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Home My WebLink About11676-zFORM NO. 4 TOWN OF 5OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, .N.Y. Certificate Of Occupancy No..Z l 102.3 ...... Date ........ .J.u.n..o..8 ,.. .............. 1982. THIS CERTIFIES that the building ................................................ Location of Property . ~ 7.1.0 ............ l'nd.:Lau. ~.e.ql~. L.e, iI~ ............ .P,e.c.o.n. ic ... House No. Street ' ' ' ~t~rnlet County Tax Map No. 1000 Section .09B ........ Block .., 05 .......... Lot . . Q .I ,4. ,. 0. 0, .3 ....... Minor Subdivision../tn~.new. lq.ahn ................ ]~klod,,Map No. 87 ...... Lot No. 3 ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated .... 1,~ a j..5 ........... , 1982. pursuant to which Building Permit No...1.1.fi 76..Z. ........... dated . M.~Y...~ 9 .................... 19 .'32, 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 ......... ,~ .deck .adct:Lt ~[~n..arid..a.], ~. ~ r~.5. 9.n..g.o...ap..o..x.5.a.~.5. r)~..d,~,? .e,].,1,:[,n.~;: .............. The certificate is issued to .. P,e.~er. ,0.,, $ j..z.~ ~ .~.%l.l.J....a.n.d...~.i.f.e. ~..M.a?.~ .e. ...... (owner, a(g~ae, or cto~az~) of the aforesaid building. Suffolk County Department of Health Approval .... .n./. ~ .................................. UNDERWRITERS CERTIFICATE NO ............. rl/. ~. .................................. Rev, 1/81 Building Inspector ~o~ ~o. ~ ,0 ~)UT.O TOWN F$ BUILDING DEPARTME ~1'1~ TOWN HALL SOUTH'OLD, N,. Y. · BUILDING PERMIT: (THIS PE~IT ~UST BE KEP~ ONTHEP~ IS UNTIL LL COMPL~ION OF THE WORK AUTHORIZED) 11676 Z Permission i~ hereby omnted at p~emise~ located a .~ .... · Coudty Ta~ Map No. 1000 Section .i(~..~...~....,,..i B, lock Fee $/...,,m/.;..27 .......... nSPecto~ 6/30/80 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 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 app{icable, For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing al~ property lines, s~reets, buildings and unusua~ 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(Z). _/Y_.. - =/Vacant Land -" Location of Property .~,.,~/~/,~...~-.~. ~.~'-/'.~.~/ ..... ~X- ~' X/qC. ...... ./d...~. ........ ...... _~oo. ........ K/_~'C~. .......... House No. L Stree , t .~'¢~ ~ ~ ~ /~ 0 ' I' ..Ham/et Ownar or Owners of Property p~F-f~/~ ?r~; 7~ ,q/~.~7././ ,~X/~ t/V/J:~- County T. ax Map No. 1000 Section . .~..~e~. ......... Block .... ~..'~. ....... Lot....~.Y.~... Permit No.Z./~. Date of Permit../~./?/..~..Applicant .~.~ . ~~ ..... Health Dept. Approval ........................ Labor Dept. Approval ......................... Underwriters Approval ........................ Planning Board Approval .................. Request for Temporary Certificate ..................... Final Certificate ........ Fee ~ubmitted $..o.z~.',. ~ Construction on above described building an~H~s ~. I~cabte.~co./~ a~ regu lations. A' licant., ~.'.,.~ ...... ' ......~ ............ PP ~.~ ~~ .......... FIELD INSPECTION FOUNDATION FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL DATE COMMENTS ADDITIONAL COMMENTS: I r I L FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN~ CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL File No .............. .~.~ ............... for e~it to Construct House No, Street Hamlet County Tax Map No. 1000 Section ... ~ ~... Block . .~ ~ ....... Lot . Q~ .~.-~.' .... Subdivision ~ Filed Map No ~ Lot No ~ is returned herewith and disapproved on the following grounds ~-'~.?,/././..C-, .~.-? ,~./.~t'~...~. / .r'~-... ~C~.~/. . . ~T. ~ ~ ~% . . ~. . .~. . . ~.~ ~-~ ~¢ ..... A~...~,~.. ~. ~/~ ....... ~,.~..~~. ~.. ..... ...~ ~ ~.. ~.~. ~~¢.,: ................ Build~g Inspector RV 1/80 FORM NO. 1 TCWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 .................. ..... Z./ (Building Inspector) APPLICATION FOR BUILD1NG PERMIT INSTRUCTIONS Application No/~.7~. ...... Date ....~..~.~..~..~. ..... 