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Home My WebLink About11716-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z.fl.34/36 .......... Date ............. .i~.a;y..!./3 ............, ]9~.~.. THIS CERTIFIES that the building-~d.e. Clg. &d,(}$.~_.qn.., .............................. Location of Property .. 398.0. ................ .~.~ .c.k~.~.m...~M.e... ............... ~..~.'b.i.~.~. 9k House No. Street Hamlet County Tax Map No. 1000 Section ... q 0.~. ..... Block .. f] 0 .......... Lot ...Q9.4 ........... Subdivision ....... .X. ...................... Filed Map No...X. ..... Lot No....X .......... conforms substantially to the Application for Building permi~t heretofore filed in this office dated .... ~[~7. ~ .......... 19 .~.2. pursuant to which Building Permit No .... 5.~l.~J G. ~ ......... dated ........ Jl2,I~,e. c) ............. 19 ~.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 ......... · .. ~ .4e~k..~4¢~:[9r~ .~..eXS. s..~.:i-.n.~, .cl.w.e.Z..1.i.n..~: ................................ The certificate is issued to JO3~N .&. OATI-LERINEi SZDOR .................... ...................... of the aforesaid building. Suffolk County Department of Health Approval .... 3I/J~ .................................. UNDERWRITERS CERTIFICATE NO ............ .~/.R. . ................ Building Inspector Rev. 1/81 (THIS PERMIT gUST BE KE~! ON ~.E;~,PR~M COMPLETION OF THE WORK}AOTN~RIZE~)i ~. 1'~1716 Z Permission* ~s hereby granted to: at p~emise~ located at C:~ ty To~ Map No 1000 Secton .,.,/.. , ? ·p~'!,:, t~~ 'dot~ ant ~ application by the FORM NO. 6 TOWN OF $OUTHOLD 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 submitted 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 buildihgs, property lines, streets, and unusual natural or topographic featu res. 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 Residehces and similar buildings and installa- tions, a certificate of Code compliance from the ArchiteCt or Engineer responsible for the building. 5. Su bm it Plann lng Board approval of comp leted site p lan requ i[.ements wh ~ere app licable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operty showing all property lines, streets, buildings and unusual natural.or topographic featu res. 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 $1 5.0 0 3. Copy of certificate of occupancy $1.00 4,Vacant Land C.O. $5.00 Date...-~(-~-~/.---- ./..j..Z~;~. ..... New Building, .,V~, ......... Old orPre-existing Building ............ Vacant Land/ ... ~~__..~ Location of Property ,~,(:~.O, . . ~ [',(~-~/~0./~'2../~ z~)£~?.~ .... /~('~,~ ,C~./~ ...... House No. Street Ham/et Owner or Owners of Property ..../~/~... FJ~/~)/'~... L~/.'d~ ./~....~.C ....................... /o I County Tax Map No. 1000 Section .... .* ~.... T' ....Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. J.[..~./.(?. ~ Date of Permit /4~.l ~.~-..Applicant .. ~ . .~;~. ~.<~,~-, ........ Health Dept Approval Labor Dept Approval Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $...~. '..~)..(~ .... /. '~ ~.,~... Construction on above described building and permit mef~s all applicable codes and regulations.... ,, ~,~(~ ~z~,~ ,[~_~ Applicant .....~...., ~. ~..' ...................... FIELD ~SPi~TION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: ~/o 2¥" leOBM ~qO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWH CLERK'S OFFICE SOUTHOLD, N. Y. ............. ,'~:)praved ~..~...~.....'~.......~... ............. , ,~Permlt No..../.../. ............................ Application No..../../., .~'..../...'~.. ............ Disapproved a/c ........................................ _,~,/~ .................... ,./ ................. .............................................. ii',~i...i .......... .~ ............... .~ .......................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .......... ~...~./. ~..~... ................... INSTRUCTIONS 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 plat 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 ofproperty must be ~lrawn on the diagram which is part of this application. 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 cede, housing cede, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. .... ...... ..................... (Signature,~f ,~J,'cant, or r~me, iS,~.,~:orparotion~, ,, ...................... ["'i,~i~'~ ~f applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. '~';'~; 0 OW er of pemises ...... ~~,~.i~..,...