The URL can be used to link to this page

Home My WebLink About11694-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Date ............ ~ul.y,.... 1.9. .............198..4. THIS CERTIFIES that the building .................................. S~c.o. rac~e .S. he.~ ......... Location of Property 450 O?,k. St. . ..... .C.u..~.c.h.o.g..u.e ...... h~ ~i~ ...................... ~r~i .... H, mt, t County Tax Map No. I000 Section .1:..3.6 ........ Block .Off: ............ Lot .0.4..6 ............. Subdivision..E..ug.e.n.e...HS[~s.: ............... Filed Map No. 8. 5 6 .... Lot No. 2 0 & 21. conforms substantially to the Application for Bulldins Permit heretofore filed in this office dated ...... .Ii.ay.. 1. ~ ........ ,19.8..2 pursuant to which Building Permit No...1.1.6.9. ,4 .Z ............. M.ay 2.4} 19 8.2. was issued and'conforms to ail of the requirements dated ........................ , , of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... · ~.t;o~ .~b~.cl ................................................................ The certificate is issued to .. g~r.TJ~. 1~,..qDl~P.~.q~. ............................. (owner, temee-er-mm~ of. the aforesaid building. Suffolk County Department of Health Approval ' ~ !/~. UNDERWRITERS CERTIFICATE NO .... hi/.k .......................................... Bufldin8 Inspector Rev. 1/111 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PER/~IT MUST BE KEPT ON THE PP. EMISES UNTIL FULL COdVtPLETION OF THE WORK AUTHORIZED) Permission is hereby gronted to: ..... ~.,..z'~....~;:~',~.~ ~. ........... ....... .//.t..~..~..a~..;p.o.~.,~...~¢~ ...... ~..~..~...~/.,~.~.~....,..z,...~. ~7¢¢ ,o ........... C~...-...~..~.....~z~.~..~.....=~.e.~... ............................................. .~ .................................................................... .:. ..................... . .~.7.c~.~..,...~.......~" ........ .................. County Tox Mop No. 1000 Section .~'....~.....~.. ......... Block ..C~../, ........... Lot No. C.,2...~"..~'. ....... pursuant to application dated ........................................................ , 19 ........ , and approved by the Building Inspector. Fee $ ...................... Rev. 6/30/80 FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 isappro eda c .................. ..... ......... / , APPLICATION FOR BUILDING PERMIT Application No.././.~..~. ....... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted ~n=ta~ii~i~al~ to the Building Inspector, with 3 sets o£ 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 permit 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 for 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 name, if a corporation) %. ?£ .4 .z .f . . . /?)/~k~'~ ,q ~_-' ~'u/9 ~ ' (Mailing address of applicant) / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .~../..'/-..~. .... .~..... C. '4' '~'(as .D.on./..C<..~.the tax ........................................roll or latest deed) If applicant Is a corporation, signature of duly authorized officer. / Plumber s License No ......................... ElectriCian's License No ....................... Other Trade s License No ...................... 1. Location of land on which proposed work will be done .................................................. .............................. . ............ e .r. ...... e ........................... House Number Street Hamlet County Tax Map No. 1000 Section ...... [3 ~ ..... Block ...... ~ J ......... Lot... ~.~ ........ Subdivision..~.~.. ~'~.~ ........... Filed Map No.. ~ ~ ....... Lot..~.~. ~ .[... (Na~e) 2. State existing use and occupancy of prem~es and ~tended use and occupancy of proposed construction: a Exis~g um and occupancy f- ~i ~ ~ ~' "4 b. Intended use ~d ~cup~ey ......... ~. ~ ..... . ~. ~...~. ~. ~ ................... 7 g-y-o ?d FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted~ia=duf~ieet~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. 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 featu res. 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 / 3. Copy of certificate of occupancy $1.00 landuse--Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Date .......................... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property...~. ~ ...... ~..~./~.. .... .~.7~.; ..... ~.C~. 7~..e-<.i~.O .~ M. ~ ............... House No, Strut Ham/et Owner or Owners of Property ./~.~ ~./~.,..~..~-~7~. !. ,C~[~7f .................................... County Tax Map No. 1000 Section .... J,~. ~. ...... Block .... ~. / ........ Lot .... .~..~.~. ....... Subdivision..~'..v:c~_~.~.~...~. ~-.,.C~i~?..~' .......... Filed Map No....~.~..Lot No..'.~?.~:' ?...?.~. ~,~ q ~- ~_~/.~ .~///~.~ A p p ' 'C a n t Permit No. II ....... Date of Permit ................................... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate . .L-~... .................. Fee Submitted $.. ~. ......................... Construction on above described building and permit meets all applicable codes and regulations. ~..~ I, ~ / ~d¢~ Applicant ....... ~--...-~-... ~~_ ..................... FIELD I~S?ECTION FOUNDATION (1st FOUNDATION (2nd 2. ROUGH FRAME & PLUMBING INSULATION FEE N. STATE ENERGY ~ODE FINAL DATE COMMENTS ,, ADDITIONAL COMMENTS: ~10, 11. 12. 13. 14. Nature of work (check which apphcable) New Building .......... Addition ........... Alteration .......... Repair .............. Removal ............Demolition ............... Other Work ............... I (Description) , ./ 'cS /.0 ' ............. Fee .. .: ..................... Estimated Cost .... m. ..... : ............ i (to be paid on filing this application) If dwelling, number of dwelling Units ............. Number of dwelling units on each floor ................ If garage, number of cars ........................................................................... If business, commercial or mixed occupa Dimensions of existing structure~, if any: Height ............... Number of St Dimensions of same structure wi~h aitera~ /, specify nature and extent of each type of use ..................... Front ............... Rear .............. Depth ............... )ties ........................................................ ions or additions: Front ................. Rear .................. Depth i Heigh' Number of Stories ..... ~ ~. /..O. Rear Depth Dimensions of entire new construction: [ rent ...................................... Height . .:(.. ~'.~. ........ Number of St )nos ......................................................... Size of lot: Front ........... ............. Rear ...................... Depth ...................... Date of Purchase ........... i .................... Name of Former Owner ............................. Zone or use district in which premises ar situated ..................................................... Does proposed construction vinlMe any z )ning law, ordinance or regulation: ................................ Will lot be regraded ......... ~ ......... ~ ........... Will excess fill be removed from premises: Yes No Name of Owner of premises .~.,I.T.~ d ~E2~ I~/t Address z/dT~..,p..A.~.: .~ [~ Phone No ....... ' ' ...... iiiiilAdd ~lt~( .'~ .............. Name of Architect .......... i .... ross ........... Phone No ................ Name of Contractor .................... Address ....~.7~. q,5'..a~ ~. Phone No ................ Locate clearly and distinctly property lines. Give street and block interior or corner lot. STATE OF NEW Y-O~K, -- ~ ~ ~ COUNTY OF. ~ ~'~ ........... (Name bf individual Signing cont~ above named, i PLOT DIAGRAM whether existing or proposed, and~ indicate all set-back dimensions from ~tion according to deed, and show street names and indicate whether e is the..; ................... ~.~. ( of said owner or owners, and is dul3 author application; that~ all statements contained in' work will be p Sworn to before me this ~... being duly sworn, deposes and says tha~he is the applicant act) 2ontractor, agent, corporate officer, etc.) zed to perform or have performed the ~.ai,d?o~rk and to make and file this his application are true to the best of 4,nrs~/tli6X~ledge and belief; and that the in the application filed therewith. County (Signature of applicant)