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Home My WebLink About11624-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z. 1..3.3.8.9. ......... Date April 25 19 85 THIS CERTIFIES that the building ..... ,A,d,d, .i,ti,o.n. ................................. Location of Property . .2~.8. Q .............. p.e.t? .o.~..~.9.n.e ............... c..u.t?.h.o. ~.u.e. ..... House No. Street Hamlet County Tax Map No. 1000 Section . .1.0.2 ........ Block ...0.2 ........... Lot 004 Subdivision ....... X. ....................... Filed Map I'/o ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... A.p .~.1. .....8. ...... 19 8. 2.. pursuant to which Building Permit No ...... 1. 16 2 4 Z dated ............ .Ap.~.~.~. .... 2.2. ....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 ......... ........... -~O~.JJ;iQn .t;9. xx.i..s.e.J..n.g.p.N.e. ,~$.~.~ .................................. The certificate is issued to ....... ~ G...i~ · ). ~qbg~.t..a...P.e. qgy..D.I.C..K.E.R.S.O..N ............... (owner, des~ee.oc.t~a¢~) of the aforesaid building. Suffolk County Department of Health Approval ......... NJ~ ............................. UNDERWRITERS CERTIFICATE NO ................. N.6.7. 9 713.1. ........................ Building Inspector ~o. 11624 Z Pet~i$~ion i~ hereby gronted to: TOWN BUILDING DEPARTME TOWN HALL SOUTHOLD N Y ~ BUILDING P"I~vIIT ! (THIS PERM * MUST BE KEP* ON THE P~M~IS~ UNTIL COMPLETION OF THE WORK AUTHORIZED) :;; ~? ~t° F~LL at p~.emises located at County Ta}( Map No 1000 Secton .~.~. ~.. ~ I~°~ : .~;'~.~. , ~Lot-No. '.~.~. ...... pu;sOant (o application dated ..... ...~:.,,:.....~,...~...., lg;~and ~pproved by the B~, dlng~ I~spector.~ ~ ~,: ;~ ~ Fee ,.~: ................. ~, ~ ~ ~ ~tor. Rev ~6/30J80 ~ ~ ~ ~ F~ELD~iNS?ECTiON COMMENTS FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qOSE FINAL ADDITIONAL COMMENTS: i?~ii!!!~i-[%:!~';:l!!i ""~H~ 'NEW"¥ORK BOARD OFFIRE UNDERWRITERS , ,,," :~:lll~:~ :' "-:'~b-~' 2o 1~8~ ' ~ " ~16560/85 ~ ~R~ ~ i~..~**,., cw T~ ~ I TURES ,: a~ ~GES ~OKINO DECKS OVENS DISH WASHERS EXHAUST FANS ~T~ :~IP~" ~"T~"~ ~C~C~T ~bo~"r ~I~~ ~T' ' x W '~ ~ w ~T .W ~f tW ~ ' '~.. qt z' . ': ~'l , ' [ : ' ', ",' ~ II~tltF~ IFFII~Jltl- It . .t ~l . , Il ' Per- ,1~ ' ' li~/!] Fl!lSJlk q!J- ql- :',1~ ',f i~.''~ ~:. [ ' ' ' ' c . " "lg~IT,(~te-~uslnnql. be alterea sn any manner; return to the office of the Board If incorrect. Inspectors may be identified ~i~ credentiab. FORM NO. 6 TOWN OF SOUTHOLD Building 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~to the Building Inspec- 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 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: 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 landuse--?re-~×±s~±~ C.0. $15.00 3. Copy of certificate of occupancy $1.00 V~c~t,'ia~ C.O. $ 5~00 Date... Z/L/.%~2.Q / Z-J ............. New Building ............. Old or Pre-existing Building .... ~.. ..... Vacant Land ............. · ocat o, of .roperty.. ..... House No. Street Owner or Owners of Property . .~.O.~r~. (.(~. '. .~. .° ). · CountyTax Map No. lO00Sect,on ...(¢..~'. ....... Block ..... ~.~.'~.T .... Lot .... .~. ,.. ~":"7 .... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept Approval ~ Labor Dept Approval Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... F ,e Su bm ittod $ .... ~"-.o. C~. O ................ Construction on above described building and permit meets all appli¢,~abl~code~,and r¢~lations.~ '0_~>-~. ~. ~ ~,&~q Applicant.., .. ~. ~. ?.~. ............ Rev. 10-10-78 ' '~ -i, ? TOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ~..~ ~z~-Z---- , 19..?.?/ Approved i.~.~.'.'iiiii~.'.~iiii, 19.~...~Permit_. No ..... ,~./..~...~.'~.~.....~..... ......... Disapproved a/c ............................................................................................ ' (Building Inspector) Application No..../.../..~...~....~.~.' ............... APPLICATION FOR BUILDING PERMIT Date ......... ./..~.'.~... ......................... , 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 ofproperty must be drawn on the diagram which is part of this application. 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 Occupa~my shah have been granted by the Building Inspector. State whether applicant is owner, lessee, agent, architect, engineer~ Builder's License No ...... ~ .................................... Plumber's License No .......... ~.0.~.....~..~:~ ..... Electricians License No ......~.C.F~ ............. 