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Home My WebLink About11864-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..g. 1. ! .4 .8.9 .......... Date ...... .F.e.b.r.u..a ?.¥..2..2 ..............198..3. THIS CERTIFIES that the building deck addition Location of Property 250 Smith Drive North Southold hi~Js~ ~iol ....................... 's'd~ ....................... h~,;,i~ County Tax Map No. 1000 Section . . 9.7.6 ....... Block . .0..2 ........... Lot .. 0..~ .9 ............ Subdivision....G 9.o.s.e...N.e.q k. ................ Filed Map No.. 6. 6..3 ....Lot No..8.5. r .8.6 ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated .... ~.u.g.u.s.t...~ J ......., 19.8..2pursuant to Which Building Permit No...~.1.8.6..4..Z. ........... dated .... ~.u.g¢.s.t.. ! 7 .............. 19.8.2., 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 ......... a deck addition to existing one-family dwelling. The certificate is issued to WILLIAM J & CLARA A. COLEMAN ..................... ..................... of the aforesaid building. Suffolk County Department of Health Approval ....n/.a. ................................... UNDERWRITERS CERTIFICATE NO .... n / a Building Inspector Rev. 1/81 : TOWN 'OF ~OU~H0!~D F BUILDING DEPARTMI NT TOWN HALL SOUTHOLD,. N:- Y.' BUILDING P,i:RMIT (THIS PERMIT MUST BE KEPT ON TH,~ PREMISES UNTIL EULL COMPLETION OF THE WORK AUTHORIZED) Permissiofi is hereby ~t~nted to: .~~ C~unty Building Ihspector. :/' ( } Rev. 6~30~80 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 subr~itted 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 disposat-(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 requirementswhere 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.. New Building . ~.~, ..... Old or, P~re-exJstin~ Building(X) ........ =/Vacant Land .......... Owner or Owners of Property .......... 7 ~.,~.~L~...t ................ County Tax MapNo. ,000Section ...~.[/~ ....... Block..~ ......... Lot.../~...~ ....... Health Dept. Approval ........................ Labor Dept. Approval ........... Unde~riters Approval Planning Board Approval Request for Temporary Certificate ..................... Final Certificat~ ..... ~ ....... Fee Submitted $ ........................... F~ELD ~NS?ECTION FOUNDATION ( 1 st) FOUNDATION (2nd) 2e ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY q. ODE FINAL COMMENTS ADDITIONAL COMMENTS: t [ 7 7.'?'?~ CF 3OUTHOLD ~U.LDiNG DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 e~. TEL.: 765-1802 E×amin ./.7 ..... , , ..~- ......................... // ...... // APPLICATION FOR BUILDING PERMIT Application No.../.?...6~..~. ....... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted.~ 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 Southotd, 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 regul~ions, and to admit authorized inspectors on premises and in buildings for necest&a~ry i~ections. /~ //t ........."-'7',,/,~ (.~,~¢,fe'd. V.,l,¢. .~. . . ................... lj.:.d ._, . ;; d '~ , ;"; ' i ...... . (Signature of applicant, name, if a co po at'on) .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... ................................................................................. -.a."- -fl Nam f fp i ' eo ownero remses ....................................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of c~porate officer) Builder's License No .... .'~, ~..~..~ ............... Plumber's LicenseNo ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done ..... . .~..~.0...~. !.~. .................................. .s. ...... .... ............................. ...................... House Numbe~ Street Hamlet County Tax Map No. 1000 Section ...~.r~.¢ .......... Block.. ~ ............. Lot... [¢. ............. Subdivision .~..~...5~.. ~.~ .~. .................... Filed Map No./~..~. ......... Lot: .~.77. t~ ..... (Name) , State existing use and occupancy of premises and~ntended use ~ind occupancy of proposed construction: a. Existing use ailS occupancy ....... ~..~'..~'~.~.. ................................................ b. Intended use and occupancy . ].2.: X.[.~..t .... /t~...~ ............................................. ~'-- ~, e~ (Description) (to be paid on illin§ this application) 5. I f dwelling, number of dwellinglunits ............... Number of dwelling units on each floor ................ If garage, number of cars .... ~ ................................................................... 6. If business, commercial or mixe'd occupancy, specify naJ;ure, atad extent of each ty2ooe of l~Se .................. , .... 7. Dimensions of existing structures, if any: Front .... ~.....q! ..... Rear ... d~-'..t'/0. ... Depth....d~r... ~ ..... Heigh~ ............... Number of Stories. ...... /. .................................... , ............ Dimensions ~s~me structure with alterations or additions: Front . ..~.~ ............ Rear ...~t'~ ............. Depth ................... ~.. Height ................. Number,of Stories... [ .................. 8. Dimensions o£entire new ¢onstructmn: Front... ]~ ......... Rear .... ~ .......... Depth .../.~; .......... Height ...... ~ ........ Number of Stories .... --~. ....... ,~, ........................... ~ ............... 10. DatedfPurchase .......... i .................. Nameo.fFo,rmerO.wner ..:.~'.~'./~'~4'7~ ......... 11. Zone or use district in which pr~mises are situated ........ Jf'~Yt'&.k'9~.~ !~..~ ............................... 12. Does proposed construction rio)ate any zoning law, ordinance or regulation: .... .3(.~ ......................... 13. Will lot be regraded ........ ~, .,0/~ ..... ~ .......... Will excess fill be removed from premises: ~.,.5~e~ .~[~...No 14. Name of Owner of premises . ~d.l.t..~fl~...~'. Address ...Z~..QT.~.ap~ ......... Phone No ........ Name of Architect ......... ; n..... Address ' Phone No ..... ' .... Nmne of Contractor..."T~ iU~o.*.l~.. Address i i~.' i ~t~.~i Phone No..t{~7. , i PLOT DIAGRAM Locate .clearly and distinctly ali 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. STATE OF NE~fi~OI~,,~ ! COUNT~,ff-~ ',q , ......... ?~;~~---~' ,~--~ sT~&;;v;JS;;:i;]"'~ ~"~*~ -,~'c77;;:c;; .......... berg duly sworn, deposes and says that he is the applicant above named. , He is th .......................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have perfomed the said work and to m~e and file this application; that all statements contained ~ this application a~ true to the best of his knowledge and belief; and that the work will be perfomed in the mann6r set forth ~ the application filed therewith. Sworn to before me this ..... .... .... .... ..................... ~__/ ........ [ .... No. 52-~524711