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Home My WebLink About11649-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildinl Inspector Town Hall Southold, N.Y. Cer fica Of Occupancy No. ~.1.107~ .......... Date ....... ~U~.. 1 THIS ,CERTIFIES that the building ................................................ Location of Property ..{~Q~: ........... ~B.~.ql~9.~.~q. ]~.op.q. Je~.l~l. ........... l~9.~.~.:L.~.u..cie.,.. Mouse/vo. Strict Hamlet County Tax Map No. lO00 Section . .113 ....... Block . ..13 .......... Lot ...01 ~ ........... Subdivision..B. qn. !~9.~.~a...P.o. qd. .............. Filed Map No. 5.4.8.5 .... Lot No.. ~ ........... conforms substantially to the Application for Building Permit heretofore ~ in this office dated · .. l).e.~9~]~.e.r.. 3 ......,19 J~.l pursuant to which Buildin~ Permit No..11 ~.~.~1. ~ ............ dated' ... ~lPX. 1.1 .................. 19 ~R, wss issued, snd conforms to sll of the requirements of the applicable provisions of the l~w. The occupancy for which this certificate is issued is ......... ..... ~n. ~.~q~P~.x. ~.~.~c~g~..#u~l,~,~g .......................................... The c~rtificate is issued to Robert A. & Bernice Phillt · of the ~oresaid building. Suffolk County Department of Health Approval .... n../.~ .............................. UNDERWRITERS CERTIFICATE NO ............ rl./~ ................................... Rw. 1/81 Buildins Inspirer TOW oF sOUTH Li BUILDING DEFAgTMEHT TOWN HALL SOUTH'OLD, N~ ¥. BUILDING ;FEIU~ITi, ~ (THIS PERMIT MUST BE KEPT ON TH,E PREN COMPLETION OF THE WORK AUT~tORIZED) UNTIL F,~J LL Perrhissionl is hereby granted to.o:_ /~7 · ....... .~.~..~.~c~ ...... g. ...... ~... ~o .......... .~....:~.~Z..,...~.,..~ .............. at premises located at ..~.¢~.....~....~... ..~ ......... ... ~ ,:.~. ........................................ Coua~ Ta~ Map No 1000 Section ..~.¢ ....... ~ ~l~k put,ant to apphcation doted ................. ./.......; ................. Bui ding 16spector. ~o~ $ .................. R,V. i6/30~80 tLot No., 19~.~Z.,~' and approved 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 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 installa4 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 inspectio..n 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(X) ......... =/Vacant Land . Location of Property . ..,(.0~.~? .................... ~ ....... House No. ~ Stre~ ~ . Ham/et Owner or Owners of Property ........ 0-~ .~:. ~-.-.,-.. '~; .~ ~. ................. l-/~I~-'L ~ ?;~..~.~..~. ~ County Tax Map No, 1000 Section ..-/-(-~--~. ....... Block .../..~, ......... Lot...~ .l.~. ....... .. .(-.~ .............. Subdivision. ....... F,ed Permit No. [/.(.~..~. ~-b'Oate of Permit. ~-..~'./~..~..Applicant... ~..¢; .-F?..I.r." .d~.~.....~.~./.'.~..~...~. Health Dept. Approval ....... - ........... Labor Dept. Approval ... ............... Underwriters Approval .~./L/.~..~ .Planning Board Approval Request for Temporary Certificate ................ .....FinaICertificate .......:......... Fee Submitted $... ,C~.., .~,¢? ................ Construction on above described building and permit~mee~s all appl~cable~co~es and regulations. / Applicant ..... <~ ........ . ...... ..~. ................................ Rev, 10-10-78 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Braiding Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Date ................................. 19 ... THIS CERTIFIES that the, building ......................................... [ ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated .................... 19 ... pursuant to which Building Permit No ..................... dated .... .~..~/// ............... 19 .Y~s issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... of the aforesaid buildiug. Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO ................................................... Building Inspector Rev. 1/81 FIELD INSPECTION FOUNDATION (1st) COMMENTS FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C~ODE e FINAL ADDITIONAL COMMENTS: FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL File No ................................ 2~.~,~ .~./, //~.p-~ .. .AF~/.¢~.N: .... '~: ........... PLEASE TAKE NOTICE that your application dated . ~O.. ~.~ ~. ..... 19 ..... for pe~it to construct.. Location of Property County Tax Map No. 1000 Section ..... ~ ........ Block ....... ~ ...... Lot ... ~ ......... Subdivision ................. Filed Map No ................. Lot No .................. is returned herewith and disapproved on the following grounds ~W~Z~..~) ....... .~.~..~. ~. ~-. ~~.~.. ~. :~ ........ .~. Building Insp~/~ ~ ' RV 1/80 FORM NO. I TOWN OF SOUTHOLD BUll. DING DEPARTMENT TOWN HALL SOUTHOt. D, N,Y. 11971 TEL,: 765-1802 Approved ~ ,<~ ..... 