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Home My WebLink About11893-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No... Z 11.3 73 ........ Date .... D. e..cg.m.b.e..r' .1.6. ................ 19..8 .2 THIS CERTIFIES that the building ................................................ Location of Property ..... 430..Skunk ,Lan.~, C u t c h o gu e Ho~,~e ~Vo. 's'd~3i ................... h3~M County Tax N{ap No. 1000 Section .. 09.7. ...... Block ...0.3 ........... Lot ...0 9.8 ............ Subdivision X X ............................... Flied M[ap No...X ...... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated · . .Aucj~.sL. 3.L ....... , 1982. pursuant to which Building Permit No.. ,]-i]-.8.9..3 .............. dated ..... S ep, ternb~2c. 8 .......... 19 .~3 ~, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certific~ate is issued is ......... · · .re3.,ocate..exis,ting. ,cj. ar ag.a ,&. c.o.n~t3r.u~c.t.. B.e.w' .fg.u, qd..a.~.i, qn. ................ The certificate is issued to ... Craig..and, Susan..Lehm~,nr~ ................... (owner, le,~e~-t~mmt~ ......... of the aforesaid building. ,, Suffolk County Department of Health Approval .N/&. UNDERWRITERS CERTIFICATE NO. Iq/P~.. . Buildino Inspector TOWN OF $OUTH0~ ~ BUILDING D~pARTME~iT TOWN HALL · SOUTHOLD, N'. Y. BUILDING P,ERMITi (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL'GULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: _ BUilding I~spector. Fee $.(..I ................... Rev.; 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Buiiding Deparzmen~ 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 ~vater supply and sewerage disposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, fndustrial buildings, Multiple Residences and similar building~ 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 ahd "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 ' v New Building ............. Old or Pre-existing Building(X) ........ =/Vacant Land .......... Loeat on of Property .... - Hou~ No, Seres r Ham/et Subdivision Filed Map-No Lot No ' Health Dept. Approval ........................ Labor Dept. Approval ......................... Unde~riters Approval ........................ Planning Board Approval , Request for Temporary Certificate ..................... Final Cerdficat~ Construction on above described building and~er~i~me~ll apP~cabl~odes and r~gulations. FIELD-INSPECTION FOUNDATION FOUNDATION (1st) ROUGH FRAME & FLUMBING (2nd) INSULATION FER N. STATE ENERGY C,.ODE FINAL DATE COMMENTS ADDITIONAL COMMENTS: C~A1G t4.81' ~"/'50"E. ~cale: 40%' I' - 1";'4-.Z $ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 76§-1803 .... Approved ............... No ........... Disapproved a/c ...?:.........~~.. (Build~ag t~nspector) APPLICATION FOR BUILDING PERMIT Application No../. (.a.f.T?. ....... Date Dtl.t3bt.g~5...3. t.t .., 19 .~.~.. 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, ho~ng code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. Cxx [ \ oration) tlS. (Mailing address of applicant) [ / ~ $,5~ ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............. ........................................................................ Name of owner of premises ....~.~..~. [~.f~..M..A)../..~..~._. t~...~...~.~..D.....6)..~... ............................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ...... 71.: ................ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done.. ~. 7. ~ ~. ¢ ~ ~.. b~. ~.... ~. ~. ~. ¢~.~gJ~ · .~..~ ~.~ ~7. House Number Street Hamlet County Tax Map No. 1000 Section ....... ~..~. ~ ..... Block ....... D. ~ ...... Lot .... ~. 2. ~ ....... Subdivision ......... ~.0 ~ .~ ..................... Filed Map No ..... ~ ........ Lot ....... ~ ....... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........ ~.. ~. g.~...¢ ~.'¢i~.~.~.. b. Intended use and occupancy .......................... ~.~ ........................................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal ..... ~/. ....... Demolition .............. Other Work .$~.~... (5...~.~.o. qJ 4. Estimated Cost .............. ~ ...................... Fee ....... , ..................... (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. Dlmensmns of ex~stmg structures, ffany: Front ...... /?. ....... Rear ..... ~' ........ Depth...].~ .......... Height . ! ~.. (q rrr. ~.). Number of Stories ..... ~[ .................................................. Dimensions of same structure with alterations or additions: Front ..... ~/1 p} ¢ ....... Rear .... $~q t~.~ ........ Depth ...... 51:t Fl i. ......... Height ....... 5~ 0~t~ ......... Number of Stories .... ~.~ (r//~ ............ 8. [)imensions of entire new construction: Front ....... '-n. ....... Rear ............... Depth ............... Height ............... Number of Stories ................. ) ...................................... 9. Size oflot' Front . ~.j).O ~ GO/ Rear [oO. OO Denth I~--c.O0 / 11. Zone or use district in which premises are situated... [~.~ ~.b ~. M'~.IF} .~..../~[ ............................ 12. r)oes proposed construction violate any zoning law, ordinance or regulation: ..... t~ .5. ........................ 13. Will lot be regraded ..... ~0..... ................. Will excess fill be removed from premises: ~ Yes No 14. Name of Owner of premises ~.[~'~..[C~q/4.~..{..R~.. Address/g.a.to.r/.}:4~,, .~'d.0~t/q~lt/e'Phone No. /7 ~g? eX [~.~ ... Name of Architect ........................... Address ................... Phone No ................ Name of Contractor ......... : ................. Address ................... 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 according to deed, and show street names and indicate whether interior or corner lot. STATE OF NE~ORK ~ S COUNTY OF. i~.O.F.~. O..lw.~... ~' ........................ .~(A,.q/~ .~.. J~{~14:.07.~.~/~). being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. .eisthe ....... .... ........................................................... (Contractor, agent, corporate officer, etc.) of said 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 contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ......... / . ..:. ..... dayof ) . , , ..... No,fy Public, .... .~... 2.~.. ~ ........ ~-/.,¢~County 0 , ~n ,~n ~.1~ ~ ................... I no~ ~um~, stm ~ n~ v,n / (Signature of applicant) NO, 52-8125850, Suff/~k Coup. / ; ?e~m ~xpires M~rch 30, l~