. .............. Rear ..... Z~ .................Depth ..~.~ ...... Height Number of Stories / Dimensions of some structure with alteratiqn~ ~r,qdditions: Front ...... ~:,.~ ................... Rear Depth ................................ Height ................ ~. ....... Number of Stories ..........~ .................... 8. Dimensions of entire new construction: Front ............ .~...J~ .............. Rear . Z Height .................... Numb~r,?f ~tories ..................................................................................................................... 9. Size of lot: Front ~ ' ~ Rear .~:~ .~ .............................. De~h ../....;..~.~ .................. lQ. Date o~ Purchase ........................................................ Name of Former ~ner ........................................................ 11. Zone or use 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 remeved from premises: ( ) Yes (~) No 14. Name of Owner of premises ............................................................................................. -enone No ......'..&&.....; ..... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ........ ,....~. .............. ] ............................. A~ress ................................ Phone No ....................... PLOT DIAG~M Locate clear y and distinctly all buildings, whether existing or proposed, and indicate all set-~ck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW-Y,0R/K,/,~ //x ~ c c COUNTY OF ..¥...!~../.,{.TJ.L.,(! ...... / '/, ,~(,f/,x7, , ,~. ,' ( ? ,'/4 L~//' b 'n .................................................................... '.,~.. ...... ]. ................. e g duly sworn, deposes and says that he is the applicani (Name of individual signing contract) . above named. He is the (.~/{ZP//'/;.~. (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 thar the work wi[I be performed in the manner set forth in the application filed therewith. Sworn to before me this 17 . . , ) i /',., ,' /: , 2'f , ,{ ,/I Notory Pubhc ................. /;../l.. ........ ~ ...........Co,n~ ..... ~ ......................................... .,4.~ ...................................... " (Si~n~ture of o~ica~t) ~ / ~ NOTAbly PUBLIC, State ot Now York -, . · . .. .. .. . :'.~, _ , , . .- . - .. ,~ - . . . - ...: · .,:~-.. -: ti = . .~ ~'- ~ · ~.'~: . . ~ : .. I ~- .- . ~ '.-. ~'.'- * ~- ~-'-. . ~ - ~ --.~- ..... ~ '~' -.' -~:k .... - :-' · .... ~ "-' ~'.-' .... ~./; t- ..... :-~' -:~. ,A-t .. ,-- -,~ ~ ., .~- ~,~,._- . -~ .- .... -D. ,:~7~: ..... :.-,. -:~-.- o ....-,I., .-.-...,,~ :.~,.~.-, ~k: ,.-,-. . .~ ......... .:¢:-', ........r.._. ',':""' ~- - ",-': ': -*:'.~',-" " - -, ~-%3¢ :. ¢~ ." :'::: '" -~;I.'}:- -"-';:',':" ' ~" , 0 ...... .~'" ~:~,, .,% , , ~ , - ., _ . .;.. : :~.. :;'..".-_¢-,, v.: - --..,,. .... %..: _:.~ ~.~.<..-. : .:' ~--. ~ . -. . . ._,:. , . .... . : ....... - ~...' .= ...- . ~t~ , . .... ~,.. '-:: - ::. : ~ ........ ~ .......... ~ ...... ¢~;'.; -:~'' "..'-.~ - __- . . ~:~¢- ~ ,, . . .... '~ ""t '. '- ..... ' "~' - ~' :- .r-,' .'- .. ..... .. .... :....., .._... ..,, , . ' '":' -i~ ~ ~o~ ~. :~--,': . :.--~ :. ' '~W '.,; '' :': ' ' ': '-'""-' "" .--:-'.. -':E~.:~ ~:.::~:o,v ':' "'"' '?~._. W~~~Q --: - --' :~Ovg~ O~~C°, t~.~-. } '~ ~. ~ sdav~o~.~. ~. ~. -" . -/ 5U~, CO. D~. ~ H~4TH S~V]~ ~A~ENT OF ~tl . ', ~OR APPROVAL OF C~'kU~oN ONLY . - . . H. ~. ~. NO,: ,, ' .............. ' APPROVED AS NO-TED 765-2~0 ~/~L~ ~o 4~M FOR REQUIR. ED 1, BEFORE B~CKFILLING FOUNDA- 3, B[(FO[IE COVE~NG P~D;'S OF ANY KIND 4. RHAL ~/H~H fiO~ COMPLETED NOT R~:~POH~SH~LE FO~ D~SIGN OR CONSTEUCTION ERRORS ~. ALL CONST~TUCTION MUST MEET REQUirEMENTS OF N.Y. STATE CODE AND TOWN HOUSING CODE ~ ZONING