1 ermit No.. / D, appro~ed a/c ............................ ~ ...... APPLICATION FOR BUILDING PERMIT 1 NST P, ucrloNS Application No. (.,'.6'..~. ........ a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi Inspector, with 3 sets of plans, accurate plot plan lo scnle. Fee according to schedule. b. Pict plan showing location of lot and of buildings on premises, relationship to adjoining promises or public stre{ or a~eas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this apl cation. c. The work covered by tiffs application may not be commenced before issuance of Building Permit. d. Upon apprc :aI of thN application, the BtdldJng Inspector will issue a Buikting Permit to lt~e applicant. Such peru ,,hall be kept on the premises available for inspectiou throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever uutil a Certificate of Occupan shall have been granted by the Building Inspector. APPLICATION IS ltEREBY MADE to the Building Department for the issuance cfa Building Permit pursuant to t Building Zone Ordinance of the Town ~f Southold, Suflblk 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 applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and r*;gulations, ~d admit authorized inspectors on p~emises and in buildings for necessa~7~ ~ff~)iuspecti°ns' ,~, (Signature of applicant, or flame, if a corporation) 5;tare whether applicant is o~w~er, lessee, ageut, architect, engineer, general contractor, electrician, plumber or build. .xd lc owner o )foil aa i 1 tte,t deed) applicant is a corporation, siguature of duly authorized officer. (Name and title of corporate officer) Builder's License No.~....,,~?,.,tS~.. ~ ........ Plumber's License No ......................... t2lcctrlclan s Llcense No ....................... Other Trade's Liccuse No ...................... Location of land on which proposcd work will be douer--: ............................................... ..... ........... .,-, ...... ................ Subdivision .'~.., (~.e..t,:~.,o.e.'~.~,.. ,~o~ ........... Filed Map No~., ~.~ ..... Lot~. ~ ........ (Name) Sta~e existing us ~ and occupancy of premises and intemled usc and o~cupancy of proposed construction: a. Existing use and occupancyX.. ~..- ..... ~&~% ........ b. ln/cnded use and occupancy ....................................... Demolition ~ Other Work Repnir .............. Removal ......................................... Estimated Cost ..... r ...................... [ ........... , .............. .r .... (to .be paid on filing this application) ;. If dwelling, number of dwelling units ............... Number o f dwelling 0nits on oach floor ................ If garage, number of cars .................................. , ...... 4 .............................. i. If business, commercial or mixed occupancy, specKy hature and extent of each~type of use ............... 1. Dimensions of existing structures, if any: Front ............... Rear .... ; ......... Depth ......... Hoi~t Number of Stories' Dimensions of same structure with alterations or aOditions: Front ......... ~ ....... Rear ....... ' ..... Depth ................. i-.... Height'. ..... '7 ............... Number of Storie~ ........... ~.~... L Dimensions ~e~tire new constn ctioa~ Front' size of~ot: F~nt../~0...~..... ........R~r../~.,. ~ ....... Depth ~/0,..' .... ' ..... Dato 6f Purchas~ ............. . ............... Name of Former Owne Zone or Use district in which pr¢nnses nrc situated .~ Does proposed ¢onstruotioa violate any zoning lawJ~rdinance' or regulation: . Name of Owner of premises~ ~ I ~~ddres~~ Name of Architect ......................... N~¢ of Contractor ........................ Addrgss ............ ). PLOT DIAGRAM ~ premises:..., ~ Y,~s. hone No.d~ 7~. 7)'.~5. Z... ..... Phone No ................ ·.. Phone No ................ Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from roperty lines. Give street and block number or description according to deed, and ~how street names and indicate wh~ther tcrior or corner lot. ........ ~f~ ./~~ .......... being dui9 sworn,, lepos~s and says that he is the applicant (Nanie of individual signing correct) ~ov~ n.m~d, is the .. d~ ............................................ , ............................... (Contractor, ageut, corporate officer, ~tc.) said owner or owne~, and is duly authorized to perform or have performe0 t}~e said work and to m~e and file >plication; ~at all statements contained in this application are true to the best ~f his kllowledge and belief; and that the ork will be performed in the rammer set forth in the application filed therewith. ,yom to before me this ........ '~' ' ....,. ..... , 19 otary eubli~~~... County