The URL can be used to link to this page

Home My WebLink About11627-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildin§ Inspector Town Hall Southold, N,Y. Certificate Of Occupancy No. Z13295 Date APRIL 1 -,19.~, THIS CERTIFIES that the building..~.D.P.Z.T~.O..~ ..................................... Location of Prop erty . 7.3 .2.5...~ .A.S.S. ~..U. ?.0. I. ~ .T..~ 0..g .D .......... .C .U.T C. U 9.G.E ~. ............... - House No. Street Hamlet County Tax Map Ho. ]000 Section ............ Block ,, ! ~ ........... Lot ....~ .2 ............ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofOre filed in this office dated .... g?. ~ .5.L..... J ........195.2. pursuant to which Building Permit No .... 1.1.6..2 7.Z ............ dated ~ .P ~.Z.L....2.4 .................. 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 ......... · FOE ALTERATION & ADDITIO~ TO .E.X.Z..S.T,~.i~9' DWELLING The certificate is issued to .. hr .~ ~.R.~ 5J. ~..~ U Y b.~ .. ~.U.s.~ ~ T~t.A I~ ~ I~ ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ... ~J [ g .................................... UNDERWRITERS CERTIFICATE NO.. J~./.g ............................................ Rev. 1/81 Building Inspector 11627 ~o~ ~0- ~ TOWN OF ,~Qu*HO~Di~ BUILDING DEPARTMEMT TOWN HALL SOUTHOL.D, ~ Y~ BUILDING PE~IT ~ (THIS PERMIT MUST BE KEPT ON IH,E PREMISES UNTIL FULL C~PLETION OF THE WORK AUTHORIZED) z .... .............. Permission is hereby granted to; ............. ; ............. .~.....~ ......... , ...... ~!. _ _ ~ ........... ~ .... : ....... ~ ...... ~ ..... .................................................................. ; , t~ ...... t ............................ at premises IOC~te~ at ............................... ' ............. ::..L...,.....~....:~ ................ ~. ......................................... ........................................................................ :..? ............. ~:.. ~ ...: ~ ................................ cou,~ T~x M~p No. ~000 S~t,o~ ..~ .......... ,:...,/,~.. m~,..,~,.../~........~, Lot No~. ..................... Buiidlng Inspector. ~P, MIT; ~NCLUDES APP i TO ~EMOVE EXCESS FILL ~,OM A~OVE pREMISES BY CE~SPOO~ coHS~RUCTION ~-~ Rev; 6/30/80 i: 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 [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 topographic features. 2. Final approvat of Hea{th Dept. of water supply and sewerage disposa[-(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~ex~stmg land uses; 1. Accurate survey of p~'~operty showing a~l property lines, streets, buildings and unusum 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 occupency on pre-existing dwelling $ [ 5.0 0 3. Copy of certificate of occupancy $1.00 //~..~..~.. 4.Vacant Land C.O. $5.00 ~ ~ Date .. · .~ .......... ¢/~'¢..~.O d Vacant Land ............. New Building .... or Pre-existing Building ............ ... Location of Property ..... ~.3~ .5.~ "'~'~ ................ House No, Street Owner or Owners of Property ~/~-~./D, '~ ~./~,;~/~/[ ~.~'~.7'~,'/~'/"~'~' ............. County Tax Map No. 1000 Section /.!./ ........ Block.../..-~. ......... Lot · · · '( ''~' .......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. [L~. ¢.7. ~.. Date of Permit .~.2.~/~..,Z..App ,cant . .~.../h~-~..~. ~., Health 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 a~Pplicable codes and regulations. App,icant ..... ~..~... :..~ ........... Rev. 10-10-7a ) FORM NO. 1 TCWN CF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHQLD, FLY. 11971 TEL.: 765-1802 ^ppro,.ed .... :.'. yea a/c. ~ ' (Building Inspector) APPLICATION FOR BUILDING PERMIT Date.~,~.../. ............ 1 9~. '~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and snbmitted in triplicate to the Buildie Inspector, with 3 sets of plans, accurate plot plan to scale. Fee accordiug to schedule. b. Plot plan showing location of lot and of buildings on premises, retationship to adjoining premises or public strea' or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part ot~this appi cation. e. