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Home My WebLink About11645-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certific8te OI Occupnncy No .... J-.~.L9g ......... Date ................ ;.. ,hJ2.y. 2g ...... ,19 3.2. TItIS CERTIFIES that the building ................................................ Location of Property ,. ~30. ~lonse][ J.. Lane,· Eu~chogue,. NY ............................... I~ouso No. Street Hamlet County Tax Map No. 1000 Section .... 09 ? .....Block .. 08 ........... ]Lot .. 02.3 ............ Subdivision ............................... Filed Map No ......... ]Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ ~lay. 3 ........ , t 9 .&2 pursuant to which Building Permit No .... ~-J-fi.65 ............. dated ......... .~.ay..]_ .1 ............. 198.~: ., 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 ......... ·..~ql~t. ~99f .9Yet. e>~$~ ¢$ug. ~err~ce ............................................... The certificate is issued to . . Frataees..4.,. Verity. · [o~n'e'r,'l~,~s~e'c;r't~t;a'n'tl ...................... of the aforesaid building. Suffolk County Department of Health Approval ... ~/.~ .................................... UNDERWRITERS CERTIFICATE NO .... S/~- ........................................... Rev. 1/81 ,TOWN BUILDING ~ E~PARTME~IT;~ SOUTH'OLD, 'N~ BUILDING :~ P,E~IT (THIS PERMIT MUST BE KEPT ON THE P~E~IS~S UNTIL F ~ COMPLETION OF THE WORK *HTHORI~D) Pen hission is hereby granted to: ~ : /~ Rev. i6/30~80 - · BUil~ihg JLL .... .or No. ~,'~,~ ......... and ~pproved by the FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Insped~ tar 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 featu res. 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. 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 New Buildin§ ........ Old or ~re-exist[ng Building(X) ........ .~ ~Vacant /and ..... Location of Property..House.~.-~--,,~.No. ......... ~ ~;~ 'Street ~ ~ .... ~~g Owner or Owners of Property . ..~~. ~.-,~~ ..... ¢,~ ........ County Tax Map No. 1000 Section ,. r/, ./ ........ Block .... ~ ........ Lot .... ~. ..... Subdivision ................................. Filed Map No ........... Lot No .............. Date of Permit ~ ~2 .Applicant . ~&e.l~,C~ &.. ~ .... Health Dept Approval ~ Labor Dept Approval Underwriters Approval '" Planning Board Approval Request for Temporary Certificate ..................... Final Certificate ..... Fee ~ubmitted $.....~.~..~..~... ~ ............ Construction on above described building and permK~mee.ts all app~cable~oodes an¢ regulations. FIELD INS?ECTI~ON 1. FOUNDATION (1st) COMMENTS FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY FINAL ADDITIONAL COMMENTS: )7,' Z Approved. ~"~' 7'' 'q'' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1802 APPLICATION FOR BUILDING PERMIT /?o" 5_-- Date ...... ?.~_/t. ~'~.. / .~.,/~., 19... 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 oi~ 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 of property must be drawn on the diagram which is part of this appli~ 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 pennit 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 Occupancy shall have been granted by the Building Inspector. 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 fox' 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. (Signature of applicant, or n~m,e, if a corporation) - (Mailing address of applic~vht) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises..~....~. ' ~~. i~ ............................... If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. Plumber's License No. ~:~R. ~. ............... Electrician's License No~ ............. Other Trade's License No.~ .......... 1. Location of land on which proposed work will be done...~.~...~. ~.~..~..~. · ~ .................. ................................ House Number Street ~ Hamlet County Tax Map No. 1000 Section ........ .~...~. ..... Block ..... ~. ........... Lot....~..~ ........... Subdivision ............ '..~.~....~..~. .... i ...... Filed Map No ............... Lot .............. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... . .0~.~..~. ~,~ .............................................. b. Intended u, and oceup ey . [ 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteraji°nj2 · · '/t · '-' Repair ............ . .~j~m~vai .............. Demolition .............. Omer '~ orl~t~ ~ (Description) O,t atedC st (to be paid on filing this application) 5, If dwelli~g, ntm,.b:r of d,,ve!Ik,~g iunits ............... Number of dwe!Hng '::dtn on each floor ............... If garage, number of cars ..... i ................................................................. 6. If business, commercial or mixe~ occupancy, specify nature and extent of each type of use ................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............. Height ................ Nun]bet of Stories ...................................................... Dimensions of same structure with alterations or additions: Front ................. Rear ................ Depth ................... J.. Height ...................... Number of Stories .................... 8. Dimensions of entire new constructmn: Front ............... Rear ............... Depth .............. Height ............. : · Number of Stories ....................................................... 9. Size of lot: Front .... 7..~7..~..' .......... Rear .... .~x-. ;~. ?. ........... Depth/.~...>...'::/..':)~).,,.~ .'~..... 10. [)ate of Purchase ......... ]..~./~...4 ........... Njme~f i~ormar Owner ............................. 11. Zone ~)r use district in which pr~mises are situated..: (--~/.. ~ ....... ~ ............................... 12. Does proposed construc2~gn violate any zoning law, ordinance or regulation: ."~.. ............. ~ ............ 13.- Will lot be regraded . .'. ]<"~O, i ...... ~ o ....... ~..,~.-9, WH1 exce~s frill:= removed from premises. Yes _ No}/ Name of Architect ...' ~ .............. Address .......... [/ ......... Phone No ................ Name of Contractor ...~ ........... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block ~umber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF COUNTY>O~. ,,-~ ...~.~...~..i~-being duly sworn, deposes and says tha~-~he is the applicant (Name of individual signin~ contract) / above named. ' e is the ............ ~,. ............................................................. i (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of, l~s~owledgo and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this , V