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Home My WebLink About11987-z FORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z.l.lfi. ~ 9 .......... Date ....J.a.n..u.a?.y...2.8 .................. 198.3.. THIS CERTIFIES that the building . .a.c}d..k .~.J_.qn. ..................................... Location of Property . .6..4p .............. 5lgr.~.h...B.ay.v.~. 9.w..R. 9 .a.d ........... .S.qq t..hp.l.d' .. House No. Street Hamlet County Tax Map No. 1000 Section . .0. ? .8 ....... Block . .0. 9. ........... Lot .,. 0..4 .2 ........... Subdivision .... X. ........... ~- .............. Filed Map No..X. ...... Lot No....X. ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated October 21 19 82 pursuant to which Building Permit No. 11987 Z dated .... 9.c.t< Q]9~?..2.7 ............ 19 .8.2., was issued, and conforms to all of the requirements o¢ the applicable provisions of the law. The occupancy for which this certificate is issued is ......... .. % ~.a.c..ag~..a..d.d.i.~. ~. 9.n..~.9..e.x.~. s..~.S_.n.g..d.w.e. ~..]_~.n.g, ............................... The certificate is issued to ...... .T.H.O, .M.A,S. ,J, :..&..T..E.R.R.I., .L.E~;..E..L.A.K, ..................... (owner, le~e or-tek,t4 of the aforesaid building. Suffolk County Department of Health Approval ...n./..a .................................... UNDERWRITERS CERTIFICATE NO ........... n./..a .................................... Building Inspector Rev. 1/81 FORM ~qo. 2 TOWN O~ ~OV~OI~I~ · BUILDING DEPARTMENT TOWN HAL~ souTHOLD, N~ Y. ~ BUILDING PERMITi (THIS PERMIT MUST BE KEPT ON THE PRE/~IS~S COMPLETION OF THE WORK AUTHORIZED) UNTIL EULL N'? 119 8 7 Z Dote ... ....... ~ ................ ~, .......................... , Permissio~ is hereby grante~ . · ....~-=:..~........-......=..- .... ~. ...~~.~.,~.:~.,.=.........; _ .......................................... :, .................................................... . ................. ,~ ........................... L./ ......... ................ : ........ '~ ................... g~:: ............... ~:'""=:~ ............ ut~l~'7~ ......... ~'~""7' ~' ......... . at premises located at ................................................ ~ ......; ................ ~'.*t ...... .......................... ...... ........................................................................... ~.-, ...... :..:...~ .............. Coun~ Tax Map No. 1000 Section ..~.7~ ;.. ~Block ~ g ~ . ~ ..... ,.,Lot No.;.g.~ ...... : ....... pursuant to application dated ...... ~....,.........~..];...~......, 1 nd ~approv~ by the Building Inspector. Fee $ ....... ~ ................ Building Inspectdr FORM NO. 6 TOWN OF SOUTHOLD Building Depar~men~ Town Hall SouthoM, N. ~." .... FOR CERTJ?iCATE OF OCCUPANCY Ins~ructions A. This apoI cat on must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor wit. h the following; for new bui!dings or new usa; 1. Final sunzey of property with accurate location of all buildings, property lines, streets, and unusuai natural or tooograohic features. 2. Final approval of Health Dept. of water supp y and.~ewerage dispose --(S-9 form or equal). 3.Approval of electrical installation from Board of Fire Unden~¢riters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar bu[Iding~ 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 buildinas ahd "pre-existing" land uses: - 1. Accurate ~nzey of peoperty showing all prooerty lines, ~reets, buildings and unusual natural or topographic features. ' 2.Sworn s(atement of o~vner 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 ce~ifica~e. ./ C. Fees: 1. Ce~ificate of occupancy 85.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 New Build ng ~.~ ..... Old or Pre-existing Building(Z} .. ....... = /Vacant Land .......... -, Ham/et OwnerorOwnersofPrope,ty '~O~j' ~ ~ /e~ 78 - .o9 County Tax Map No..lO00 Section ........ Block .............. at Suboiwsion .... ~ ........................... Filed Map'No ........... Lot No, Health Oept Approval Labor Dept Approval .... Unde~,vriters Approval .......... Planning Board Approval Request for Temporary Certificate ~ ' Final Ce tificate - ~SELD'INSPECTION COMMENTS FOUNDATION {qst) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING 3. INSULATION PER N. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ExaminedC . Approved 7..>. . .... , (Building Inspector) APPLICATION FOR BUILDING PERMIT Application ..... 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,jssuance 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, ~luilding code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary i~]spections. ~, ....... (Signature of applicant, or name, if a corp6fation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...~...D..°Y.'Q.*.-~..~-.. ' ~ .I.er -.t ......................................... (as on the tax roll or latest deed If applicant is a co~oration, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .... 1./..~.'. .............. Plumber s License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. House Number Str&et O ~. Hamlet County Tax Map No. 1000 Section .0 ~ .8?. ~ ~ ...... 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 ........... '... ~. ~ ~. .L .'. ~. l ................ b. Intended use and occupancy ....... q-. ~. ~ ........ .~ ............................... 3. Natt~re of work (check which applicable): New Building .......... Addition .......... Alteration .......... ~epair .............. Removal ............. 4. Estimated Cost .... .~. 0. (~ !(,.D ~..q~..~D ..... Demolition .............. Other Work ............... ./.~.. ~. (Description) ...... 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 nqture and extent of er~cl~ type of use Depth . ~ .......... 7. Dimensions of existing structures, if any: Front ~.~.o. .......... Rear .4~ ..C). ........ ' ........... ~ ......... Height .'P,..~ '. ......... Number of Stories .... ~. ................................................. Dimensions of same structure with alterations or additions: Front ..~..-7. ~.~ ......... Rear . .7. ~ ............ Depth... 2~.~.~ ............ !.. Height .... T-~ ~ ~ .............. Number 9f Stories....>~-. ....... ~ ........ 8. Dimensions of egtire new construction: Front... [ .-)..~ ........ Rear . .'2~ .LI ......... Depth . .~-.'7_ ......... Height . ...]. ' ......... Number of Stones ...................................... 9. Size of lot. Front .. I .~.~,, .2.:7, ......... Rear ... 1/~r)....[.~. ......... Depth . .2~ ........ 10. Date of Purchase ' ~--~ .. Name of Former Owner ....... '. .... 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violhte any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ........ /~,1.~ ................ Will excess fill be removed from premises: Yes No 14. Name Of Owner of premises ...~ ................. Address ................... Phone No ................ Name of Architect : Address ................... Phone No ................ Name of Contractor ......... . ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly allI 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 NEV~Y!ORK, above named. duly sworn, deposes and says that he is the applicant He is the ................... ~: .... ~ ................................... ; ............... of said owner or owners/, and is duly authon~ed ~ 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 : .......... ........... dayo .... a P? ................ ' .Co.nt .7 I ~lor~s¥ ~ua[t0, st~t, o~ ~I0~ ~lignature of applicant) No.i 52-8125850, Suffolk Coun_ty. , L E~" EL,qkL .