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Home My WebLink About11621-zFORM NO. 4 TOWN OF 5OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hail Southold, N.Y. Certificate Of Occupancy No.~l 09 B.5. ....... Date ........... M~,¥. 1'2.; .............. 1982. THIS CERTIFIES that the building ................................................ Location of Property . 2.1.50 .............. .~.e~tplzalla..Road ............ Mal;~;;~.%qck.. House IVo. Street Ham/et County Tax Map No. 1000 Section . 1.1.4 ........ Block , 07 ............ Lot .. ~).1.1., 00.~ ....... Subdivision ... X ........................... Filed Map No.. X ...... Lot No..X ........... conforms snbstantially to the Application for Building Permit heretofore file~ in this office dated $~.p~.~-1. ,20 ........... ,1982. pursuant to which Building Permit No..1.1.6.2., .1. jZ. ............ dated ...A p r J.~L .20 ................ 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 ......... · .a. d ~.c.k. ecl.ct J,t; ~-on. ~;~..an..e;~.~.~ .~PF,. 9 .n.e.-.~. a..m.~.~.~...d.up.~..~ .~.n.~.: ................. The certificate is issued to .... J.(~hn..d..,. il~.~ ......................................... (owner, J~.o~ .t~3~,) of the aforesaid building. Suffolk County Department of Health Approval .. n/.v. .................................... UNDERWRITERS CERTIFICATE NO .......... r~f.~, .................................... Rev. 1/81 Building Inspector rom ~o. ~. TOWN BUILDING DEPARTMENT TOWN HALL SOUTH'OLD, N. y. BUILDING P,ERMIT · ,CTHIS PERMIT MUST BI[ KEPT ON THE PREMisqf~ UNTIL FgLL THORIZED) COMPLETION OF THE WORK AU 16 21 Z Dote ..................... ,, ........ .~ , Perm ssion is hereby granted to: / _ . (~;~. ,.-,~/-,,-,,-T ~ cdc_ -~.cE~...~/~z~:~,~: {..,2~ ..... ...... ~../.~.~. ,~........~..¢~., .,d/../. .:,...~ ................ ~ ............. , .......................... at ,~emise, located at ..~.-...~ .......... ~.~.'~.'~.d..~....i: .~.:~'~-'~": ........................ · .: .............. r ........................................... .......................... ""';"'17'"i; ................ 1;''''''''',~-' ........... ....... : ......... ~.~ ............................................................... 7'*'t ......... '?"f~ ............ ~ ..... ' ' *, ........................ Cour~tY Tax Map No 1000 Sect on ...... ./'d..~-....- Block ...... ii."~.. ........... iLar No. ,..(~.. ........... pursdont t~o application dated ...... .'r'~''t..~''' .................. i''''!:''''' 19~'~'~and approved by the Bbildlng I~spector. /~ FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, 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.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), I'~on-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topograph[c features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing cod/e or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. ~ Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 New Building .... .~ ....... Old or Pre-existing Building(X). ~'~_.. _ Location of Property ........................ ~ ~ . . House No. Street Ham/et Owner or Owners of Property ..... :'. .... ....................... ¢. County Tax Map No. 1000 Section .. [ ./'~ ....... Block ............ Lot..././/~ ........ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. /.//~L) .'.~Date of Permit .,~/~z;)/~.~-.Applicant .... ~.4~.~. ~t/....~.J... ~./~..A..~~. ...... Health Dept Approval Labor Dept Approval ...... Underwriters Approval ~ Planning Board Approval Request for Temporary Certificate Final Certificat~ Fee Submitted $....O..~..~..~/..~ ........... Construction on above described building and perm~t~meets all app~cable~c~es and regulations. Rev. 10.10-78 FIELD INSPECTION FOUNDATION (~st) COMMENTS FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N. STATE ENERGY q?DE FINAL ADDITIONAL COMMENTS: socl or emb:.%od seal shall not be considered to bo a FORM NO, 1 TOWN CF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 ,~ .~,/~..,. TEL.: 765-1802 xan, ncd.. ..... >/ Appro,,cd ...... ........ · D~sapprovcd a/c ...... ;: ..... .2 ..................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Application NO. / .Z/~. 77( ...... Date ..... .'