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Home My WebLink About12064-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z.~. ~..5.6.8. ......... Date ........ l~Ia2¢h..2q- ............... 1953. THIS CERTIFIES that the building Accessary Location of Property .... ~.255. J~ockY..t~Oiht.. Rd ........... Ea~q.h. ~a,r. ioB ............. House No. Street Hamlet County Tax Map No. 1000 Section . . 02.~ ....... Block . .. O.'q .......... Lot ... 00.(~ .......... S~ratmors Estates Subdivision ............................... Filed Map No... 3?23 .Lot No .... 3 ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated November 29 1982 pursuant to which Building Permit No. f120Gz~Z December 9 82 dated ............................ 19..., 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 ......... ......... 4 .e.<e.s.s..~rz .s..~.o.r.a.~.e. ~u. ~..~.%n.g ........................................ The certificate is issued to ...S.t.a.n...1.ey..A, .n.d.r.e. 9.u ....................................... (owner, 4ossoo~or-ttma~) of the aforesaid building. Suffolk County Department of Health Approval ....N/..~ ................................... UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector ....... Rev. 1/81 BUILDING Di'.'I'ARTM~Ni TOWN HALL SOUTHOLD, N. y., BUILDING' PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL ~ULt. COMPLETION OF THE WORK AUTHORIZED) N.° 1206<t Z uoto ...... ; ................................................ , ~9 ....... Permissiori is hereby granted to: ..~ · .... ..... x ............. .....~... ............ .......... ~.......~ ....... ~ ......... ~0 .., ......................................................................... ~ .............. {""~', i ..... K- ~'} ............ ~ .......... ~"" ~n~ Tox. ~op ~o. ~u~u ~ecbon ........................ ~ ?..~., ........... ~...~ ~o. ~ ....................... Building inspector. ~ ; ............... Building n.speCtor }6130/[80 FORM NO. 6 TOWN OF SOUTHOLD Bu,{ding Depar~men~ Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY R~, ~o-la.Te Instructions A. Th~s app]icat;on must be filled in typewriter OR ink, and subr~itted in duplicate to the Building ~nspec- tot with the following; for new bui!diogs or new use: 1. F~na] su~ey of property ~Ih accurate ~ocat~os of a~ buildings, property ~nes, streets, and natural or toPograoh;c features. 2.Final approval of Hegth Dept. of water supply and seweraae dispose -(S-9 form or equal). 3.Approval of electrical installation from Board of Fire Und~riters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar building~ and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5.Submk Planning Board approval of completed site plan requirements where applicab e. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildinas and "pre-existing" land uses: 1. Accurate ~¢/ey of peoperty showing all property lines, ~reets, buiMings and unusual natural or topograph ic features. 2.Sworn s~atement of owner or previous owner as to use, occupancy and condition of buildings. 3. Da~e of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a ce~flca~e. ¢- C. Fees: 1. Ce~ificate of occupancy $5.00 ~ 2. Certificate of occupancy on pre-existing dwelling ~r land use ~/~/~5.00 3. Copy of certificate of occupancy $1.00 Date .. ~ .... New Building ............. OM or Pre-existing BuiMing(~) .. ........ = ZVscant Land Location of Property .... ~.~ ....... ~.QC-~.Y.,. R~] ~:~. :. g~ :'. ...... ..... ......... Hou~ No. S~ree r Ham/et Owner or Owners of Property ..... . , County Tax Map No,.1000 Section .... 0.~ ....... Block ,.. ~ ~ ......... Lot.. ~0:~ ......... ~ - . Subd v son. ~'~D~:~. ~.% ...... F~l'ed Map'No..3:7~5...Lot No.' Permit No .......... De,eof Permit . .. . : p~ App ' Health Dept. Approve{ ....................... Labor De . ro~at ....................... Unde~vriters Approval .... ~ ............. Planning Board Approval .................. ' Request for Temporary Certificate ........... FFnal Certificate ................. Fee Submitted S ~ ' Cpnstrucdon on above described building and rer~i~' meet~ all app~cabl~odes and ragu latiQns. - - _"% c ...... .... ' . - -.; · ...:: · ' ':: t.' :"' - :-' EIELD INS{~E~T iON 1. FOUNDATION (1st) FOUNDATION (2nd) 2. COMMENTS ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved .~..O-g~.. ~. ..... , 1~..c~ Permit No../(c27.4~.( .