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Home My WebLink About11536-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z.13. q 0..2 Date NoveInber THIS CERTIFIES that the building . ~.c.qe..s.s.q~.~z .................................... Location of Property . .5. 7. ~ ........... .G.~.~. ~..e.t~.e...D.r.. ................. .E.~..s.c..~.~..~i.o.n.~. . House No. Street Hamlet County Tax Map No. ]000 Section . .0.~ ~ ....... Block .... Q .4 ......... Lot . .0.0. 2. ............ Subdivision .... H. 9.~.o.n...M.a.n.o..r ............. Filed Map No..2.0.3..8...Lot No. 62 conforms substantially to the Application for Building Pem~it heretofore filed in this office dated ·...~.a.n.: .....3. ....... ,19 .8.2. pursuant to which Building Permit No. 115 3 6 7. dated .... O.a.n.: ........... 7. ....... 19..8.2, 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 ......... ... ~.c.q~$ ~p.r.7. S.~.qr~.e..gu.i.l.d.$.ng .............................................. The certificate is issued to ............... D. U~I~. s ~.C.H.E..L .............................. {owner, le,~,~ee ~r..t~a~ - of the aforesaid building. Suffolk County Department of Health Approval ........... .N [.~. ........................... UNDERWRITERS CERTIFICATE NO ................... .N[.~. ........................... Building Inspector Rev. 1/81 Perrhissior BUILDINQ i:)i[P~R~I N~: TOWN HAt. L SOUTHOLD, N~'Y. i ~ BUILDING; P, ER~ITi, · (THIS pERMIT MUST BE KEPT ON 'IFH,E PRE41s~S:uNTIL:~ULI~ COMPLETION OF THE WORK AUTHORIZED)" Z Daie ..,..~....~..../../.~':~.~..~.~ ...... .7,. 19.~,~ is hereby granted to: ~ i :~ ........... :~.~Z....,.~ ......... Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall ~outhoid, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted~;~,![cctc 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 featu res. 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: I. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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 /. landuse--Fre-~;×±st~.ng C.0. $15.00 3. Copy of certificate of occupancy $1.00 Vacant. la~d C.O. $ 5.00 New Building ............ Old or Pre-existing Building ............ Vacant [.and ............. Location of Property . .5~'?,~ ~,~/cc~,'7'~ '~Z House No. Street Hamlet Owner or Ownars of Property ..... :' ; .................................. County Tax Map No. 1000 SectiorO ,~. ,?:~,~,... Block ,.. ,(~).~ ........ Lot.,..~-").0..~,~ ..... Subdivision .~'2/~..( ,OK,..~,4~IK',~, ,*~,, ........... Filed Map No. , ,¥~,, ,3, ,~,. ,Lot No. :,~,..~.~- ...... Permit No.~.~ ~'~{o ~ Date of Permit Health Dept. Approval ... ~ J~. ................ Labor Dept. Approval ........................ Underwriters Approval .................... Planning Board Approval ................... ~equest for Temporary Certificate ..................... Final Cartificate . ..'~.... · . Fee Submitted $ ...... ' ~ *' Construction on above described building and per[;~t meets all app-'l?ca~e codes and regulations. Applicant .......................... Rev. la. la-7s FIELD~I.N~%~ECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION FER N. Y. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 7G5-1802 Examined .~. - · · .7 .... ,19 '~' '~ Approved .... .Z ..... , l .' ermit APPLICATION FOR BUILDING PERMIT ApPlication No. ~./..~..~. ~. ...... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi 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 stref or areas, and giving a deta/Ied descriptmn of layont of property must be drawn on the diagram which is part of this ap[ cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon apprc.'al of this application, the Building Inspector will issu~ a Building Permit to tile applicant. Such peru shall be kept on the premises available for inspection throughout tile work. e. No building shalI be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupan shall bare been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to t Building Zone Ordinance of tim Town %f Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors ou premises and in buildings for necessary h~m'i~rr~..~,~,~... (Si ~t~- ~re of applicant, or name, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build Name of owner of prelniscs ........................................................... (as on the tax roll or latest deed) If applicant is a corporation, 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 ................................................ .............. tv/: . . .,W&/:.. .,q. . . ./.q ×'.... House Number Street Hamlet County Tax Map No. 1OO0 Section . ...(J.~B~ Block ~ Lot.. Subdivision..../?../~f~...D../~f..~'//(.~.c)~. ............ Filed Map No... ~ .2-.Q.*.~. .~.... Lot...~..'.~. ....... (Name) 2. State existing usC .... ' "' ' a~td 9ccupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... b. Intended use and occupancy /~../~.U ./~ //-~c~ C2),~-~" _C>"P',~-~rr_ F, epair Rcm!oval Dcmolidon Other Work (to be paid on filing this appIication) i. If dwelling, number of dwelling! units ............... Number of dwelling nnits on each floor ................ If garage, number of cars .... [ .................................................................... i, If business, commercial or mixed occupa icy, specify ~atnre and extent of each type of use ..................... t. I)ime~sions of exist ng structnrks, if any Front.....s..'~. .... , ..... Rear .... ~ ........ Depth .. 5{0 .......... lteight~ ..../fl. ......... Nml~ber of Stories ..... / .................................................. Dimensions of same structure w~th alterations or additions: Front ................. Rear .................. I)eptt~ ................... i... Height ...................... Number of Stories ...................... ~. I)imensions of entire new const!ruction: Front ... ]..~.. ........ Rear .... ./..2:-7 .......Depth ... ?. .......... )..H. eight ... ? . . Nnraber of Stories . / ............... &.~ ........ Size of lot: Front . ! ./.,0. .... ,.. .... . ..........Rear ...~.~ ................ Depth .../.~... :..g'7. ........... ). Date 6fPurchase .. /?roy., ~ ~ . .... .......................... N~me of Former Owner ..... /.~, ./.&~..,~. ...... Zo&e or use district ..... ~,~...~.~.. t. ~ .'Z~. 77~ 1. in whtch premises are s~tuated ...................................... .>. Does proposed construction vi6Iate any zoning law, ordiaance or regnlation: . .,~..~. .......................... L '9,'ill lot be regraded ....d¢.O... i..' .................. Will excess fill be removed from premises: Yes I. Name of Owner ofpre~nises ~. ~.~.~..~ .'~..~.~...(.c.. Address ~T¢..j-'.~/.~dgte744...~..... Phone No. ?. ??.--?.t.f.9'. ..... Name of Architect ' .'.. Address Phone No Name of Contractor ........ i .................. Addreis ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly al! buildings, whether existing or proposed, and. indicate all set-back dimensions from roperty lines. G~e street and block number or description according to deed, and show street names and indicate whether :tcrior or corner lot. ~'~_~.~T__5..~oc~? ~ 620/2~,~,.d rATE OF,NEW YORK, OUNTY OF. ~...o/5 .r-9..~...'... . worn to before me this ....... ~ ............ t~ .day otary Public, .......... ......... ,19 g. ". NOT,~RY PUBLIC, St~te ef Suffolk Couflty NO. 4748183.. .... County ~' Term Exes M~h 30, S.S ~-~"~/~-/~J "Dw&~..c... being'duly sworn, deposes and says that he is the applicant , (Nan/e of indMdual signing, contract) :>ore named. is the (Contractor, agent, corporate officer, etc.) said owner or owners, m~d is drily authorized to perform or have performed the said work and to make and file this ?plication; that all statements congained in this application are true to the best of his knowledge and belief; and that the 'ork will be performed in the manner set forth hi the application filed tl,~erewitb.