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Home My WebLink About11851-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southoid, N.Y. Certificate Of Occupancy No. Z 1 1 6 0 2 Date April 8 ~..5 ................................................. ,19 . Addition THIS CERTIFIES that the building ................................................ Lncatinn of Prnnertv 305 pvt. rd. #3 off Oaklawn Ave. Southald ....... ~ ~Hoa' ' 's' ~V'e o. .... ' ............ '''' ''' '' ' '' '' '*' '' ' ''' '' '' '' ''Street .... Ham~et' .... County Tax Map No. 1000 Section 070 .Block 06 .Lot q 2 Subdivision ..... .X ......................... Filed Map No. .X. ...... Lot No. X conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... ~ .~.g,~.s.~. ,5. .', ..... ,19~.2.. pursuant to which Building Permit No. ql85q Z dated ... ?.~.~.u.~.~..?.0 .............. 198.2.., 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 ......... Deck addition to existin~ dwelling The certificate is issued to Lawrence I~arks ..................... ..................... of the aforesaid building. Suffolk County Department of Health Approval ...N./.A. .................................... UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 Foal~ ~o, ~ TOWN OF $oUTHOI~D !' BUILDING DEPARTMENT TOWN H~LL sOUTH'OLD, H~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT oN THE PRE/~ISES UNTIL COMPLETION OF THE WORK AUTHORIZED) ULL N? 11851 Z Date .... ~<.~.....:;./..~. ........... , 19../~ Permission is hereby gronted to: ......... ~.~ ~ ~ ... ~..'. ;~ ~ ....... ~ ........ :.z~......~..z ........... ,o .....?~.a~~::; ....... ~,.~._:...~...i ..... :~ .. ................ ~ ....... . at premises ~ated at ..... ~'.e.~....~a,.~....~..~.~..:.,..~.m~.z~...,..~..~ Co~ ,~ ~p uo. ~o0o so~,o~ ..... ~.~. ..... ~ L..~..~ ........ lot ~o.: ...... ~.X..~.. pursuont ~o opplicotion doted ~ ~, Builaing Inspector. ' .....'~ "' .......... :", '~'''''' 19L and ,approv~ by the Rev. 6/30780 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 Build}rig 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. 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 .. NewBuidng C~.~.°.~. OdorPre-exstngBu ring(Z) ~ZVacantLand Local on of Pro ert O ~-'" '~ ':¢~ ........ ~:)~ "''" ........ p ...... ..... ....... ........ Stree~ Ham/et Owner or Owners of Property .... ~~.... ~..~ .................... County Tax Map No. 1000 Sectior~ ...d~...(~. .... Block . ..~ ~ ........ Lot .... .~.../:..~..... Subdivision .............. .~. ................ Filed Map No...~::. ....... Lot No.~.. ........... '/ J?~"/ -~' . .~.~.0...Applicant . Perm,,No. /. .... OateofPerm t Health Dept. Approvat ...... .~/.~. .............. Labor Dept. Approval .... . .~/.~ ............. ,.. Underwriters Approval ....... /¢¢?-. ............. Planning Board Approval . · . .~/~ .......... Request for Temporary Certificate ..................... Final Certificate .............. Fee Submitted $.. ~ ............... Construction on above described building and per.,,~e~s~c,L~pp~cable~codes and regulations. FIELD I~SPECTION COMMENTS ? FOUNDATION (lst) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C~ODE 4 o FINAL ADDITIONAL COMMENTS: R~g~at~ry Aff~O~ Unit. Bldg. 40~ SU~IY--Room 219 Stony Brook, NY 11794 (516} 151-I~00 A r~vi~ ~ be~n made of your proposal to: -~e.~- York S~e. Dep~ of Env~o~e~ Co~v~on h~ found Th~efore, no p~ und~ ~e 25 (TZ~ ~an~} of the Env~~ Co~v~on L~ ~ req~d sinc~ ~c propos~ ~ ~yo~ S~e Da~el Regional P~it Administrator DJL:RNT:~z FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Disapproved a/c ........... ~.&~ ................... (Bui ing inspector) APPLICATION FOR BUILDING PERMIT Application No.././.d~..~.'? ........ 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 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~d regulations, and to admit authorized inspectors on premises and in buildings for necessary inspectio~P /~ ~///~'&-,~tJ,~-~ t g PP , P ....... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (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 ..... .~.~.~..5 ............... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ..... : ................ Location of land on which proposed work will be done .................................................. ................ . . . .0. . . .oz. . ; ..... . . dd ........ ttouse Number Street Hamlet County Tax Map No. 1000 Section . ~.~. (~. ........... Block .... ~. ............ Lot.../.~. ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) ,- 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... /...~~...~ .~. ~ ................................... b. Intended use, and, occu,.pancy .~- · .~~~~. ~ · ~d. 10. 11. 12. 13. 14. Nature of work (check which applicable}.;.~I~w Building .......... Addition ........... Alteration .......... Repair .............. Rem6val . ..'~(~'~.... Demolition .............. Other Work .............. Estimated Cost ......... .~ e ................. (to be paid on filing this application) If dwelling, number of dwelling units .............. Number o f dwelling units on each floor ................ If garage, number of cars ........................................................................ If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... Dimensions ' ' ' if any: Front Rear Depth of ex~st~ng structures ............................................. Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .............. ,... Depth .................... ~.. Height ....................... Number of Stories ...................... Dimensions of entire new constrUction: Front ..... /.'.2-. ......Rear ............... Depth .~.~l. ......... Number of Stories ' Height ................................................................... Size of lot: Front ........... ........... Rear ...................... De h .De~t~ ~.. ................. Date of Purchase .... ~./~r..~. .................. Name of Former Owner Zone or use district in which premises are situated .................................. Does proposed construction vie!ate any zoning law, ordinance or regulation: ................................. Will lot be regraded ............................ Will ~xcess fill be removed from premises: .Yes No Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect .. ~I ............ ~ ~ ..... Address .......... Phone No ...... "-'~/Z' ' "~ Name of Contractor./~(,~te[~,~z~z~ddress ~.~)i 61 ~.7 ..... Phone No. ,-~...~.~.~..~". · PLOT DIAGRAM Locate clearly and distinctly all. buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block 'number or description a~cording to deed, and show street names and indicate whether interior or corner lot. ~ i 0.~'0O~,~ STATE OF NEW~X~)R~,../~, .~ ~ 'S S COUNTY ~ · ........ ./ff.. i..../../..: .... ~ .................... being drily 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 said owner or ownen, ~d is duly autkorized to perform or have perfomed the said work and to m~e ~d file this application;that all statements contained ~ this application are true to the best of his knowledge and belief; and that the woik will be perfomed in the m~ner set forth in the application filed therewith. Sworn to before me th~ ~ 52-0344963 Suffol~ ~un~~ · ~misslon Expires March 00, .J q: U. 0