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Home My WebLink About9685-zFORM NO. 4 TOWN OF 5OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z12~43 .......... Date .... .Iq.a.r.'g.h..1.3. t 1984 ., 19 THIS CERTIFIES that the building l)~.cJq ........................................... Location of Property . .1215..P.:[ke..str~.~t; ......... Mal:t. itxuck Houst; No. Street Nam/et County 'Fax Map No. t00O Section . .140 ....... Block 0.3 ............. Lot . .0.2.0. ............ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ,Tu±y 7 1 9 8 t. pursuant to which Building Permit No. ~.6.8.5.~. .dated . .~7. U~1.7.. 'l ................... 1 9 .8.21.., 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 ......... ... ~.~.q k...o.~..???., e.~..m3?..v.' .~.~.~..~ ?.~y. ............................................ The certificate is issued to charles 3. & 6rean 2'. za,hra [owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N/A UNDERWRITERS CERTIFICATE NO ........................ .IN[.&. ...................... Rev. 1/8~ Building Inspec[or I~OB~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~OUTHOLD, N:. Y. BUILDING PERMIT CrHIS PERMIT MUST BE KEPT ON THE Pi~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 9685 Z Permission is hereby granted to: -" - - IL' ' ~ L ~1~... to ........ J~l~,l~ .......... O.~..-'~ ........ .~ ....... ~...~..IV~..-T~ ........... ~.~.r- ........ .JZ.~.~ ....... ~ .... ~ .~ .~.~ at premises located atl{~,~l.~:~ ............................ .~.....~..~,.ff, ................................................. '~'~ ... - ~'¢P,-'t'~ I"'T'LI~_Ix~ pursuant to application dated ................... ................ ~..l...~.....~.~ 19..~.~..., and approved bY the Building Inspector. F. ,..../.~ ........ FORM NO, 6 TOWN OF SOUTHOLD 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 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. Fina~ approval of Hea~th Dept. of water supply and sewerage disposal-(s-g 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. §. Submit Planning Board approval of completed site plan requirements where applicable, For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing ali 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 / Certificate of occupancy on pre-existing dwelling / land use 2. 3. Copy of certificate of occupancy $1.00 ~ --Pre-Existing C.O. $15.00 Vacant land C.O. $ 5,00 Date /'~'~r /.~/~ ~.~. New Building .. ?F. ...... Old or Pre-existing Building ..... ~...-~.. Vacant Land ...... Location of Property.../..~.../.~ .............. .~. '.~. C.. ?. ?..'~. ............... · ./~...~. ~. House No, Street Hamlet Owner or Owners of Property . -~..~.?..~. //'~'-q ~ ~'t~ ~ '7~*~'~. County Tax Map No. 1000 Section .Z ~ ?. ........ Block ...~).. ~ Lot zg. '~- c~ . Subdivision ................................. Filed Map No ........... Lot No .............. Permit No.~. ~/.~.. · .~. · · Date of Permit/~l/'£/~ ./.~.7..~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 permit meets all applicable~codes and regulations. Rev. 10-10-78 FORM NO. I TOWN OF SOUTHO!.D SUfLDING DEPARTA4rNT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved (Building Inspector) No. 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 o 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 necessary inspections. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...................... ............ . ..................................................................................................................................... Name of owner of prem ses ................................................... 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 ........... ~.~.. ..................... Location of land on wh,ch proposed work w. II be done. Map No.:_J)I$~L,.I.QO.O..~C,..~....J]..~3 Lot No....'~O. ............. Street and Number ..J....~...]...~.~......~.2.2~.~........~..~._~.~.~...7~/ . ./~...]/~./2/.2/:.~./;..7~....~..C~..~ ........................................ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ............ ~,..,0,..~,.~,.~......,~..~..~../.,~./):~,.,~. ................. b. Intended use and occupancy ............. /~.J~.~... U~..~. .................................. 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work .... E~..~:')... ~c~.C \ (Description) 4. Estimated Cost ........... ,.t~..l~. ................. Fee .......................................................................................... ,/~/// (to be paid on fi ting this application)~/Z, 5. If dwelling, number of dwelling units .............. Number of dwelling units on each floor ....-~.././../. ............ 6, If business, commercial or mixed occupancy, specify nature and extent of each type of use ..../...f.x.~ ............. 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with all, rations or additions: Front .................................... Rear ............................ / Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ........... /~,.L ................. Rear ....... J..o~9..~. ............ Depth ...~4~...~.../. .......... I-[eight .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ......... ,~.......~..~. ................................ Rear ........ .......................... Depth :,....~.....'~.,~..'ff. ............... 10. Date of Purchase ...... '' -- -- .',~.~.p .~.:..../..c/...7....7.. ................... Namef~ of For~ner O~n~r ~..L~;.~...~.~; .~..~...~..'~J~.Y2?I?..~ ..... 11. Zone or use district in which premises are situated ......... /~.~.45:?.i.Q((~;/:'~..*.~../.~;/.....~ ........................................ 12. Does proposed construction/violate any zoning law, ordinance or regulation: ...... /....~..O. ....................................... 13. Will lot be regraded .~...~..~,4/~ ................. Will excess fill be removed from premises: ( ) Yes ,~ No 14. Name of ?wner of premise ..K. c~....~..¢..~.¢t..C..O~.. Address .(~,.../~.. .... Phone No..~..~..~..~ Name or Architect ....... ~. ~:~:,~,~.. ~/ ........................ Address .~~.....iiii Phone No. J~ Name of Contractor ..... ~..:..z...'rc......':z:~... .................... 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 ,vhether interior or corner Iol. STATE OF NEW YORK, /~ c c COUNTY OF ................................ f '~"~ ~ , ............. .(~..~....(~ .r..I..~,',-.~ ......... ~ ........ ,~... ,0~ h · ~..'. - .Ct~, ......... being (Name of individual signing contract) above named. duly sworn, deposes and says that he is the applicant He is the ........................................................................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the s6id 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 that the work will be performed in the manner set forth in the application filed therp, w~ith. Sworn to,before me this n /"/ ,4 /' / ~ Jq~---- day/of ~ ~IL , 19~ /~// ~ / / ~ ......... ............................. ~n~ro or o~p~conrj ~ ~ ' //~ * ~N~TARY PUBLIC, ~taie of New Yo~k ~. ~ No. 52-4612739 Qualified in Suffolk County Commission Expires March 30, 19~ OCCUPANCY OR ,USE IS UHLAV FUL VflTH UT CERTIFICATE OF OCCUPANCY APPROVED AS NOTED ~ ,:,AT~?/? ,,.P.'~~ NOT]~ ~NG DEPARTMENT A~ 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: ], FOUNDATION - ~O REQUIRED FOR POURED CONCRETE 2, ROUGH - FRAMING & PLUMBING 3. INSULATION 4, FINAL - CONSTRUCTION MUST BE COMPL~E FOR C. O ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR D~IGN OR CONSTRUCTION ERRORS. APPROVED 8~ I DRAWN BY L ~ I