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Home My WebLink About11695-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy July q9 198.3. No. Z'1'1789 Date .......... ..................... THIS CERTIFIES that the building ...aco.assory .s~;.o~ge ......................... Location of Property ............ e.e. ........ Hat~;ituck House No. Street Hamlet County Ta× Map No. lO00 Section ...'1./~ ...... Block .... 2. ......... Lot ....... q ~ ........ Subdivision .M~t.t:.J, tuc~: .P~rk; .kO, op. ....... Filed Map No.. ~30~ .... Lot No ....... .~.0. .... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... Nay..'1.c) ...... , 1982. pursuant to wtfich Building Permit No... ~j[G. 95.g. ........... dated ............ FIa.y .2.~ ......... 1982., 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 ......... .... ~¢oossor. y · ~t:~.a{ge..buiZd,J, ng ............................................. The certificate is issued to ...... O©]~q~ .J .. gON]30~. .................................... {o wrier, ~oo~or ..... ,-rt') of the aforesaid building. Suffolk County Department of Health Approval ......... N./.A ............................. UNDERWRITERS CERTIFICATE NO ................. N./.A ............................. Building Inspector Rev. 1/81 Per~ss~on~ cs hereby granted TOWN BUILDING TOW~ ~H~:.L i! SOUTH'OLD, N~;Y. ~ BUILDING p,ERMI~;; : ~, ; (THIS PERM T MUST BE KEPT ON THE PRE~IS~jS UNTIL FDLL COMPLETION OF THE WORK AUTHORIZED) i' J ~ 1!1~95 Z : at p~em se* located at ....~.. C0u~ TaXx Map No. 1000 'Section ~......---~ L..~.. BlOck pOts~uant t? application dated :B~il~lng ,~Spector.~ ....... and ~pproved by the FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, 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 disposaJ-(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 compriance 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. Pees: 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 . .Z. ?~,--~-,~. .......... ~..~.~.~.../~. ;~'.~.....,~.~...,~;~ ........ ~?.~...~..7'z..-r.c/.~,.,~ .... House No. Street Ham/et Owner or Owners of Property . ~/~, .'~.-~. ..--~...,. ~(~..~./t/'~) ~....~. ............................ County Tax Map No. 1000 Section .... ! ?..C{_ ..... ~.'~. ~,...'~T... Lot .... ~../.~... Subd vision/:~]7.'C,?.~ ,~-...~.~q,.,/~.. ,(..~.~. ...... Filed Map No. ~'0.] ...... Lot No, . .'~.~. ........ Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. Underwriters Approval ....... .~. ~ ............ Planning Board Approval .................. Request for Temporary Certificate ..................... Final Certificate' . ...... .- ......... Fee Submitted $ .... . .~.. ~ ................ Construction on above descr,bed b~m,~cable~codes and regulations. FIELD INSPECTION 1. FOUNDATION (1st) COMMENTS FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL YJ ADDITIONAL COMMENTS: ~ Care and M~intenance ~u~estions NO~INAL SIZE: 10' X 9' .A ............... ~ ............. ~,~_..~.~ . .. .. ..... o~ ....... ..... C~ ~ ~ a~ ...... ~ ~ ~ ........ ~_ ....~ ~ :a .... ~ ~ ~ __ ~ _ ..~ ~ ~i b~.__, o ~Z.... ~ ................. ..... :___~m...:. ~~ ' - ....... ' ............ FOR~ NO. 1 TOWN OF $0UTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~VU I ~IUL. IJ~ H. Y. E am,ned ............ 19~.... Permff No. Disapproved a/c .......... ~ ............................................... ~ ............ Application No ........................ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buiiding Inspector, with 3 sere of 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 ofproperty must be drawn on the diagram which is part of this application. 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 througF, out 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 aiteratians, ar 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 ~nspections. ome/ I1' a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............................. ................................................................................................................................................. Name of owner of premi.ses ........ .~.~..~...~......~....~..~.~.. ............................................................. ' .................................... If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............ , ................................ Other Trade's License No ............................................... Subdivision-/~/~/~d~' ,-,.~a ,o~ u, ,a,,u u, w,,,c. ~,,upOoeu work will be done. '/v~ep No.: ............. .~,~.'..{ .................. Lot No ......Z.o. .............. Street ond Number ............. ./..7..'~...'~.. .............. ~J.~or..~.l~.~.~':..~.O.~?. ....................... ~../~..-~.l."[/d..4.~-~ ................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ........ b. Intendeduseondoccupancy ....... .~.OI29...~O.~71'~..l~.~Z$,t,~.,..~.,..~z... ...... ~'~'"'/f~f~'/--~7'~ ............ ....... County Tax Map No Dist. 1000 Se ' /"~ k____~ 10. 11. 12. 13. 14. If dwelling, number of dwelling uni If garage, number of cars ..i .......... If business, commercial o~ mixed Dimensions of existing structures, if Height ........................ Number of Dimensions of same structu[re with Depth ................................ ' Height Dimensions of entire new cbnstructi Height .....~..~_..~.~'.'l .... NumbFr of Stc Size of lot: Front .............. I.P.~- ....... Zone or use district in which premis, Does proposed construction ivlolate c Will lot be regraded ..... ~ ............. Name of Owner of premises Name of Architect ............ : ............. Nature of work (check which applic, lble): New Buildina'. ................. Addmon ..................Alterahon ............... ,, (to be paid or, filing this app~ic~t:~,n) ........ ..~'//.~. ........... Number of dwelling units on each floor ..... ,,~?/~'.. .............. occupancy, specify nature and extent of each type of use ...... ,.'~'./..~.. ............. ,ny: Front ............................ Rear ................................ Depth .................... ~tories ............... /. .............................................................................................. alterations or additions: Front .................................... Rear ........................... ........................... Number of Stories ....... / ....................... ries .............. I ..................................................................................................... ,s are situated ..... .~.~)..~....~..~..../~,~.J.~..~...~..~ ............................................... ny zoning law, ordinance or regulation: .............. ..~'...~. .................................. .. Will excess fill be removed from premises: ( ) Yes (l~No .................................... Address ................................ Phone No, .................... Nome of Contractor .......... [ .................................................. Address ......' .......................... Phone No ..................... i PLOT DIAGRAM Locate clearly and distinctly all build rigs, whether existing or proposed, and indicate atl set-back dimensions fror property lines. Give street and block nu ~ber or description according to deed, and show street names and indicat whether interior or corner lot. STATE OF NEW YORK,/~,~ , ~ [ S S COLJNTY OF .~.~..~....t,R/,~...~......~ · ....................... .~.,.o...~.~../~......,~..: .... .~,./~....~.,.~.../~... ................. [....,being duly sworn, deposes and soys that he is the applicar (Name of individual s!gnlng c(ntrocf) above named. : He is the ........................... ~) ~JAF ;~ ./~.....ii ........... ................................................................... : ........................................................ : (Cc of said owner or owners, and is duly auff this application; that all statements cant', that' the work will be performed inl the mar Sworn to before me this i ......... day of ......... /..~..6, f. y. .......... Notary Publ of New D3-4647~34 Qualified in Bronx Counly Term Expires Marc~ 30i, 19,~,,,~ ntractor, agent, corporate officer, etc.) orized to perform or have performed the said work and to make and f~ ined in this application are true to the best of his knowledge and belief; ar her set forth in the application filed therewith. (Si'~nature of applicant)