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Home My WebLink About11632-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of fl~e Buildin8 Inspector Town HaH Somhold, N.Y. No..Z 1.1.1.7.6 ......... Date ...... ~.o.P. ~. Pl~.b.q .v. 9; .............19 .8.2. THIS CERTIFIES that the building ................................................ Location of Property 4. .4.0. .................. ~.u..np.~.~.. ~.a.y. ............... .B.o.u..~.h.o.l.d. .... ~ Hous~ No. ~d'~t Hamlet County Tax Map No. 1000 Section .. 0.~1'. ..... Block .. 0.1 ........... Lot.....0.Q~ .......... Subdivi~'on.. Ce~la~'. B.aacb. ~a~'k .......... Filed Map No. 9{) ...... Lot No..l{~ ......... confo~ns substantially to the Application for Building Permit heretofore ~ed in this office dated · .1.I~ .~ ~.1..8. ............ 198..2. pursuant to which Building Permit No...1.l~i~..~ ........... dated . .H.a.~..3 ..................... 198.2.., was issued, and confo/ms to all of the roquiremmts of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ..... p..c[~$1~ at~ltl~t~gp tq prl, v.~te .q~e f.a..mlly dwelltn . The certificate is issued to ......... ,J. ql;p..P.,..Op~%.ey. ............................... of the aforesaid building. Suffolk County Department of Health Approval .. %a/.r. ................................... UNDERWRITERS CERTIFICATE NO .......... n/.r. .................................... Rw. 1/81 Bnilding inspector BUILDIHG ~[PARTME~Til SOUTH'OLD, H. Y~ BUILDING; (THIS PERMIT MUST BE KEPT ON THE PREMIS~ UNT L COMPL~ION OF THE WORK AUTNORIZED) N°. 1~1632 Z Permissionqs hereby granted to: ~ F~EL at p(emise~ located at .......... CouniW To~ Map Bio. 1000 Sechon ........ .., Bilk ...... ~. ....... ~t ~o ......... pufsaont t~ application dated .... ,~K./......g..;'....~,....¢~..:~{...., 19~&~and ~pproved by tho Budding I~specto . ..... // FORM NO, 6 TOWN OF SOUTHOLD Bu ilding 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), 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. ,' 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 Date.. New Building. ......(~' .. Old or Pre-existing Building(%) .... .-,~- = /Vacant Land Location of Property ~..,~'~¢;~,~,0. !~.~, 7~, .~'..W.,~I~ .................... .~,.I.~.~..~.~ Hous~ ilo. Street Hem/et Owner or Owners of Property ~ "~ ~ County Tax Map No. 1000 Section ............... Block ............... Lot .......... Subdivision .............. ..-,, ,.............FiledMapNo .......... .LotNo .............. Permit No. . Date of Permit · ·. App cant . ., ............... Health bept. Approval ......... ~..' ............. Labor Dept, Approval ...................... ,.. Underwriters Approval ........................ Planning Board Approval .................. Request for Temporary Certificate ..................... Final Certificat~ Fee Submitted $ ........... ;,, ' ,,' Construction on above described building and perc~it'mee~s~ a, ll alTC~cable~cOde,~ and regulations. ,4 ~CTION COMMENTg~.Z~ ~? ~ FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY QODE FINAL / ADDITIONAL COMMENTS: FORM ,O. &U TOWN C~ SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, FLY. 11971 TEL.: 765-1802 Examined ........... 19. ~ Application No ................ . ............... ........ A?P. LICATION FOR BUILDING PERMIT INST RUCTIONS a. This application must be completely filled iu by typewriter or in ink and submitted in triplicate to the Buildk Inspector, with 3 sets of plans, accnratc plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining promises or public stree or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part offthis app~ cation. c. The work covered by this application may not be commenced before issuance of Building Pe~it. d. Upon apprc.'al of this application, the Building Inspector will issue a Building Pe~it to the applicant. Such penn shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in pa~ for any purpose whatever unffi a Certificate of Occupam shall h~ve been granted by the Building Inspector. , APPLICATION IS HEREBY MADE to the Building Department for th~ issuance ora Building Pe~it pursuant to t~ Building Zone Ordinance of the Town ~f Soutbold, 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 describe, The apphcant aorecs to corn ~ly w~th all apphcable laws, ordznances, bmldmg code, hot sm~ code, ~d regulatmns, ~d admit autl~orizcd inspectors on premises and in buildings for necessa~ iuspections.. ' (Si~ature of applicant, or name, if ~rporation) (MailLt~ adflress of applicant)( - State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electfiman, plumber or build~ If applicant is a corporation, signature of duly authorized officer. (Na ne and title of corporate officer) Builder's License No ..... ~.-~... ~..~ ............ Plumber s Dcens.. Nt ....... ..~ .............. / El*ctrician s License No,' . ..,/. ................ / Other Trade's Licenie No./. i. Location of land on which proposed work ',rill be done..Q...~. ~..~..~.,. ~.~.~...c77 ¢ ...... .~.(7-.~../...[.~..~) ...... House Number Street Hamlet County Tax Map No. 1000 Section .................... ..................................... ie , aprqo ............... L (Name) 2. State existing use and occupancy of premises and intended usq, and occupancy of proposed construction: a. Existing use and occupancy ~0. 12. 14. Nalurc of work (check whit,s, applicable): New BuU~ling .......... Addition .......... Alteration ......... Repair Removal D~'molitlon Other Work (to b~ paid on tiding th~ application) If dwelling, munber of dwelling units ............... Number of dwe~ing units on e~h floor ............... If garage, number of cars .................................................................. ... . . If business, commercial or mixed occupancy, sp~y ~tu~ and ~xtent of ~ach typ~ of u~ ..... Dimensions off existing structures, if any: Front ............... Rear .............. Dep~ ............... Height ............... Number of Stories ..................................................... . . Dimensions of same structure witl~ alt,~ations or additions: Front Rear Depth ...................... ltei~/ ....... .... ...........NumberofStodes.. .................. . Dimensions of enlire new construction: Front ............... Rear .............. D~pth .............. Height Number of S~ofies ' Siza of lot: Front ' Re~ Dep~ Date df Purchase N~e of Foyer Owner Zone or use dist~ct in which premises a~ situated ...... Does propos=d construction viohte any zo~ng law, ordiaance or regulation: . . . ............. . ...,..............~. Wiff lot b~ regraded ............................ Will execs fill be removed from premises: Yes No Nmne of Owner of premises .................... Addr:= ................... Phone No ............... Nam~ of Archkect - Addre~ Phone No N~e of Contractor .......................... Address .................. · Phone No ............... PLOT DIAGRAM ~' Locate clearly md distinctly all oulkh,.gs, whether existing or proposed, and. indicate all set-back dim.-nsions fron~ property lines. Give street and block number or description according to deed, and show street names and indicate whather '~t~terlor or corner lot. $ 0i t Cou,x,'rv s.s ·' ~ ;a'n"{~ ~'f'i~o;'t;~'~~_ --~----~., .......... being duly sworn, deposes and says that he is the applic~nt above named. ' corporate officer, etc.) o-t' said owner or owners, and is duly uuthorizt:d to perform or have performed thc said work and to make and file this n~plication; that 311 statcm mrs contai]~ed in this application are true to the best of his knowledge and belief; and th.'.t the ~ork will be performed in thc manner s,~t forth ha the application filed ti~erewith. ---qsvorn to before me this