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Home My WebLink About11600-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19133 Date JUNE 11, 1990 THIS CERTIFIES that the building Location of Property 1975 YOUNGS AVENUE House No. County Tax Map No. 1000 Section 60 Subdivision ADDITION SOUTHOLD~ N.Y. Street Hamlet Block 01 Lot O1 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 1, 1982 ~ursuant to which Building Permit No. 11600-Z dated APRIL 8~ 1982 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 FIREPLACE ADDITION TO EXISTING ONE FAMILY DWELLING The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A MARILYN G. LAMBERT ~'u i~l ding Inspector Rev. 1/81 TOWN HALL SOUTHOLD, N~ ¥, BUILDING pERMIT, (THIS PERMIT MUST BE KEPT ON THE pREMIsE~ UNTIL F~LL COMPLETION OF THE WORK AUTHORIZED) N:°. 11600 Z Permission is hereby granted to: Date ............. · ..................................................... ~"~"':~ ............... ':L ~ m p~emises located ~t .............................................. ~ ........ ~"~"{",'9 ................ j ...................................... Coun~ Tax Ma~ No 1000 Secton ......... ~ ....... ~ Bl~k, ..~...i, .............. ~ot No. ~ ...................... pursaant th' application dated ......... ; ..................... ~...z..~ff..,..., 19.,...~., and approved by the Bull~Jng I~pector. :' r~pecto~ FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 NAY - 2 1990 ," APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted ~ ~ 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. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operty 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: Additions $25.00 POOLS $25.00 ALTERATION $25.00 1. Certificate of occupancy New Dwelling,$25.Q0, Accessory;$]O.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50~. 00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20,00 5.Updated C.O. $ 50.00 Date .......................... NewCons truc tion ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property . ~. 9 .~..~... ~.0.¥'~0X.~..'7~y~,. .... .~..~..~..~.~ .......................... House No. ~ ~ Street /Yam/et Owner or Owners of Property ~0~.\~.~.~..~.:..C-0~v..~...e~.~.. ............................... County Tax Map No. 1000 Section .... .~.~. ....... Block .... './. ......... Lot ..../. ........... Subdivision ............................. ,...Filed Map No ........... Lot No .............. Perm 0 f[~O'Z,~ e P t ~~/~'/~ ~'~ ' 'j~' ' ,, ........... Oat of erm ...,.-./.....Apphcant. ~,.j.,.~.~.Y" / ~ L v~.~..~'. :~y.~?.%- ....... Healzh 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. 10-10-78 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [~ FINAL REMARKS: ~),.{~', ~/.~, C, ~ , FOll~ NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ......................... .(?:: .~'.. .... 19........~'~'--~' ........................................ , 19 ........ Permit No ......... Disapproved o/c ........ ~ ........... ~ ....... , ............. ............... {Buildin~ Inspector) Application No. / f (~ 0 0 APPLICATION FOR BUILDING PERMIT Date ............. :;?Z~/. ............. i ......... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the BuiJdin 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 c areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this applic~tior 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 perm 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 Occupunc 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 th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describec The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t admit authorized inspectors on premises and in buildings for necessary inspections. ...~,,::...~.,,,;~'::.z..fi::....~./...~./.Z.~.~..:sw: (Signature of applicant, er nome, if a ..................~ ~ .,'( C zZ ,~ L.: ............... i~ess ~ ~ c ~ ..~ ./.~ ~ D2 ~ · .............. 2~ ....... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buJlde~ ................ ............................ z ...... . .................................................................................................................................... Name of owner of premises ..~].(~.~.~Zz~ ...... .~; ...... ~.~ff~./~.~ z.... ........... 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 dane. Map No.: ........................................ Lot No ........................ Street and Number ' O~ '~u , ' .../..~.Z ............ ~..'.....~.~,,~..,...-(t..~ ~ .......................................................... ,.~:? ? c~; ~x~, . Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy b. Intended use and occupancy ......,~.,..,~'.,~,S,.f.¢..,fZ.,<¢,~ ............................................................................................ 3. Nature of work (check wh!ch applJicoble): New Building.. ................. Addition ................... Alteration ................ Remogal Demolition Other Work Repair .................. ........ [ ....... v .................... .................. (Description) 4.Estimated Cost. ..... i ......................... Fee r '~ (to be paid on filing this application} , 5. If dwelling, number of dwelling un]ts ............................ Number of dwelling units on each floor ........................... If garage, number of cars .............. ] ........... .................................................................................................................. 6. If business, commercial or mixedi occupancy, specify nature and extent of each type of use ........................... D~mens~ons of ex~stmg structures, tf'any. Front ............................ Rear ................................ Depth .................... Height ........................ Number of]Stories ................................................................................................................ Dimensions of same struct,'ure w/thlalterations or additions: Front .................................... Rear ........................... Depth ............................... [. Heightj ............................ Number of Stories ................................ 8. Dimensions of entire new construc(ion: Front .................................... Rear ............................ Depth ....................... Height .................... Number of Siories ..................................................................................................................... 9. Size of lot: Front , . ............ J ............ 1 ........... ] ................. Rear .......................................... Depth ............................... 10. Date of Purchase ............i ............. i ............................. Name of Former Owner ....................................................... 1 1. Zone or use district in whigh premi!es are situated .................................................................................................... 12. Does proposed construction violate ?y zoning Iow, ordinance or regulation: 13. Will lot be regraded i ~, Will excess fill be removed from premises: ( ) Yes ( ) No ! 4. Name of Owner of prem ses r.~.~6~.,,v~...[...z,¢'~.~.~..~. .............. Address 4,CF.<.~J'~6,.c~.,~..."~4ES. Phone No..~.~.~..~..~ Name of Architect .......... L ............. i ..................................... Address '~;'~:~,~'~,~'"4~'~2 ...... Phone No. ;~¢'-~/~' Name 'of Contractor/,,4~'...i....,....,/:L~..[fl ................................ Address ...~.~.../~?..G..~.,~,..... Phone No.,-C.~..?..?..~.?..~ i I PLOT DIAGRAM Locate clearly and distinctly~ all buik~ings, whether existing or proposed, and indicate al set-back dimens OhS fron property lines. Give street and [block n~mber or description according to deed, and show street names and indicah whether interior or corner lot. STATE OF NEW '~(,.., ,~ . .~"~, ..... ~.......~,~.....,,..~..~/~,~....,beMg duly sworn, dopo~o~ ~nd soy~ th*t ho i~ tho (~ome of individual ~i~nin~ c~dtr~cf) above named. ~ H~, ~s the .......................... ~..,... .............. ,.............:~ .............................................................................................................. , ~ .~~ agent, corporate officer, etc.) of said owner o, own~s, and is duly authorized to perform or have performed the said work and to make and fil. this application; that ~ll. statements contained in this application are true to the best of his knowledge and belief; thor the work will be performed ih the mahner set fo~h in the application filed therewith. Sworn? [)tobefore me this/~/~~ ~ .. ...... ...... ,-,