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Home My WebLink About9901-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building ................................................ Location of Property ...... ~.~.0.0..~.o.~..~.~'..1~.o.~..cl..~.~. .............. .P?.o.o..~.:[.o.,...~1:.~.o.... House No. Street Ham/et County Tax Map No. ! 000 Section . . . .T.l'k ...... Block ..... .[I-. ........ Lot . .1. . ~..,~ ......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...g.~.g .~.~..1.7. ........ , 19 ?.~. pursuant to which Building Permit No .... .c).9.Q 1. .~ ............ dated ....~.~.gl3..~.g. ?.~. .............. 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 ......... ............ 4 .~¢~.~.~. 9.n..~.o...~..t. ~..~.~.n.g..o.~.v.~.gg..B.u.~..~.a.l.n.g ......................... The certificate is issued to }/illter~ ~T, R~'erl ......................{o ..... wrier, ..... ~'~ '~ ............................. of the aforesaid building. Suffolk County Department of Health Approval ............. .1{..~. ......................... UNDERWRITERS CERTIFICATE NO ..................... .hl./.~. ......................... Rev 4/79 Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWbi CLERK'S OFFICE SOUTHOLD, bi, Y. BUILDING PERMIT (THIS PERM!T ,MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETI(~ (~F THE WORK AUTHORIZED) 9901 Z Permission is hereby granted to: !:...~.. .......... ..U..u.~...,...~..~ ...... .~.~..~.Y.?~. ,o ........ ~.~. ...... .~L...~.: ...... ~..~.~.~.~.~....~:~.C..~..~.~ f.;L..~.....~.~.~.~.~T .... FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be fil~ed in Wpewriter OR ink, and submitted 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 natural or topographic 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 buildings 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 where 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 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. 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 ~.4~,/.~''~'. Vacan- t Land ..._. ......... Location of Property /~/~ IFvT'~ ~ 6, f~)~ y~', c~ House No. Street Hamlet Owner or Owners of Property ... ~,/~./.I .... .'~...~.~" .~..~..~. .................................. County Tax Map No. 1000 Section ............... Block ............... Lot ................ Permit No ......... :. Date of Permit . . .~...)...Applicant . ~ ....... ~ Health Dept, Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate , ~ .................... Fee Submitted $ ' Construction on above described building and p/~r)rni~; me_~s ~ app~cable codes and regulations, Applicant .... /f~. -'~( .~.... ~ ..... ~ ....... ;~. ..... 1~2~- TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN HALL SOUTHOLD, N. Y. 11971 TEL. 765.1802 August 5, 1980 Colonial Home Improvement Co. Jennings Road Southold, New York Dear Mr. Corwin: : This is to advise you that the job~nder Building Permit No, 9901Z issued to Wm. J.Ra yan on Aug. 28, 19'f8 for acc'y o±mg. (garage) appears to be completed as of our last inspedtion. Before you can legally use or occupy this structure a Certificate of Occupancy must be issued. Please fill out the enclosed form and return same to the above office. There is a fee of $5.00 for a Certificate of Occupancy Thank you for your prompt attention. Very truly yours, GEORGE H. FISHER Sr. Building Inspector encl. FORNI NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ..................... ~.~.......~...~2~ 19...?..? Approved ................... ~(.~...~....~..., 19...?..~Permit No......~....?...~....(.~ .... ..................... ...... .............. (Building I nspec¢'~r) Application No...~'.....?..~../ ................. APPLICATION FOR BUILDING P[RMIT Date ...... ................ INSTRUCTIONS a. Th~ 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 Jot and of buildings on premises, relationship to adjoining premises or public streets o~ areas, and giving a detailed description of layout ofproperty must be drown on the diugram 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 in. buildings for nece~,iarylinspections. ) (Signature of applicant, or name, if a corporation) C~Lz-LO~,~ ,y(,~ ~- C ~ "" '1' "'" :'" ': .......................... : ..................................................... .... ~ (Address ~:~ a~ii~i' ' ')' ~'-'~"' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................ :. .................. ! ..................................................................................................... '~'~m~ of owner of pre~;'i ..... U f L: i~ L,' '~ '~ ' ' ' ' ~ ' .'.~.' ';f ~/' ......................................................................................... 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 ............................................... 1. Location of land on which proposed work will be done. M~p No.: ........................................ Lot No ......................... Street and Number ................................................................................................................................................... Municipality 2. State existing use and occupancy of premises and in~ended use and occupancy of proposed construction: n. Exisiting use and occupancy ............... ..~...(~.....~......~.~. ....................................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alto. ration ............... Repair .................. Removal .................. Demolition .................... Other Work .................................................... (Description) 4. Estimated Cost ............................................................ Fee .......................................................................................... (t0_q,, c:-.be~paid on filing~this\% application) 5. If d~c~'x-i~umber of dwelling units ............................ Number of a~v~ling aqni~ o~xe~ floor ............................ If garage, number of cars ................. .....===.,~. :..~..~.~,..~3...~ ....................... 4~.~ ................ ~-.....~x- .................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, ff any: Front .( .......................... Rear '~'""~x .......... '~.~.. Depth .................... Height ........................ Number of Stories .............~ ............. '~..........'~ .................................................... 8. Dimensions of entire new c°nSt~~'""....~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 Jaw, ordinance or regulatioo: ........................................................ 13. Will lot be regraded . ........................... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ....................... , ............................. Address ................................ Phone No ....................... Name o¢ Architect .............................................................. Address ................................ Phon~ No ....................... Name 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 lot. STATE OF NEW YORK, COUNTY OF ................................ ~' '~"~ ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name 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. Swam to before me this ........................ day of ............................................ , 19 ......... Notary Public, . ................................................... County ! '