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Home My WebLink About11970-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z.I.~ 5 p.4 .......... Date ....... ?.e.b.v, .u .a ?. y. . .2 5 ............ ,198, .3. THIS CERTIFIES that the building . .~.d.d. $.~.$. q n. ..................................... Location of Property .6. 3.6.0. ............... .B?.e, .~.~F.e. ~..e ?..~ o..~.d .......... ~.e.'c.~. z.' ?.u.c.~,., House No. Street Hem/et County Tax Map No. I000 Section ,, ~ .0.6 ....... Block . .0. c) ........... Lot ... ,0.0.2. .......... Subdivision .... .X .......................... Filed Map No..X, ...... Lot No..X ............ conforms substantially to the Application for Building Permit heretofore filed in tiffs office dated .... 0. q ~ ~).b.e. ~.. ~3 ....... , 19 .~} .2 pursuant to which Building Permit No...t .1.9. 7. 9..~. .......... .' dated ....O.q ~. 9.b.e.l~ . .1 .~ ........... ,.. 19 .8.2., was issued, and conforms to all of the requirements of the applicable provisions of the law, The occupancy for which tiffs certificate is issued is ......... .... fl...s.h.e.~ ~. g.c[c] .$ .L3.qn,. ?.o..e..x.5..s.g. 5; .n.g..s,e, .~.s.o.n.a, .]...c.o..f, .g ~.g.e.t..c).b. +.n..:/~.2.; ......... The certificate is issued to ........ ~ ?~.A.~ .D..L.a. ~..A.S.S.~. .................................. (owner, 4e~ee'or-terT~t/ of the aforesaid building, Suffolk County Department of Health Approval ... r~/.a ................................... UNDERWRITERS CERTIFICATE NO ........... naa ................................... Building Inspector Rev. 1/81 No. ~1970 Z · o~ ~o. 2 ~ TOW~ OF~SOU~TS~L~ SOUTHOLD, N~ ~. ~ : (THIS PE~IT MUST BE KEPT ON TH,E PR~I~ES,~ UNTIL COMPLETION OF THE WORK AUTHORIZED)' D~te FULL at premJses located at ......~......~....(~.. ........ ..... ~ ................................................................... CouhW Tqx Map No. 1000 Section .. . .,. Bilk ~ .......... ;}t~t No.t~ ...... purguant ~o application dotod ........ ,.....,,,..,:~:....~;,....~ 19~ ~nd opprovod by the Bu I~lng 19spectOr.~ ~ Roy. 6/30~80 FORM NO. 6 ~,TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPL~CAT~O~ ?OR CERTI?iCATE OF OCCUPANCY Iflstruat]ons A. This applicat on must be filled in typewriter DR ink, and subn~itted in duplicate to the Building Inspec- tor ,.rich the followiflg; for gew bui~d{n~s or new use: 1. Final sun~ey of property with accurate location of ali buiidlngs, prooerty lines, streets, and unu~a, n~tural or tooograoh[c fan.res. 2. Fina~ approval of Heaith Dept. of water sugply and seweraee disoosat--(S-g form or equal). 3. Approval of electrlcaj instaJlation from Bo~rd of Fire Und~rit~rs. 4. Commercial buildings, industrial buildings, Multiple Residences and similar buiiding~ and installa- tions, a certificate of Code compfiance from the Architect or Eng{neer responsible for the building. 5. SubmJ~ Planning Board approval of completed srte plan requirements where appficabfe. B. For existing buildings (prior to April 1957), Non-conforming uses, or build)nas and "pre-existing" land uses: 1. Accurate ~p/e~ of peeperw show~ng all pro~erty lines, ~reets, buildings and unusual natura~ or topographic features. ' 2. Swam statement of owner or prev[ous owner as to use, occupanc,/and condition of buildlngs, 3. Da~e of any housiR9 code or safety inspection of build~ngs or premises, or other pertinent informa- tion required to prepare a ce~ificate. '/ C. Fees: 1. C8~fficate of occupancy $5.00 2. C~rtificste of occurancy on pre-ex~s~ing dwelling or land use 3. Copy of certificate of occupancy $1.00 New ~'!~}~g .~-~, ' ' ~t~. Old or Pre-existing Building(X) / =/Vacant Land ". .......... Co ,t T: M:pmo O00Seo:ion ....... 9:ook ...... Sub¢[vis}on Filed Map'No ; Lo~ No ' Health Dept. Approval ...... ~. ' .... Labor Dap(. Approval ...................... ,.. - Undenvriters Approval .... ~, * ..... .Planning Board Approval Request for Temporary Certificate ' .................... Final Card ficate Construct¢on on above described buJldin0 and permit'mee~s all applJ~abf~odes and regul3tions. O,o. /5-0¢ " - .............. · ..... · . ;'-.¢:} .... ],.,'.. ;..' : .. (... .,' F1ELD~ INSRECTION FOUNDATION (1st) COMMENTS FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER STATE ENERGY G,ODE FINAL ADDITIONAL COMMENTS: Memorandum from.... BUILDING INSPECTORS OFFICE TOXYN OF SOUT~IOLD TOWN HALL, SOUTHOLD, Iq'. Y. 11971 ' 765-1802 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y, 11971 TEL.: 765-1803 Disapproved a/c .... ~ ...., ............... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No..~..~.6.). ......... a. This application must be completely filled in by typewriter or in ink and submitted in triplicate 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, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. . .../_f.:.4ex ;. .. (Signature of applicafit, or name, if a co pot t'on) .......... ,,,'h . zY, ld.,.'. .............. (Mailing address of adpplicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ¢ /3 u ........ Name of owner of premises . .~.~A~.../~'..~..~..~. ..... .~...~......~..,~..~.. ~:'~. ................................. (as on the tax roll or latest deed) If ap,~t is a corporation, signature of duly authorized officer. . ......... (Name and title of corporate offi'cfir) Builder's License No ..... ..~. ~. ............... Plumber's License No ......................... Electrician's License No~.~. ...~. · .~,, Other Trade's License No ...................... 1. Location of land on which proposed work will be done...Z~.~... House Number ~-r//~t/-~ Street Hamlet County Tax Map No. 1000 Section .... ./.tg..~. ........ Block ..... .~. ........... Lot...~ .............. Subdivision ..................................... 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... 't'' '~' '~" '/~' '/'/'/' · · ~?.~..~..X.Z../..A/..~j ............................... b. Intended use and occupancy ....... ~..?]..Ad..~. ........................ ............................ 3. Nature of work (check which applicable): New Building .......... Addition .... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... 4. Estimated Cost ...o ~. 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. Dimensions of existing structures, if any: Front ...... /, fix/. ....Rear ..... /a°5. ...... Depth .../.,0 .......... Height . . .//.. f ....... Number of Stories . .../ ..... i ............................... ~ .............. Dimensions of same structure with alterations or additions: Front .... /(.~. ........ Rear ..... ~. ............ Depth .. .... ~ ~.~ t. ......... i Height ..... ~/~t. ~9~. ........ Number of Stories ..... / ................ 8. Dimensions of entire new construction: Front ......... ] ...... Rear ............... Depth ............... Height Number of Stories 9. Size of lot: Front ............ ~ ......... Rear ...................... Depth ...................... 10. Date of Purchase ............ ~ ................ Name of Former Owner ............................. 11. Zone or use district in which premises are situated ..................................................... 12, Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded .......... i ......... ~. ........ Will excess fill be removed from premises. Yes No 14. Name of Owner of premises . ~ ~..~.~...~.~.~..-~.. Address ................... Phone No ................ Name.of Architect 'i~. ~ ~1~.'' i...[ ........... Address ................... Phone No ................ Name of Contractor /.~.4/~.~-'~ .~.o.~ff..-4../}W~tdress ...~.~.~ .... Phone No..,g..~..~.-..~Q...~. ?. 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. STAT/,; OF NEW Y~RK, ~5 c, -te'~oz ~ S.S COUNTY OF ................. ..J/iaN./.~.O....../~.. ~ .... ~:...' ........ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract)- above named. (Contractor, agent, corporate officer, etc.) of sakt owner or owners, ~d is duly authorized to perform or have perfo~ed the said work and to m~e and file this application;j that ~1 statements contg~ed ~ this application are true to the best of his knowledge and belief; and that the work will be perfomed in the m~n~r set forth in the application filed therewith. Sworn to before me this ........ : ..... ayoS .... No¢~ Public, . ........ NI, ~2,8125850, Suffolk Co~., NOTIEY Bi!I¢Dlix, G D~P~RTMENT AT 765;1802 9 AM TO 4 PM FOR' THE EOLLO\MING I"~cDECTIONS: ,1. FOUNF'ATION -' TWO R, EQU~ED FOR PQUP. CD CONCRETE 2. ROUGN - FRAMING & pf_UMB~G 3. INSUf 4, FINAl. - ¢?~STRU~TIQN MUST BE C~°!rTE FOR C O. ALL CON~R~¢CTtON ~HALL MEET THE REOIffR~ME~S OF THE STATE CON%RUCTION '& ENERGY CODES NOT RESPONSIBLE FOR DESIGN OR CON.RUCTION ERRORS.