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Home My WebLink About11935-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hail Southold, N.Y. Certificate Of Occupancy No. ZZ1.371 .......... Date .... D.e, cem.b.o.r.. J_.6 ................ 19 .8.2. THIS CERTIFIES that the building ................................................ Location of Property .. 15 3.0.5 . Ne.w..Suf£.Q ~..AXe ,..5.0...G.r.a.~h...wg.h.1...R.d...,..N. 9.w' .S.u..~.~.o. House No. Street Ham/et County Tax Map No. 1000 Section . ./,J, 7 ....... Block . .0.6. ........... Lot . . .0. J:5. ........... Subdivision ...... X. ........................ Filed Map No.. X. ...... Lot No .... X, ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ S~]~temher'. 2,419.8.2 pursuant to wlfi~h Building Permit No....~.1.9.3.5. Z. ............ dated .. S e.pA;ernb.e.r. 2 Y ............ 19 .8.2., was issued, and conforms to all of tlte requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ....cons.tmuc~:..acces.aorT..l~u $ J..d.i.n. cj ........................................... The certificate is issued to . . .Frmlk. .... io¥.'o;, ................ . ...... of the aforesaid building. Suffolk Connty Department of Health Approval ...hl/K ................................... UNDERWRITERS CERTIFICATE NO .......... .N./,A. .................................... Rev, 1/81 Building Inspector (THIS pERMiT MUST BE KEPT ON: ~H,E' P~gEMIStS UNTIL qULL COMPL~ION OF THE WORK ~HTHoRi~tD) ~ ~ ~ N? ~1935 Z 6~e ..... , ]*..~ Permissio. is hereby granted to:/ / . ~/ . V; ~ at p~emise~ Couhty Tc~x Map No. 1000 sectio~...../..,..Z...;:,:, BIo~ck~ ~..~.~.:...?...[Lot No..(,~../.~... ......... pursuant to application dated ~-~:~~'..~..:;,, ~ 19~ and ~approved by the Builalng Ihspector, ; FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southo~d, l~. ~, ' .... APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and sub~ tted in duplicate to the Building Inspec. tot wi~h the following; for new buildings or new use: 1. Final survey of property with accurate location of all buiMings, property lines, streets, and unusual natural or topograohic 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 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 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. ! C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 New Building .... Old or Pre-existing Building(X) ......... ~ ~Vacant [.and Location of Property House No. Owner or Owners of Property ...... .~. (:L,%~.~ ~ ............................... County Tax Map No 1000 Section ' Block Subdivision Filed Map'No ' Lot No · · · -r ,, .......... Applicant ................. Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. Underwriters Approval ........................ Planning Board Approval .................. Request for Temporary Certificate Final Certificat~ Fee Submitted $ Construction on above described building and per~'irmeets all app~cable~codes and regulations. - , _: ........... .............................. FORM NO. 6 TOWN OF SOUTHOLD Buiiding Department Town Halt $outho~d, N.¥, 1 i@71 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in Wpewriter OF~ ink, and subr~itted in duplicate to the Building Inspec- tor with ~he following; for new buildings or new usa: 1. Fina~ survey/ of property with accurate location of all buildings, property lines, streets, and unusual natural or zooograohic fe3tures. 2. FinalepprovatofHeaJth Depz ofwa:~ersupplyandseweregedisposa[_(S.g form or equal). 3. Approva( of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and sm ar buildina~ and installa ~ t..io,ns,.a ~cartif,ica~e of Code compliance from the Architect or Engineer responsible'~r the building~ o. ouom~t t'lanmng Board approval of completed site plan requirements where applicable. For existing buildings (prior to A~pril 19~?), Non-conforming uses, or bul]dings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and ~Jnusual 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, 1. Ca~ificate 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 NewBuild[ng ~..,~.~.... Old or Pre-existngBuilding(X) ' /Vacant and - Locat on of Property Hou~ No. ~ ~r~ Hamie~ Owner or Owners of Property .... . , Count~ Tax Map No,.1000 Section , , ~loc~ ............... Lot ........ Subdivision ................................. Fi~ed MapNo, ,.; ....... Lot No, Health Dept Approva~ . · Labor Dept Approval Unde~zriters Approva~ ........................ Planning Board Approval .... Request for Temporary Certificate ..................... Final Certificate' . .... ~.- ..... . , Fee Submitted S ..... Construction ..... on above qescr~bed budQ~ng aca permt['meet~ att aP~cabl~odes and regulations. R~. 10.10-78 FIELD ~NSP~CTI, ON COMMENTS FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUT',qOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ~.,=,,,~n~d...