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Home My WebLink About11722-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy NoZ.l.1. l 2 0 ........... Date ..... Augu~. 6 ................... 19. THIS CERTIFIES that the building ................................................ Location of Property . 1 0 7.4.5 ................. ~ ~[~..1~ OO.d .............. I~ ~.t..~ ¥.$,qr~,. Hou~ No. Street Hamlet County Tax Map No. 1000 Section .. 03.1 ....... Block . .Q 4 ........... Lot,.. ~) ~ .7 ........... Subdivision .... ~t .......................... Filed Map No..X ...... Lot No.. JO. .......... conforms substantially to the Application for Building Permit heretofore f'ded in this office dated · ~Tpr~. ~ .............. 19 .~2 pursuant to which Buildin$ Permit No.. ] .1.7.~.~. ~ ............ dated .. J~q. 9 ................... 19 .$.R, 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 ......... The certificate is issued to . .~JV~....r. C~g. ~..qqv.;0p.. ~;',.,..~r... (owner,/e~e. of the aforesaid building. Suffolk County Department of Health Approval ..... n/.a ................................. UNDERWRITERS CERTIFICATE NO ........ .~.. 5 ? .0.6.~ ~ ................................ FO~,M NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N~ Y. BUILDING PEBJ~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 11722 Z Permission is hereby gronted to: Building Inspector. / Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD 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; tot with the following; for new buildings or new usa: 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 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 buildings and installa- tions, a certificate ~)f Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. 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 topograph ic featu res. 2. Sworn statement of owner or previous owner as to usa, 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 usa 3. Copy of certificate of occupancy $1.00 $5.00 ama Date .... ~..~. ~. Z.~...~.. ...... // New Building ............. Old or Pre-existing Building ~ Vacant Land Location of Property ..... ~.. ~..~..~..~. ........ .~.....O~.... ~ou~ ~o. S~ / Owner or Owners of Property ........ ~ ..... ~ ...... ~ C ~ ~' C~nty Tax Map No. 10~ ~ction ...~.~..t ..... Block ..... ~.../ .... Lot .... ~ .( .~ ..... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No.. 11.72 Date of Permit ~/~ ..... Applicant. ~ .u ~.~q~...~.,.~. Health Dept. Approval ........................ Labor Dept. Approval ........................ ~nd,~riters ~roval..0.~. ........... Pl~nninfl Board ~pprov~l ...................... ~equ*~ for Tempor~ ~rtific~te ..................... Final C~ificat~ ......... ~ ......... Fee Submitted $ ..... ~,. O. ~ ......~ ......... c o FI~LD'INS?ECTION COMMENTS FOUNDATION (1st) FOUNDATION ( 2nd ) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ODE FINAL ADDITIONAL COMMENTS: ~00o?u~ THE NEW YORK BOARD OF FIRE UNDERWRITER~ · BUREAU OF ELECTRICITY Jo.. STREET..EW ~.,. ~ zl, [~ .~,,,,.~,~o..¥o.o.~,,. N570694 THIS CE~IFIES THAT ~t~examinedon ~Y andfoundtobeineompliancewiththerequirementsofthJs~rd. ~ ~XTU~E ~=~,=~[ ~ T~ = FIXTURES ~ RANGES. ~C~GO~CKS~ O~NS J DRYERS [ FURNACE MOTORS j ~TURE A~IANCE FEEDERS ~SP~IAL R~'~ TIME CL~KS ~ M~ ~UNJT ~T~S ~ MULTI~ J ~ ,, SERVICE DI~N~T ~ NO. OF ~ S E R V -- --~- C E , ~u . ~. ~ o~ cc. co~ ~ ~ ~-~o _ ~ 1-~ ~, 2~.F.1. 'a '--" certificate must not be altered in any manner~ return to the office of the Board if incorrect. Inspectors may be COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY '.. *' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-186~ Examined .~.~'...?. ..... 19R~ L~_ Application No.//. 7..~..~. ...... Appro,/~. ~. ..... , 19~...~Permit No./~.~./7..Z..~..