19. a. This application must be completely filled in by typexvriter or in ink and submitted~a-t-ri¥,tiea~ to the Build Inspector, wit!x 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan ' ' , s m,vm.., location of lot and of buildings on premises, relationship to adjoining premises or public strc or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part crt~this ap 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 per:. shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in wkole or in part for any purpose whatever until a Certificate of Occupa~ shall have been granted by the Building Inspector. APPLICATION IS HEREBY blADE to the Building Department for th~ issuance of a Building Perm*if pursuant to Bufldmg z. one Ordinance of the Town of Soutbold, Suffolk County, New York, and other apphcable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describ The applicant agrees to comply with all applicable laws, ordinances, buildinu code, housi.ug code, and regulations, and admit uuthorized inspectors on prenliscs and in buildings for necessa~" ' ·..;.fa,.,'. · ': .": .mr. ~.../~'/'>X:': ......... ' .......... (,gjgnattkre of applica&4/,~,r.q~,ame, if a corporetiop) . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or built N,'une of owner of premises ....................... (as/on the~r~atest deed) If applicant is a corporation, signature of duly at:thor:zed officer. (Name and title of corporate officer) ti Plumber's Licens: N~. ......................... Electrician's License No.' ..... (~ ............. [?. Other Trade s Lic~ ~}' No 1. Location of land on which prolmsed work will be done .............. #' ............ ................ House Number Street Hamlet County Tax Map ~7.. '_~9.00. Section ...... .~..~. ........ Block ..... .O'fY...'7./. .~.4 .~.. Lot ..... .~. ......... Subdivision .. ,~5.~, ./~.t"~l. ........... Filed Map No. '' '~'7' ....... Lot ...'~. ...... (Name) 2. State existing use and occupancy of premises and intended t,~e,, and. occupancy of proposed construction: a. Existing use and occupancy..~ ~ .................................... L N~ture of work (check whlc,,~ apphc ale): New Building ..... Addition .......... Alteration ...... i (to be paid on filing this application) ;. If dwelling, number of d:vel.l ng unit:~ . ..... /~. ....... Number of dwelling units on each/leer.. .Z'... If garage, nomber of cars . ~ ...... i .......... ' ..... i. If business, commercial or n)ixed ocr upancy, specify nature and extent of each type of use ................. t. Dimensions of existing stru{t, ures, irony: Front ..... i ......... Rear .............. Depth ........... Height ............... Number ~ff Stories . ~.. ........... Dimensions of same structure with al terations or additions: Front ................. Rear .............. I. Dm~ensmns et tnt,re new construct ~n' Front ~ 2.-0 ' ). ,-, [~ of Pu[d!ase ..... /.~.7. .t-/.. i .............. Name of Fom~er Owner ~ ~.~ ...... I. Lo.e or us,: oistdct in whict', prdmis~ are s tuated ' ' x°,-'! ":. Does proposed constrnctionlvio~late a~y zoning law, ordi ~ance or regu ation ... ~ ................. '.' ' 'I' ' ' ~ .......... YVlI~ e eS 1111 De rem d from r raises: Yes ?,amc oI Contractor ..... .~..' .... .:. · Address ................... Phone No .............. [ PLOT DIAGRAM Locate clearly ~d distinct/y! ail bull xoperty hnes. GiYe street and block numl :terior or corner lot. lings, whetl{er existing or proposed, and. indicate all set-back dimensions ftc let or d,eseripdon according to deed, and show street name~ and indicat~ whet~ being duly s~vorn, dep~es and says that he is the applicm]. e is the ~ ' r ~ i (Contractor ...................................... ~ ¢ ,.agent, corporate officer, etc.) f said bwner or owners, a~ld is dilly authorized to peiTorm or have performed tht: said work and to m,'tke and file )plicatioa; that all statements contained ih this application are true .to the best of his knowledge and belief; and that th 'ork will be performed in the maturer set forth h~ the application ~led therewith. worn to before me this -- . ~ ; [ ' -. RqDOLPH 8. 8RUER / ~ ' ' ~ , / ~ a -- N~a~ P~bll~State of New Y~ ........... z .......... d~yor ....{}vk~ ........ 19~3 _ otaw lie . . ~ . ~ , ' L.,,.,,.., ..... .. co,,,,,, //// ' " *' N4~,', ,~ York ~ : = . ~ R( ~ ~' -, , R ' '.C. :,~-.:"~.. ,: . ': "'" ' - c°~B'&~2;'?')~.'~l~"~¢~o,,h~ ........... ~ ..... ~i: ...... ; ....... ~' ...... ~ ........ ~ ............ amr~ ivlareh 30, 198~'