¢,Z. ,Z.Z; ........ .19~..¢" ^~pro,'e'~..7 ./.Z..Z ...... , l .¢~.'¢'. ~'er,,,~t No././.¢..'¢T.'C...~ Disapproved a/c ......... .~ ................. (Building Inspector) Application No../../?.'~.~?. 7 ..... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Duild Inspector, with 3 sets of plans, accurate plot plan to scale. Fcc according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stx or areas, and giYm§ a derailed descrip£ion of Iayout of property must be drawn on the dia~am which is part o¢'this ap cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon apprc.'al of this application, the Building Inspector will issue a Building Permit to the applicant. Such pen shall be kep~ on tile premises available for inspection .throughout the work. e. No buildb~, shall be occupied or osed in whole or in part for any purpose whatever until a Ce;tificate of Occupm shall have been granted by the Building Inspector. APPLICATION IS HEREBY blADE to the Building Department for th& issuance ora Building Permit'pursuant to Building Zone Ordinance of the Town 'of Southold, Suffolk County, New York, and other applicable Laws, Ordinances. Regulatioos, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descrilz Tko applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. _ / (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buik Nmnc of owner of premises ....................................... (aS'on the tax roll or latest deed) If applicant is a corporation, signature of duly attthorized officer. (Name and title of corporate officer) Builder's License No....~.~..( :.~. .......... Plumber's License N:_ ......................... Electrician's License No.' ...................... Other Trade's License No ...................... ~(1. Location oflandon xvhich proposed work will be done .... ?. ....... ........ ....... House Number Street Hamlet County Tax Map No. 1000 Section .... l.t..r"/ .......... Block .... .(7).(.9, .......... Lot...0./.~. ....... Subdivision .......... ~ ......................... Filed Map No... ~ .......... Lot..."4/ ......... (Name) State existiug use and occupancy of premises and intended us~, and occupancy of proposed construction: a. Existing use and occupancy ....................... 2 ..................... ,:.,, ~ · .',.. ~ .... 4 5. Nature of work (check whict,i, applicable): New Building ~Addition .......... Alteration ........ Repair .............. Removal .............. Demolition .............. Other ",York ............. Estimated Cost ....... If dwelling, number of dwelling units ..... Fee .'2f.?..O. o~'~. (,Description) (to be paid on filing this application) ......... Number of dwelling units on each floor ............. If garnge, hum bet o f cars .............. If business commercial or mixed occupancy specify f~0ture and extent of each type of use Dimensions of existing stnctures if any: Front ' Rear Depth Height Nmnber of Stories Dimensions of same structurei with alterations or additions: Front ................. Rear ............... Depth ............. i ....' ....llei~t ...................... Numbqt: of Stories .............. ~. Dimensions o£entire ne,v con'struction: Front .... /.Q ....... Rear .. ,/, .'7{7 ........ Depth ....... FO Nilmber of Stories Height .............. . .............................................. . 9 Size of lot: Front ' Rear Depth 10. Date 6fPurchase ......... : .................... Name of Former Owner II ' Zon~ or usa district in which premises situated ' ":, 12 Does proposed construction violate any zoning law ordinance or regulation: 13. Will Iot be regraded ....... !. · .' .................. Will excess fill be removed from premises:, ,Yes · N 14. Name of Owner of premises .i ................... Address ................... Phone No..7.3..'.~.-. ~ .~..c/f.. Name of Archirect ........ i ................. '.. Address ................... Phone No ............... Nan e of Contractor ' Address Phone No PLOT DIAGRAM . Locate clearly ~d distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions frm property lines. Give street and block number or description according to deed, and show sireet names and indicate wh=thc trite 'lot or~ corner lot. , /~ i( . c~ bev.:, named. ' () being duly sworn, deposes and says that he is the applicon ~-Ie is the ' (Contractor, agent, corporate officer, etc.) o't' said owner or owffers, and is dt~iI:.I authorized to perform or have performed file said work and to ,hake and file c~t~plication; that all statements contained in this application are true to the best of his knowledge and belief; and that th~ ~'ork will be performed in the manner set forth hi the application filed therewith. ~worn to before me tills ........ O~ ,/. ,~../ ..... day of.~-:5' ..., lg'~a~"l , ¢3~ '' · , COtlllty / -~ ........ 70; .... 'r~;~*~,~;~ ...... -,'0 , ~J ..... ,- .., :,,,,, ,' . ,,.,, . . (Signature of applicant