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Home My WebLink About11623-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...gl ~267 ........ Date ..... 0¢ ~;.o. llo r..2,Q ................ 198..2. THIS CERTIFIES that the building ................................................ Location of Property . 20J.Q ............. ~l.o.r.~.~..~.a.y.v..t.e.~..R..o.a.d. ........... ~.o.u..~.~.o. 1..d.. House No. Street Hamlet County Tax Map No. 1000 Section .. 0.7.~t ...... Block .. 0{~ ........... Lot ...0.0.3.,.0..0.6 ....... Subdivision... X ........................... Filed Map No...X ...... Lot No.. X conforms substantially to the Application for Building Permit heretofore fried in this office dated ..... Apr.£1..1Z ...... ,19 .~pursuant to which Building Permit No. 11623 Z dated ...... Apl.il. 22 ............ 19.8..~, 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 ......... ..... ar~ .acce~aory..al;pr. age..b.u.i..1.d.i.n.g .. ....................................... The certificate is issued to ...... C a r~l,. § ,..F.t, s..15 ....................................... (owner, of the aforesaid building. Suffolk County Department of Health Approval ... llJ. a ................................... UNDERWRITERS CERTIFICATE NO ........... R/.~ ................................... Building Inspector Rw. 1/81 ~o~ NO. ~ TOWN OF~,~ BUILDING TO~VN HALL SOUT,OLb, N~. Y. BUILDING i pEILMIT~: (THIS PEP~IT MUST BE KEPT ON THE PREN~ISE$ COMPLETION OF THE WORK AUTHQRIZED)~ j , Perrnission~ is hereby granted to: UNTIL F~LL ~../.......~d......i ............ , at p~emise~ located at · ~ .~..z..~~ , ~, Coufity Tai Map No. 1000 Section ...., Z..~. Block ,(;"~ . FO~ ,.. ............. ~ - : ~/-~72,,.,. and approved by the FORM NO. 6 TOWN OF SOUTHOLD Buiiding Department Town Hall SouthoJd, N.Y. 11B71 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and subr~ tted n 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 topograohic features. 2.Final approval of Heaith Dear of water supply end sewerage disposat--{S-9 form or equal). ,3.Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar building~ 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 requirement~ where applicable, B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings ahd "pre-existing" 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: 1. Certificate of occupancy $6.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date ..... New Building ............. Old or Pre-existing Building(X) ........ =/Vacant Land Location of Property ?.%~.~¢,_ .,~.¢ ~/~...~-~./..,~',.??'. ~ - Hou~ No, ~¢ree r Ham/et Owner or Owners of Property ~.~¢,-.. _ ~Z/~ . Cou.w T~ ~p No ~000 S~o~o....4.2 ¢ ...... B~oo* .. ¢..4 ......... Lot...~ ~r.~ ... Subdivision (>. ~ , · -. ;;¢ % ?,~ .............. .~/¢-./.?? M~p No ........... Lot ~o...' ........... Health L ...... Labor Dep Approval ..... ,. Unde~riters Approval ' Planning Board Approval Request for Temporary Certificate ..................... Final Certificate ........ - ......... Fee Submitted $ ............................. Rev. 10.10-78 Construction on above described building and part'ir'meets all apPl~cable~codas and regulations. _..' . /~ppHcant ... . ... ....................... . ..... . TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR · P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-I 802 a f~nal anspec~on base'as nD~ been done. In order to ~ ~ - ' complete ~h~s file, it is necessary that a Certificate of O~upa ~cy be issued. Please fill out the enclosed form(s), return same to the above office with a check for $5.00 payable to the Town of Southold. Please indicate to whom the Certificate of Occupancy is to be mailed, and arrange with this o~fzc~ for an inspecCion date. Thank you for your prompt attention. Very truly yours, Victor Lessard Administrator VL:ec Enclosures FORM NO. 6 TOWN OF SOUTHOLD Building Deparzment Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and sub~ tted in duplicate to the Building Jnspec- tot 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 Heaith 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 Mu t p e Res dences and similar bu Idings and installa- tions, a certif cate of Code compl ance from the Architect or Engineer responsible'for the building. 5.Submit Planning Board approvai 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: 1. 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 Building ..... ,,~., .... Old or Pre-existing Building(X) ,, ........ =/Vacant Land -, ............ Location of Property d?'{~. S ..... ' ~ 5-0. _~/,? .~.. Hous~ No, S[reet ' Ham/et Owner or Owners of Property ,~,~_ ~/~ .... ~,4'~ ...................... co..,v z~ M~, ~..~000 S.~tio, ...~,2.~ ...... ,~o~k .... ~.f ....... Cot.. ~.~;~.,,.~ ..... Subdivision ................................. Filed Map No ........... Lot No .............. Permi~ No.//~. ~.. Date of Permit ~.~ppllcant .... ~; ,~ ............. Health Dept. Approval ........................ Labor Dept. Approval ...................... Unde~riters Approval ........................ Planning Board Approval .................. Request for Temporary Certificate ..................... Final Certificat~ ........ Fee Submitted ~ ............................. Construction on above described building and permit'meeTs all apP~cable~codes and regulations. Applicant RevolO-10-7e TOWN OF SOUT]gOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 Applicant Dear .Lk This is to advise you that the job under Building a final inspection has-- /~ ha~ not~ been done- In order to complete this file, it is necessary that a Certificate of Occupancy be issued. Flease fill out the enclosed form(s), return same to the above office with a check for $5.00 payable to the Town of Southold. Flease indicate to whom the Certificate of Occupancy is to be mailed, and arrange with this office for an inspection date. Thank you for your prompt attention. Very truly yours, Victor Lessard Administrator VL:ec Enclosures FIELD ~NS~ECTION COMMENTS FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENEROY C~DE FINAL ADDITIONAL COMMENTS: CARL FISK 2010 NO. i~WIEW RD. SOUTHOLD, N,Y. 11971 FORM NO, 1 TCWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL,: 765-1802 (Buik~ng I~tor) APPLICATION FOR BUILDING PERMIT AppJication No.//6'~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildk Inspector, with 3 sets of plans, accurate plot plan to scM& Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationsh,:p to adjoining premises or publ*;c stree' or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part or'this appl 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 penn shal[ be kept ou the prfmlscs available for inspection throughont the work. e. No buildi;lg shall be occnpied or used in whole or in part for any purpose whatever until a Certificate of Occupant shall have been granted by the But[ding Inspector. APPLICATION IS HEREBY MADE to the Bnilding Department for th~ issuance of a Building Permit pursuant to t~ 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 describer The applicant agrees to comply with alt applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary iuspections. .... .......... (Signature of applicant, or name, if a corporation) ......... a--licant- - ' ' ' State whether applicant is owner, lessee, agent, architect, engineer, general coutractor, electrician, plumber or build, .. ......................................................... , .................. . ...... Nmne of owner of prcn',iscs ~; . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of coqmrate officer) Budder s Lmens~ No ............... Plumber s Dcens. N ........................... Electrician's License No.' ...................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ................................................ ,?. ...y% ...A . .R..,.o 4/, · ' /Street Hamtet House Num bet County Tax Map No. ~ 000 Section ....O.(?..Q .......... Block ...0 tiP. ........... Lot.. ~f,).*~.: (~ ...... Subdivision ...... }(. ............................. Filed Map No ............... Lot .............. (Name) 2. State existing use and occupancy of premises and intended usgk and occupancy of proposed construction: a. xisting use an occupancy ...... ; ,', ~ ,'-~-?, , b. nten cruse oc an .................. , .......... ~. ................. ~,.. ,, '-.,;:-.~.,... ,. .... ,,~,~,:.x--~.,-, .... ,z,,.,..: :-:..: ;.::.. 7, "~'}~ '~¢;'"* "~: ":!}"!':":' ::;;''~'' ........ .:,.,:,,-.. , ~0, ~i. 12. (4, Nature of work (check which applicable Repair .............. Rembvnl . 4 ['7.stimated Cost .... i .... $. If dweili,'~g, number of dwelling~tmits .. If garage, number of cars .... ~ ...... 6. If business, commercial or mixe~ occup~ '1. Dimensions of existing structures, if any Height ............... Ntm~ber ot.S Dimensions of same st~cture w)tb alter: ) - f epth ................... ,.. He~ g. Dimensions of e~t~re new const?uction: Height .... ~. ......... Nmfiber of S Size'or lot: Front .......... Date 6fPurchase .......... j ...... Zone ~r usa district in which pr6mises ar Do~s prcposed construction violate any Name ot. Architect ' Nan e of Contractor ......... ..... New Bt:i/ding ........ Addition .......... Alteration ......... ........ D,',molitlo n .............. Other Work .............. (Description) Fee - (to be paid on filing this application) .......... Number of dwelling units on each floor .............. :y, speci/?y nature and extem of each type of use .................. Front ............... Rear .............. Depth ............ orles ..................... , ................................ tions or additions: Front ................. Rear ............... ,t ...................... Number of' Stones .................... ;'rent ..../.t. ........ Rear .... /? ./ ........ Depth ../~.. ~' .... ories / .... ' '" ..... Rear ...................... Depth ....................... ........... N,',rae ut' Former Owner ............................ situated :. oning law, ordinance or regulation: ........................... Will lot be re,graded ........ i" .................. Will excess fill be removed from premises Yea · No Name of Ov.'n=r of premises .1~,,O/~.t~..: .t~./,.,~../<:~. .... Address ................... Phone No.2'.~4'7'5/. ff..'~e~... ........ '.. Address ................... Phone No ............... ......... Address ................... Phone No ............... Locate clearly ~d distinctly allI vl'ldi~ pro?erty lines. Give street and blockjnun:ber ',aterior or corner lot. , PLOT DIAGRAM :s, whether existing or proposed, and. indicate all set-back dimensions from >r description according to deed, and show street names and indicate whether , r^W[i OF NEW ¥/O PJK/, .......... .Co./. ?...E: .G'.. k ..... ...... (Nanie or indMdual sigmng contqact) obove named. : He is the ..... .O.~ ....... i ....... o'~ said Owner or owne~, and is dui(, autho ~pplication; that all statements cont~ ned in ....... being duly sworn, deposes and says that he is the applicant ..ontractor, agent, corporate officer, etc.) zed to perform or have performed the said work and to m,~e and file this his application are true to the best of his knowledge and belief; and that the ~iork will be performed in the manner set fort h~ the appl cation filed therewith. .Dworn to before me thi~9 ...... ....... ~ ............. ~.~ ~ .... '.. county ~ ,