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Home My WebLink About11658-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Halt Southold, N.Y. Certificate Of Occupancy No...Z12 .41.3 ........ Date ...... .~p.r.i,1., ,5 ................... 198..4. THIS CERTIFIES that the buildh~g .-.-.~c.e.~o.ry. .................................. Location of Property 7015 Great Peconic Bay Blvd. Laurel House No. Street Hamlet County Tax Map No. 1000 Section 1.2 6 ·Block 10 .... Lot . 013 Subdivision . ~ ............... Filed Map No....X ..... Lot No.. X . conforms substantially to the Application for Building Permit heretofore flied in this office dated ·...M.a.y. ~3 ............ ,198.?.· . pursuant to which Building Permit No. 116. 5 .8 g · dated ....... .M .a y. .1. .3 .............. 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 ......... buildin. 9 ....... .a.n..a..c.c.e.s.s..o.ry..s. -.~.o.r.a.g.e ......... : ..................................... The certificate is issued to . .G..A.M?.~. F.-..D..R.U.C?.,...I.I.!' .~...~.R. 9.U.E.R.!T.E' .K.:. ?II .s..WZFl a (owner, lessee or tenant) of the aforesaid building. CHRISTOPHER D. WADSWORTH & CATHY W. WADSWORTH, HIS WIFE Suffolk County Department of Health Approval .... .n.o.t...r.e.ciqi, ,r,e~d' ....................... ~.qqi .r e.d. UNDERWRITERS CERTIFICATE NO ............ D.o.t. ............................ Rev. 1/81 Building Inspector BUILDING DEp-~ R'rME~ITi~ TOWN Perm ssion is hereby granted to: BUILDING ~PERN~IT - (THIS PERMIT MUST BE KEPT ON i~'H,E PRE~iS~$ UNTIL F~LL :COMPLETION OF THE WORK AUTHORI~ D) 1!1 ~ 5 8, 2[ ~ote ...... ,. ' Fee $ .............. i pu~ant t~ app ~cat On dat~ ~ ~ ....... ....... ~; .; 19~ ~and ~pproved by the Bulldlng I~spector. ~ } ~ FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall ,~;outhold, NoY. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR nk, and submitted~m__~upl~ the Building Inspec- tor with the fol'lowing; for new buildings or new use: 1, Final survey of property with accurate location of ail buildings, prroperty lines, streets, and unusual natural or topographic features. 2 Fina approval of Health Dept.. of water supply and sewerage disp0sal-(S~9 form or equal). 3. Approval of electrical installation from Board of Fire UndenNr tars. 4. Commercial buildings, Industrial budd~ ge, Multiple Residences and similar buildings end 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" ~l,nd uses: 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 end 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: I. Certificate ofoccupancV $5.00 . / --Pre-Ex is ting C.0. ~ 2. Certificate of occupancv on pre-existing dwelhng / land use 3. Copy of certificate of occupancy $1.00 ~ Vacant land C.O,-' $ 5~00 Date.. ,~/I. ~./~ ,/'~. .............. New Building.,,, ,,.,,..,, Old or Pre-existing Building ............ Vacant Land ............. ....... Location of Property ......................... · .............. House No. Hamlet Owner or Owners of Property ........ ~ ...................... County 'fax Map No. 1000 Section .. ! .~...~. ....... Block ..... t..~. ....... Lot .... /..~. ......... 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 Temp(~rary Certificate Final Certificate Fee Submitted $ ............................. Construction on above described building and p~[~71eets~l~ppli~c~lbi~es and regulations. Applicant/.. ,~--~..~. · ~~. -,' .... ,~, °~,, · 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 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. C. Fees: 1. Certificate of occupancy $5.00 / 2. Certificateofoccupancyonpre-existingdwelling!landuse--?re-g×lst~lng C.0. $15.00 3. Cop¥ of certificate of occupanc¥ $1.00 ~/acanf. ~.anc~ C.O. $ 5.00 ' ............. New Building ............. Old or Pra-e×istin§ Building ............ Vacant Land ............. Looat on of Property ...... .... House No. b'treet Hamlet "pr t ck, " .-kb. . .c. r,-5 .................... Owner or Owners of Property ............ '/'....~T~.....(~.-5.. County Tax Map No. 1000 Section ... J..o~.~ ...... Block ..... ./.0. ...... Lot../.'-~. ........... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... App)icant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate Final Certificate ...... ..:~. · Fee Submitted $ ............................. ~ 0J~'~ Construction on above described building an~permi..t~0~e,~l app~icable'~Odes and regu latlons. Applicant...~/:"~/~. ..... ~//~. ? ............... COMMENTS FIELD INSPECTIO~ -_ 1. FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C~DE FINAL ADDITIONAL COMMENTS: ¢ o~l k V FORM NO, 1 TOWN OF SOUT',-iOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL,: 765-1802 Approved ................ I9 ,~.2f. ?ermit No.. ,/'./ ....... Disapproved a/c ' :~- ' ...................... ....... (Building Inspector) A?PLICATIO¢.i FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted&'~ t:'i'p!i:r.:: to the Build Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule, b. Picot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public or areas, and giving a detailed description of layout of property must be drawn ell tt~e dia~am which is part of'this apt cation. c. The work covered by this application may uot be commenced before issuance of Building Permit. d. Upon apprc,'al of this application, tile Building Inspector will issue a Building Permit to the applicant. Such per, shall be kept ou tile premises available for inspection throughout tile work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupar si!ali have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for th~ issuance of a Building Permit pursuant to Bnilding 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 descfib Thc applicant agrees to conrply with all applicable laws, ordinances, building code, housing code, and regulations, ,'md admit authorized inspectors on premises and in buildings for neck-/7 inspections. / X, (Signatff-,~ of applicant, or name, if a corporation) ;. (Mailing address of applicant) State whether applicant is oxvner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build Nmue of owner of premises '. 7' (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. Plumber's Licens: N,. ......................... El::ctrician's License No.' ...................... Other Trade's License No ...................... 1. Locati ~o,~.of land on~.Lg, hich proposed work will be done ................................................ House Number Street Hamlet County Tax Map No. 1 0130 Section ..;...(.....P ........... Block '/() Lot.. ~' .V'.~;:t. Subdivision ................................ Filed Map No ............... Lot ........... (Name) 2. State existh~g use and occupancy of premises aod intended us~ and occupancy of proposed construction: a. Existing use and occupancy ~(5 c~Y~- '-. ' .,-~-: b. Intended use ~d occupancy ~ ' ~ ' ~ ~ ,l~ · 5;'.. ................... t.. ~. Nature ofv,'or~: (check whit, applicapl¢): Ne,,',, Building .......... AddiHon .......... Alteration ....... Repair .......... Removal .t.. · ·, .... Dame tlon ............. Other Work.,. ~ ' O.~' ~%-~c:~i (~2q.,.,b(~ c~ -- (Description) 4 Estm,ated Cost . ..'~K~ .].. ..... · /O, ~ ~ . ' ' ...... ! · ................ Fee ................................... J ~ (,o be paid on fihng this application) 5. Ir~w~l~ing, number of dwelling nnits [ ...... ~..5. Number of Swelling units on each floor ............. Ifgar..ge, number of cars ..i ........................................................ .~ ....... ' ~. If business, commercial or m xed occ, tpancy, specify nature and extent of each type of use ... ~ ....... ~ j 7. Dimensionsofexistingstmctlures, ifanv:. Front... ........ . ... Rear .. .......... .. Depth.. ........ .. . Height ............... Number Dimensions of same structure with all Depth ...................... H~ Dimensions of entireoe;v constrtlctio He/ght ........ ~ ...... Numfacr Size oflot: Front ........ ;. ?...O~.2 Date o'f Pnrcliase ... L'boi: ~--7~ Zone or use district in which [prcnnse.~ Does propo..d constructmn violate W'I l l lot bt: Name of Owner of premises ,~..~...~..C amc of Architect ....... ~ame of Contractor ...... i. ~../.~ t' Stories ...................................................... erations or additions: Front ................. Rear ................ :i~t ................. x .... Number of Stories .................... 'c Front ........... ~'.. Rear ....... .~.c. '. .... Depth ... [.2.t ....... ~' Stpr/es ........ ? ....... r .................................. ......... Name of Fore, er Owner . ~}~_~b.w.~._.,. ............... are situated i ': zoning law, ordinance or regulation: .... .............. Will excess fill be removed from premises: Yes · .1~ .... Address . .~..5'~. L~ Phone No "~'8--/~'> .......... '.. Address ................... Phone No ............... =. ........... Address ................... Phone No .............. PLOT DIAGRAM Locate clearly ~d distinctly fall buiklfngs, whether existing or proposed, and. ind cate alt set-back dlm,nsions fro: propert~y .lines...G. ive street and bloqk nun:b~r or description according to deed, and show street names and indicate wheth, 'mterio, or corner lot. t . ~'I'ATE OF NE~ORK, ,~ ' COUNq'Y~S'S (Na~e of iff_JlMdual si~fing co'n named. the o..r said owner or own'ers, and is dON autlie application; Ulat all statements contained i~ this application are true to the best of h, ilJ'khmwledge and belief; and that th W'ork will be performed in the manner set fo th h~ the application filed therewith. -5'worn to before rite tliis ....... ~...day of .... AJota.~ P u~blic .... ~. .... ./~ .... ~ :: 4~' "l" .: ,, . . '~o~.~ :~ being duly sworn, deposes and says that~e is tile ~'.pplictm (Contractor, agent, corporate officer, etc.) rized to perform or have performed tit,: said work and to make and file thi