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon apprc:al of this apphcation, the Building Inspector will issue a Building Permit to the applicant. Such pen~ shall be kept on the premises available for inspection throughout the work. e. No buildiag shall be occupied or used in wbole or in part for any purpose whatever until a Certificate of Occupant shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building 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 all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on p~emiscs and in buildings for necessary iuspections. , __ (Signature of, applicant, or name, if g ccrporgtion) (Mailing addresser applicant) ~ ~-~ S~ant is o~vner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build,~ 'Z 25..151 i ..... o; 7.: : : : " :'." ; ...... ...... Na le of owner of ~rc l scs ~~~¢~1~~ . . ~'~ ~ . ~ (as on the tax roll or latest deed) ~'US~v T If applicant is a corporation, signature of duly authorized officer. (Na ue and title of corporate officer) - house mumoer Street Haml~ County Tax Map No. ~0~0 Section ....... g~ ...... Block .... (.4f.'. ........ Lot../. ......... 2. State existing use and occupanc7 of premises and intended us~ and occupancy of proposed construction: a. Existiug use and occupancy ............................................................... :( b Intended ~doccupancy ~ ~ Repair .............. Rcnioval ... $. Ifdw~lliag, ntunber of dwelling units .. If garage, number of cars .... ~ ...... 6. If business, commercnl or mixed occuI: 7. Dimensions of.existing struc!ures, if an Height .r~...~. ......... Numberot'~ Dimensions of same structure ~{ith after Depth'...~..~ .......... ... Iteig 8. Dime ~s'ons of entire new constJruct~on: Height ............... Number of 9. .~z~ of lot. Front . ./.~ ~ ....... ... 10. Date df Purchase .... leal .... I1. Zone or us= district m whtch premises al Does propoo.d constru~on vmlate any tS. Will lot be regraded .j.~..... ¢. Name of O,,.'n:r o f premls~s~ Name orArchitect . .~. g. ~ Name of Contractor .~. Nature o£ work (check whicl, applicabl~): New BuLiding ........ Addition ..... Alteration . .......... D,',molitlon .............. Other Work .............. Fc~ [ ~/ (~Dcscription)_ / (to be paid on filing this application) ............. Number of dwelling units on each floor .............. racy, specify nature and extent of each type of use .. 7 .... :~-~_.. o ..... : Front ..T .~_>,,.. ~.~.a Rear :."~.~. ........ Depth ~~... for es. /..."7...-J-~... ....... / ./ ttions or additions: Front ./~-~. ..... i .... 'I;,ear' i-~.' .' i i. iii. i. ~t ...................... Nnmb~r of Stories ..................... Front .... ~...'"~. ~vX//Rcar . .~.~.-~ ......... Depth . ./.'.~. ........ reties ........................ ' ............. ./ .......... ..... Rear .... /.~...c.>. ........... Denth ...'~ ............. ........... of :eerier Owne ........... e s rusted . ,,f-'J ,/[o. tt..,~ ./.. .. ^'"~d .... '.. Address . .: ...... ~.: .....{]...'~hone No.. ~ ...... tO,'[ ....... Address .......... Phone No.'7 ...... ~ ..... PLOT DIAGRAM Locate clearly ~d distinctly alI et//din s, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and blocki ntm:ber )r description according to deed, and show street names and indicate whether ;ntcrior c corner lot. ~op COUN"TY O~ IS'S ~ (Name of individual signing court5 above named. or said bwner or ownu~,- and i~dt:Is~ opplication; that all statements cont:~ined in ~ork will b~ performed in the maune~set for~ ~worn to b~fore me this i act) . being duly sworn, deposes and says that he is the applicant nt. corpiiJte officer, etc.) .......................... ~m or have performed thu said work and to make and file this ms appncatton are true t~ the best of ds know edge and belief; and that the h~ the application filed t;~erewith. County '. , _ / P I XI]'NVdIIIII:IO ,:!0 31V:)1-111tl3:) IflOHIIM II'HMVlt, lll SI :1SI1 '~65-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: J. FOUNDATION . TWO REQUIRED FOR POURED CONCRETE ~,' ROUGH - FRAMING & PLUMBINI~ 3. INSULATION 4, FINAL - CO~TRUCTION MU~ ~ CO. PI ~ FOR C.O. ALL CON,RUCTION SHALL MEET ~E REQUIREMENTS OF THE N.Y. ~ATE CONDUCTION & ENERGy CODE~ N~ RESPONSrBLE FOR ~IGN ~ CON~u~ION ~RO~ / /<~ V