~-'--- . (BuilEin~ 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 plot plan to scale. Fee according to schedulb. 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 Pen'nit 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 necessa~nspections. (Signature of applicant, or name, if a corporation) ~.o.,. ~..z.~. ~../~.~.~.../.~..~ ....... (Mailing address of applicant)~ State whether applicant is owner, lessee, agent, architect, engine~o~ltractor~or,~, ectrician,- -- plumber or builder. .................................................... .~... ~...C...._~..~ . ~ ......................... Builder's License No. .. ~./~..~ . . _~. ~.~, ..... ....... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. . .-~.../..o.z~ ......... ./~....~.....p~...,. ................ ~..~. ~.~¢~..,~.,~ ......... House Number Street Hamlet CountyT..ap No. 10~ ~c.o....~ ....... ~lo~ ..~ ........... ~o~.~ ............ Subdivision ..................................... Filed Map No ............... Lot ............... ~e) 2. State exist~g use and occup~cy of p~m~es ~d intended use and occupancy of pmpo~d construction: a. Existing u~ and occup~ ~ [~.~ ~ ~. b. In,end~ ~ ~d oc~p~cy ' ' '~' ' r ~ ~ ~ ~ ~ $ '' J~-- ' ................. ~.,:~:~ ~ ~. ................... . ....: - .~.~... ,.~. .... ... ~_ .-- _- ~ ~~~ _: 3. Nature of work.(ch~'~lfich applicable): New Building .......... Addition ......... Alteration ........ Repair . ....,. _. ~,~.~U/.;,~..i~, oval .............. Demolition .............. Other Work ............... .......................... $. ~f dwelling, ~umber of dwellini units ............... Number o~ dweilin~ units o~ e~ch floor ................ if ~arage, ~urnber of cars ........................................................................ 6. If business, commercial or mixed occupancy, specify ~a~tm .an~l ext~nt of each tYl~ please ..................... ?. Dim~nsiom of exjstin~ structures, it' any: Front ..... .~. ~-. ..... Rear ..... ~. ~r, ..... Depth .... ~,,~-, ..... Height .,, ~.(~ ......... blumbe~ of Stories ........ ~- ........................................... Dime~siom of sam~ structure wil~ alterations or additions: Frnm .... .~',~, ........ Rear ..... ~.~., f ........ Depth ...... s.5-. ~. ............ Height ..... ~..(,~ ........... Number of Sto~ies ...... .~. .............. 8. Dimcasions ofcatLre new construction: Fro~t ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ ~. Size of lot: F~ont ...................... Rear ...................... Depti~..... ;~. ......... 10. Date of i~rc~ ............................. N~..o~ ~orme~ O~ner .... //~-c~ ... ~.~ ...... i i. Zone 6r use district in which premises are situated ...... fiT'.:, ~ ....................... X '~ '-' ............... 12, Does proposed construction violate any zonini law, ordimmc~ or re~uhtioa: ............ ~,-~, .O ............... 13. Will lot be re,faded ............. ,, .... ~,.... ..... Will excess f'~ be l~,xaoved from premises: Yes No 14. Name of Owner of premises .~r0 .~F.~,(~ J.~T..~.. Address .. fy~G.~-.i~. :.~.:...l~one No...~.?)..'-. Name of Atc~tect ..... ; ........ Address . '.,e~ ........ ; ...... Plmne No. o Co, c or . '.d. . . . Addi , .... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or p~, and, indk~te ali ~et-hae. k dimeal~iom from property lines. G/ve street and block number or description according to deed, and show s~-eet names and india~e wire,her interior or corner lot. STA W Y (N~n~ o f individual siani~nt~ct) above named. being duly sworn, deposes and says that he is the applicant (Contractor, a~mt, corporate oflScar, etc.) of said owner or owners, and is duly authorized to perform or have performed the ~ work and to make and fil~ this application; that all statements contained in this appli~tion are tr~ to the best of his imowled~ a~ul belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this