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Home My WebLink About11570-zFORM NO. 4 TOWN OF SOUIHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hal~ Southotd, N.Y. Certificate Of Occupancy No..Z.1.1.Q?7. ...... Date ...... J.u..n.e..1.! .... , .............. 19.8.2. THIS CERTIFIES that the building ................................................ Location of Property 1980 Sigsbee Road Laurel h i~ ~se hie ...................... 's't/e~ i ....................... County Tax Map No. 1000 Section . .1. t~ .4 ....... Block ...0. ! .......... Lot . · ,0,1, 5. ........... Subdivision. M. att$.t, tlck. P.ar.k..P.r. gp~'.t~-o~Filed Map No..8.Q 1. .... Lot No...4.0 .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated · . .F.e.b. cu. gry..2.3 ...... , 19 .8.2. pursuant to which Building Permit No..1. 1. 5..7.0.Z. ............. dated ... F.e.b.P.t;O['Y..2.4 ............ 19 .8.2., was issued, and COlfforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is . .g ...... A'u;t.], .f~nq~.qq. u~.d.e.c..a.n., e..x.~.s.~..~.n~..qn, .erf. a. ,m,t,Z.y' ,d..~.e.Z.Z. Jr..~F.. ............... The certificate is issued to . .J~.DfH:l.qo.~. ,B.R$..1..&..o..g.h~.~. ............................... (owner, I~,cc *~.t~ of the aforesaid building. Suffolk County Department of Health Approval ...n./. ~ .................................... UNDERWRITERS CERTIFICATE NO ........... n./..~ .................................... Rev. 1/81 Building Inspector 'FOR~ NO. $ TOWN OF $OUTHOLD Buildin9 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- tot with the following; for new buildings or new use; 1. Final survey of property with accurate )ocation of all buildings, property lines, streets, and unusual natural or topographic features. 2.Final approva~ 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. Commercia~ buildings, tndustria~ 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: I. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date .. New ~..,,,.u~ ....... g AI.Jc..' ~...e.~¢~..¢'Old or Pre-existing Building(Z) .......... i/Vacant Land ~ ............ House No. Street Hamlet Owner or Owners of Property ............ . County Tax Map No. 1000 Section (~(~{~.~..(~. ,J... Block ..: .... / ....... Lot .... Permit No. l{ ~.~.'~ateofPermit ..5~t/~pplicant ... ~. ~.{ ...... [ ........ Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. Unde~riters Approval ........................ Planning Board Approval .............. Bequest for Temporarg Certificate ..................... F[na~ ~ort~ficate ....... · ...... Fee~ubmtted$ ~,~ .. ~ ~ ((~ Construction on above described building and permi~meets all ap~cabl~odes and reguiations. Applicant . ' ............................. FIELD INSPECTION COMMENTS · FOUNDATION (1st) FOUNDATIOn__ (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIO~ NTS. .,15 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N~Y. 11971 TEL.: 765-180:3 Disapproved a/c ..................................... Application No...13. ( . . .... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This 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 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 appli- cation. 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 necessary inspections. (Signature of applicant, or name, if a corporation) ...... .... ......... ^ (Matlihg address of appelant) ~ State whether applic~ant is owner, lessee, agent, architect, engineer, generat contra4tor, e~ecrncmn, pmmoer or ounoer. Name of owner of premises . .~'../~.~f:& .... o..g.(. , ................................... (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 ....... ~r~ ............... Plumber's License No ......................... Electrician's License No ....................... Other Trades L~cense No ....................... 0 C;'Q'" ~,'~--~,~ ~-.~--. House Number Street County Tax Map No. 1000 Section .../.~ ......... Block ...~.r ............ Lot.. ~(~ ........... Subdivision ~¢ ~.. % ~ .... ~~.. Filed Map mo.~. frO../... Lot..~ ......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .. ~. ~ ............... '.' ....................................... : b. Intended use and occupancy ...~.~ ~ ~ ~cM ~-d ~ce~ ~~ property lines. Give street and block interior or corner lot. 3. Nature 'of work (check which applicable): New Building .......... Addition .......... Altera~oj~ ...... z · ·; Repair, .............. RemoVal .............. Demolition .~(~ ........... Other Work .(~.~t.4t,. g44tt~-t.~ ' fi . ~ 7 o o F~'~ ~-- o<~ (Description) 4. Estimated Cost(fi(~. 7.~. S/..: ....... /.~ ?:..~.~fi. ~ ....... Fee.../~tS.....~f~.. y.d~.-~..~-....~.l. 0' . ~.c.cx. .~ ....... i ' (to be 17aid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If ag mber of gar e, nu cars ..... ; ................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structurei ifany: Front ............... Rear .............. Depth ............... Height' Number of Stories Dimensions of same structure with alterations or additions: Front ................. Rear .................. Number of Stories Depth . Height 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ........... Number of Stories ........................................................ 9. Size of lot: Front ' · ..................... ........... : ........... Rear ...................... Depth 10. Date of Purchase ........... i .................. Name of Former Owner ............................. 1 1. Zone o~ use district in which prelmises are situated ..................................................... 12. Does Proposed construction violate any zoning/aw, ordinance or regulation: ................................ 13. Will lot be regraded ....... ,?~'_25 Z' '. '; ' ' 7/' -/t~ ' ' ' Will excess_fill b~ remg~ed~ from premises: _Yes ._, No 14. Name of Owner of premises .~. ~. Address .,~5-.. f.~.,f~ ..... Phone No. ~,.~. ~.~.. z~/.~. ~.. Name of Architect ......... ................ Address ................... Phone No ................ Name of Contractor ' Address . Phone No. PLOT DIAGRAM Locate clearly and distinctly all lbuildings, whether existing or proposed, and, indicate all set-back dimensions from mmber or description according to deed, and show street names and indicate whether STATE OF NEWtJ~RK2 .,., ~ S S COUNTY OF ~: .... j' ~ . ~fflqame of il~dividua signing contr/fft) above named, i being duly sworn, deposes and says that he is the appliclnt He is the .................... ~<~.: ............... ..) ................................................ ~\ (Contr~nt, corporate officer, etc.) of sakl owner or owners, a~is d~4z2uth.or-ized"fo 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 that the work will be performed in the manne~ set forth in the application filed therewith. Sworn to b~fore me this Notaw Public, .............. zA~~~kC°unty ~~Z.. ~ Pusuc, ~tete of Now Y0~ (,/ (Signature of applicant) No. 52-8125850, Suffolk Co Term ExpIies March 30, 1~