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. . c_. (Signature of applicant, or nome, if a corporation) (Address of applicant) or PERMIT INCLUDES APPROVAL TO REMOVE EXCESS FILL FROM ABOVE PREMtSES BY REGRADING LOT DRIVEWAY CONSTRUCTION CESSPOOL CONS iRUCTION CELLAR CONSTRUCTION OTHER Other Trode's License No ............................................... ~ u b d ~ v ~ s & o n Locotion of land on which ~roposed work will be done. Map No.: .................... ~ Lot No > ........ ............. Street ond Number ........ ~..~.~. ......... ~.: ........ ~.~.~..~ ........... ~ ~ ~ ........ 2. State existing use ond occupancy of premises and intended use and occuponcy of proposed construction: o. Exisiting use and occupancy ..... .~..~.~..~..~.~.~.~ ......................................................................... b. Intended use and occupancy ...... ~...~..~..~.. .~.?~..~.~ ........~..¢ ...~.~ ...... /.. .~.~ ......... County Tax Map No. Dist. 1000 Section Nature of work (check whiqh applicable): New Building.. ................. Addition .......~.... Alteration ................ Repair .................. Removdl ..........1~ ....... Demolition .................... Other Work ................................................ .... ~ j / (Description) /,~ 4 o o. .7 Estimated Cast ............. ........... tee ............... ................. ......... ,...W: ........ ; (to be paid on filing this application) ~;"9,~e 5. If dwelling, number of dwelling uni~ tf garage, number of cars ...' ............. 6. If business, commercial or mixed 7. Dimensions of exis~ng struciures, if Height ...... ~..~.. ........... Number of Dimensions of same structuie with Depth .............. ..~..~-~.... ...... !Height 8. Dimensions of entire new constructi Height ........ ~... .... Number of Stc ............................ Number of dwelling units on each floor ............................ ~ccupancy, specify nature and extent of each type of use ............................ terations or additions: Front .... ~..~.~4.~. ............... Rear ........... / ............... · Front ..... ~.,.' .~...~., Rear ....~:~..~. ............... Depth ....Z~... ........... 9. Size of lot: Front ........ ~...~. ...................................... Rear ............. ...~....~.. ................ ~,~ Depth ..~...~...,~..; ................ 10. Date of Purchase ........ '.~.'..~.~..~........1 .......................... N~ame of Former Ow, per ....... ~...7~.~...~.........~...~ ............. , 11. Zone or use district in which premiseil are situated ....~-.~,~.~,~ .............................................................. 12. Dees proposed construction ~iolate o y zoning Iow, ordinance or regulation: ......... ; .i~...l~. ............ ~ .......................... 13. Will lot be regraded ,,,,,,,~,o~, ........ Will, excess fill be removed from premise_s; (~s ( ) No 14. Name of Owner of premises...~...,.~...,, ~,..,,~~ ..... Address ......~.. ~...~ .~h¢~..,..,,. Phone No..2~.~..~.~....~..~- Name of Architect ............. ,;'~ .............................................. - [ Address .............................. Phone No ....................... t ........ Phone No. Nome of Contractor ..~,,.~.~,..I.Y.~~ .................................. Address PLOT DIAGRAM Locate clearly and distinctly ~ll buildi ~gs, ~hether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block nuriber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW %O~K .... ' ~s s C O[~JI%TY, OF ...... (Name of individual signing c~ above named. 4/r~ac~.)~ ................. being duly sworn, deposes and says that he is the applicam He is the ........................................... .~¢C.......~............'~ .............................................................................................................. ~ i [- '-- ,,,.(ear, tractor, agent, corporate officer, etc.) of sa d owner or owners, and s d~ y~d to perform or have performed the said work and to make and f e this application; that all statements' contaihed in this application are true to the beef his kno~led~ and belief; and tha~ the work will be performed in the man~er set fo~h in the appl~led there~it~ ] ~ // ~ Sworn to before me this / / ~ / / // // // ~blic, .............. ~....~ ....... ~ ......... ~. ............. h~ ..... ~.' ~- ¢ APPROVAL TO,,_c' ,-.,Emw' ,-v-- _" ,:,,LE.S FILL FF, OM 'i~ ~' p '52/'o AP~ZU(,£D AS NOTED ..~ D AT.E .../&ZC'~;'I/B P. ~ //~' FE ..E/T'~/'_~ - BY: NOTIFV qC!lL'~u':G DEPARTMENT AT 765 ]?':q ¢ ,'*~'. TO 4 PM FOR THE ]. FOU: ..... :~N TWO REQUIRED FO:~ r'~'i~Tr) CONCRETE 3. INFJLu A' 4. FINAL C"'"' :- ]-N MUST ALL CON~TR'JCT]ON S: ~A,I L MEET THE REQUIREM~t:TS OF THE N. STATE CONSTRUCTION & ENERGY CODES· NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION EE?,ORS. ,/