~.:- Disapproved a/c ...... ~-;;- ..... i i:. · i>~....~ Application No...L/.~..~.. (. ·~. ...... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets 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 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 issued 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 building for necessary inspections./ ,~ ........... (Si~natur~]of a~plicant, or name, if a corporation) · ' ' (Mailing address of applicant) il3~Cq State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· ...................... ~..~ ~.~ ............................................................. Name of owner of premises .. ~b .[ ~-~. lx~.[~.. ~.x/ ..... ].3X.~ ~..~X.~.(~,'.M. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Electrician's License No ....................... Other Trade's License No ...................... I. Location of land on which proposed work will be done .................................................. ·..q.5... KO.OK,. ¥... ¢.0.~ N'?.....~. ~., ................... ~ tiS.%, ht.&F, [ O.N...). ~ ,.~. ....... House Numbel~'°~°c"--~..~_...__. .~r, . ~¢ I Hamlet '" County Tax Map No. 1000 Section . Block '. ~ .... Lot..'~.~ .~0~ .... iled No... 2:..o, ..... ....... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........ ~ ............. -;,i ,' b i~i~'t; ...................... b. Intended use and occupancy '~O ~. ~ ~ ~ D *.,, ~.~ ,.,: ,;:~d'.~ *~ 3. Nature of work (check w~ch afiplicable): New Building ...~.~ .... Addition ..~. ....... Alteration .......... Repair ....... .~r~?.~: RemOval .............. Demolition .............. Other Work ............... (Description) 4 Estimated Cost ~ ~)~OOl,~' 0O . e ....................... ' (to be paid on filing this application) 5. If dwelling, number of dwelling 'units ............... Number of dwelling units on each floor ................ If garage, number of cars ........................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dnnenslons of existing structures ff any: Front ............... Rear .............. Depth ............... Height ............... Nun~ber of Stories ........................................................ Dimensions,~same structure with alterations or additions Front ................. Rear .................. Depth ... w~- ............... i.. Height ........ / ............. Numb? of Stories ...................... 8. Dimensions. of, entirqjtew, -- construction: Front ...............I ¢ Rear ... [ (~........./ Denth~ . ;~5~' .~.~! i ...... Height .. 1 3.'t'.1~- ...... Number of Stories ....... [ ................................. 9. Size of lot: Front .... [O.q .... ........... Rear.. l.O.q.,.,~& ........... Depth .Lq.5.,).O. i11 i~.~:~iii 10 [)ate of Purchase ~. Name of Former Owne ~I~ 11. Zone or use district in which pr~mises are situated~ .................................................... 12. Does proposed construction violate any zoning law?ordinance or regulation: ......... ~.~ ..................... 13. Will lot be regraded ...... ~-.~'~' '.O. ..................Will excess fill .b,e removed-- ' '--~_fr°m~vremises:__~eC- No 14. Name of Owner of premises ~.T6.F~..~.~., glSl:b~ 0LtAddress~,~. ~'.(~{ ¢'.T'; RI~ ,~,, ~ne ~o ~3(~ 'i~,g ~ ' '?qg Name of Architect .......... i ................. Address ................... Phone No ................ Name of Contractor ....... ' .................. ·. ................. Address . Phone No ................ PLOT DIAGRAM Locate clearly and distinctly alll buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. ~ loo ,o STATE OF NEW YORK, iS.S COUNTY OF ................. .... .,.~..?(..O,¢6 .~.~.t~.../~ ~t~B. CC.~..~. ~.C~, .................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ...................... : ................................................................... ~ (Contractor, agent, corporate officer, etc.) of saki owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contfiined in this application are true to the best of his knowledge and belief; and that the work will be performed in the manne~ set forth in the application filed therewith. Sworn to before me this Notary Publi~..~..~..~.~..~----~..~ County · / ' ' NOTARY ~ILIC, Stile of New Y~rk /~ ,,~F~.(..~,~-/(. ~ .1 . Ne, 4751573, $uffelk ~ntl. ~ I ' ( ignature o applicant) Term Expires f~Irch N 2 ND,V T'~L N ~ IT~ PL~AN 7&54802 9 AM TO 4 PM FO~ / INSPECTIONS' ' &NI~T HI ~ A