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Home My WebLink About9880-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ...... ~3.3.7. 9..2 ..... Date ............ ~..ucj.u.s.~...2.2 ...........198.5.. THIS CERTIFIES that the building ...... .a.qqe..s.sp.r.y..~.r.u..c.t.u?.~.: .................. 2 0 Bra e. . Location of Property ....~3 . ...Secqn..~ .~.~.... . Mattl..t.~ck . house ~0: ............... County Tax Map No. 1000 Section .. 1..2.6 ....... Block ......... 7. .....Lot .... .1.5 ........... Subdivision...G, I...TU'~h,i,~ J~. 5..Qg .h.~,r..~. ....Filed Map No... 8..6.1...Lot No ....... .8.3 ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... JuLy..2 ~ ......... 197.8, pursuant to which Building Permit No ...... 9.8. 8..0.g ........... dated ............... g.ucJus.g..2[... 19.7.8, 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 storage structure for garden equipment. The certificate is issued to ......... BEBIEDIC~.. &. ELEAI~Q~,~4~JI ................... (owner,~;~t~ of the aforesaid building. Suffolk County Department of Health Approval .................... N/.& ................... UNDERWRITERS CERTIFICATE NO .......................... ixI/.A .................... Rev. 1/81 Building Inspector FOF~M ~NO. ~ TOWN OF $OUTHOLI~I,'~? BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Ne 9880 · BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) z Dote ........ Permission is hereby granted to:~ at premises : pursuant:tO applieation Sated Inspector. approved by the '-, ~o~,,,~ NO. ~ ~?~)~;11~ TOWN OF SOUTHOLD Building DeparTment Town Hall AP. ,.-IC.~T,O,,J FOR CERTIFICAT[ OF OO A. This aoD~iaation must be filled in typewriter OR ink, and submitted ~n duplicate zo the Building Inspec- tor '.'/~m [h~ following; for new buildings or new use: ]. Final sun,'ey of prop?ty with accu~ate location of all buildings, property lines, streets, and unu~al na;ur:J or ,oo~, a~h,~ features 2.Final aaercv~t of Hen[th Dept. of water suooiv and se,verage d~sposa]--(S-9 form or equal). 3.Aparcva~ of elec[r~cal installation from Boned'of Fire Unde~riters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Coda compliance from the Architadt 'or Engineer responsible for the buiidin¢. 5.Subm~Planning Beard approva of completed site plan requirementswhereappi]cabie. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildincs and "prmex'st'ng land uses: 1. Accura[e ~ey of peoperty showing ail prooerty lines, ~reets, buildings and unusua~ natural or topo0raphic features. ' 2.Sworn statement of owner or previous owner as to usa, occupancy and condition of buildings. 3. Date of :.n" housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. / C. Fees: 1. Ce~ficate of occupancy $5.00 2. Certificate of occupancy on prmexist~ng dwelling or ]and use $5.00 3. Copy of certificate of occupancy $1.00 Ne'.'/Suiid~n~ OldorPr~-ex stingeuiiding(% ~ , /V~cant ' - Lcc2[lon of Property ~-0 " [ y ...... ...... ~ ......... ~C¢... ~"~ · ~'~ x¢/X~ .. ..¢Z~ x .... ~'ou~ lYe. Srree[ Haml'~t Coun,/ 'ax Moo No..1000Secdon /&~ '~ /¢ Block .... , Lot ..... SubdlwsJon ................................... F;led Map No ..... ' ...... Lot ~,~, ~,o. .q~.q.. ~:~ o~: ~/~( ~d~ ~7~~ ~' I<~,~.,~tc~ '" .... Heohh Dept. Approval ...... .................. Labor Dept. Approval Undc¢.'/r hers Approval ....... ...... Planning Board Approval Request for Temporary Cert~cate ..................... Final Certificate ........ - ......... FeeSubmit odS. ~'.~ TO%VN OF SOU~OLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 - Applicant T,his is to advise ........ ~ ...... ,~ ~o. ~/-~. issued to t~ .. / .... [.'~ ...... a fi~~ct~n~ ~o ~~~- C ~p-~eo and ......... ~ n~s noz~ b=en done, I~ Order to CO ....... this file it is n~c=~ a Cerrificat~ of ~,~_~ , . , .... sary ~,~at - O.~,.cy be ~ssued. Please enclosed ~ ~ · ~r,.~(s) ~ regur~ same to t~he above rr~ o.~_c~ with a check for $5.00 payable to the Town of Southold. Please indicate to whom t~e Certificate of Occupancy is to be mailed, and arrange with this office for an inspection date. Thank you for your prompt attention. VL:ec Enclosures Very truly yours Victor Lessard Adminis t.r~ tor TOWN O~ SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam,ned . ~.. . ,19~ A ..... ........... 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 of property 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 ir~ buildings for necessary inspections. (Signature of applicant, or name, if a corporation) State whether applicant is owner, lessee, agent, architect, engfneer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly ~uthorized officer. (Name and title of corporate officer) Builder's License No ............ ~,~ ......................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ...............................................~~__~'~~ ~r~~ ~. bo~at,o~ of ~d o~ ~h,~h propo~d work w," ~ do~. ~p ~o.: ..~.~.... bo~ ~o. Street and Number .... ~ ~ ~-:~ ~- ~' 2. State existing use and occupancy of~ ~premi~es and intended us~ and~occupancy~~__of proposed construction: 3. Nature of work (check which applicable): New Building'. ................. Addition ......... :...>.... Alteration ................ Repair .................. Removal .................. Demolition .................... Other Wa rk~'-z......~. 4. Estimated Cost ......... .~..t~..~....i..'... ............................ Fee ~' ~ (Description) (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, 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 ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ................... , ................ Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 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'. ........................................................ 13. Will lot be regraded . ..................... ~ ..... Will excess fill be/removed from,~ premises: ( ) Yes (/-'Y No Name of Owner of premises...~.../.~.../.C"~...~.~ .~.... Address ,.~.(:~...].,~'Phone No..'~..~...~..~..~..~.~ 14. Name o¥- Architect .............................................................. Address~/# ......................... Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil 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 lot. ~-~ COUNTY OF ............. >,.....;: ........... .......... ..~.'...'. ......................... '..'..j ................................................. being duly sworn, deposes and says that he is the opplicam (Nome of 'individual signing contract) 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 b,efore m~ this i " . ~, i . ,, ............. ~. ......... day of Notaw Public, . ................ ................................... Coun~ (Signature of applicant)