~.....~~ ................................ · . .q_./ ,,, +.,~.,-,~L. ::~,~ :7-. ~.~-,- ,.7, It applicant is a corporate, signature at outy authorizea otticer. (Name and title of corporate officer) Builder's License No ........ .~...'./.~....... ...................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trode's License No ............................................... /0'7- <:o/ Location of land on which proposed work v/ill b~ ~dorje. ~Aap No.: ........... ~ ........................ J,.ot No....,..'T7 .......... ~ ..... Street and Number ........ w~....~...~...~. ........... ....~/.~ ....... ~Z!::..: ......................... ~.~ ..... Municipality State existing use and occupancy of premises and j'ntended use and occupancy of proposed construction: a. Exisiting use and occupancy .......... c~.~.~e.~.~m~.?~''9''......... ................................................................................ / b. Intended use and occupancy ............................................. ~.~_~ .............................................................. 3. Nature of work (check which iapplicable): New Building,. ................. Addition .................. -- -z,AIt~rati°~/~.~_ ........... Repair .................. Removal .................. Demolition .................... Other Work ..... ~.. · .~. ~.... ¢ .]. · .u/-,df,-r/~ ..... . ~ ~ ' ' e ~/~ (Description) 4. Estimated Cost ....... ~.~.~ ................................... F~e ~' ~ . ' (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... ~% ........ Number of dwelling units on each f~oor ..... ¢.~.~ ......... If garage, number of cars ............................................................................................................................................. 6. If business commerc a or ~ xed occupancy, specify nature and extent of each type of use ............................ 7. Dime~sJons o¢ e~sting slructures, i¢ any: Front ..... ~./. ................Rear ....... ~. ...................... Depth ..;T ........ Height ..... ~¢ .............. Number of Star es ........ .~)~.~ ......................................................................................... Dimensions of same structure[ with alteratiot~s or additions: Front .................................... Rear ............................ Depth ................................~eight ............................ Number o¢ Stories ................................ 8. Dimensions of entire new con'struction: Front ............. ~ .................... Rear ..... .~ ................ Depth ..~ ............... Height .................... Number. of Stories .................................................................... ~ ................................................ 9. Sze of lot: Front ...... --~; ~ ---"'"/'¢;~ .................................. Rear. .......~.....~.~..,, ~ --,' ,De~th'"'~'~'~"':'-* ....... ,0. o, .............. , me o, ,:o,mer Owns, ..... ..... 1 1. ,"Zone or u~e district in which premises are situated ..................................................................................................... 12. Does proposed construction vipiatej any zoning law, ordinance or regulation: ......... ~ ........................................ 13. Will lot be regraded ........ ~ ...... . ...... ~ilJ excess fill be removed from premis¢s:~) Yes (~' No ~4. N~me of Ow,~ of p~,~, .. *....~.., ............ Ada,~,, .3~..~ ~,~ No...R.~Z.:..~ Name of Architect ............... ~ ............................................. Address ................................Phon~ No ....................... o, *-'"' .................... ,~ PLOT DIAGRAM Locate cleqrly ~nd ~distinctly ~1~1 buildings, whether existin~ or proposed, ~nd indicate ~11 set-back dimensions from prope~y IiDes. ~ive s~reet ~nd bl6ck number or description ~ccording to deed ~nd show street n~me~ ~nd indicate whether interior or c;orner lot. /-' : - STATE OF IN~'~R~,, .¢ ,/( ~ 5 S '~ C 0 U N T)f'-C~F~.\....~,.~'~ /' '~ (Nome of,/~,v(dual signing co~f) above named. sworn, deposes and says t obo~e is the appliconl corporate officer, etc.) of said owner or owners, end is duly a"ChorffZEd to perform or have performed the said work and to make and file this application; thai' ali statements contained in this applicetion are true to the best '6f 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 - .--, ~ 'x ~IOT~RY PUBLIC, State o~ N~v ~fk -, .