~/3 .Q ...... , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Build 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 strc or areas, and giving a detailed descript,on of layout of property must be drawn on the dia~am which is part o~'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 issue a Building Permit to the applicant. Such per: shall be kept on the premises available for inspection .throughont the work. e. No buildiag shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupar shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for th~ issuance ora Building Permit pursuant to Building Zone Ordinance of the Town 'of 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 descriL T~e applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, m~d admit authorized inspectors on premises and in buildings for necessary inspections. ' ............- ' '~ '~f applicant, or name, if a corp;;a't;~)' ' (Mailing address of applicant~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build · .O.~.l~l~.V. ............................................................................ . ..... N,'une of owner of premises . : .......................................... (as on the tax roll or latest deed If applicant is a corporation, signature of duly attthorized officer. (Name and title of corporate officer) Builder's License No ..... Plumber's License No ......................... Elgctrician's License No.' ...................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ............................................ .................... /.~. .......... ,,~K .............. House Num bar Street Hamlet CountyTax 'lap o. 1000 Section lock ...'.17 ............. ........ Lot .......... Subdivision ..... .~q'b-.4-. ........................ Filed Map No, ,~-,7~./. 3 .... Lot ............. (Name) 2. State existing use and occupancy of premises and intended usc~ and occnpancy of proposed construction: a. Existing use and occupancy ~ O 7.V~ ~ .. b. Intended use and occupancy .. ,'. ~,~0,/.~'rL .~. (~.0,_,~..,.'. , ., 4 Nature of work (check whichI applicat Repair Removal Estimated Cost .../g/'~. Q~ ......... 5. If dwelling, number of d~velIihg units If garage, number of cars 6. Il' business, commercial or talked occu 7. Dimensions of existing structures, ifai Height ............... Niunber oJ Dimensions of same stmcturel with alti Depth .................. .... He ~. Dimensions of entire new constructio~ Heigtlt ............... NFmber o 9. Size oiler: Front ......... :... :... t0. Date 6fPurcliase ......... ' ...... II. Zone or usa district in which premises 12. Does proposed construction v:iolate ar 13. WiU lot be regraded ...... I . {4. Name": of Ov.'nor of premises .: Name of Architect ........ i ...... Name of Contractor ....... , ...... · l. ocat~ clearly ~d distinctly all buikl property lines. Give street and block nun',b~ ',t, terior or corner lot. ~]FATE OF NE~V~IiOF3.K.~_ ~ S S .......... (Nanie of nc Mdual sig 1 fg der e is the ............... of said Owner or ownem, and is dt~ly auth~ ~pplicafion; tl~jt all statements con?ned W'ork will be p r.ori ~ud in tae mann,hr s~t fo ~om to before me lc): New Building .......... Addition .......... Alteration . ..X. ..... ............ Demolition .............. Other Work ............. /~/ ~ (Description) (to be paid on filing this application) ........... Number of dwelling units on each floor .............. ~ancy specify natnre and extent of each type of usc y: Front ............... Rear .............. Depth ............. Stories .................................................... rations or additions: Front ............. Rear ............... ~t ...................... Number of Stories .................... Front ............... Rear ............... Depth ............. Stories ' ....... Rear ...................... Depth ..................... ............. Name of Fom~er Owner ........................... ire situated :. zoning law, ordinance or regulation: .............................. ·.. ~ ......... Will excess fili be removed from premises: Yes - N ; 15f..o. O,,~. Addr,~ss"' .~z't; ?q.~,l>:0..~.P~ ~14,g.'~Phone No. ......... '. · Address ................... Phone No ............... ........... Address ................... Phone No ............... PLOT DIAGRAM '~' gs, whether existing or proposed, and, indicate all set*back dim:nsions fro~ r or description according to deed, and show street names and indicate whethc .t..,g ~.~.ract ' ' ' ' ' ' ' ' being duly sworn, deposes and says that he is' the *',.pphcan' (Contractor, ageut, corporate officer, etc.) rizcd to perform or have performed thc said work and to m~e and file th.i= this application are true to the best of his knowledge and belief; and that' th~ :h h~ the application filed therewith. · rS : ....... 19~ ~t~ .I/N. County ~" ~ .'~.(..' ~ .~.. ;,';.. ~ ,. ,,.' (Signature of applicant