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Home My WebLink About11754-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ....1.1. l ~ ......... Date ....... Atlgu~.t~. ] D ................ 19 ..-[2 THIS CERTIFIES that the building ................................................. Location of Property .3.3.2.~ ................. .Cg.u. rt~7..R, qa..d..6.8. ......... ~a..t;.:.~.t:.qg[< .... House No. Street Hamlet County Tax Map No. 1000 Section ...1.4. .1 ...... Block . .0.2. ........... Lot ...0.1.~. ........... Subdivision...~. ........................... Filed Map No...X. ..... Lot No..X. ........... conforms substantially to the Application for Building Permit heretofore f'fled in this office dated · .~.up.e..2..2 ............ 19 .8.2. pursuant to which Building Permit No...1. ] .7.5.6...Z ........... dated . .~.u..n.e..2.8. .................. 19.8.2. , 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 ......... ... a..d.e.¢ .k..a.~. ~ ~.~.t,~,..:.q .V.x~.s.~ ~.n~ .~n..~.-.r.a.,g.~..~.e.~.~ ~¢~ ..................... The certificate is issued to .... ,lq>¢~ .,I,. ~LRq~ ......................................... (owner, ~ ~a~ of the aforesaid building. Suffolk County Department of Health Approval ....... P/.q ............................... UNDERWRITERS CERTIFICATE NO ............... p/.a. ............................... Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 11754 Z Permission is hereby granted to: ........ .................... ~0 ............................... ;. ....... ; .............................~ .............~ .....~. ................................................... '-.:' :~ ~ ~ //7 ~' f -, 77~ "f ,~-- et premises located at ...... .<..,.~...., ...~....,,~. ................... ...;.....,...7....~.. .................... &....,..,.Z..:...~...&..c..¢~ County Tax Map No. 1000 Section ,./....~.../. ........... Block ......... .'.~. ......... Lot No....(,..../.,.~...~.. .... -/ ./ ~ pursuant to application dated .~.'~'.......i ......../:. ............................. , 19,.....,.~,and approved by / the Building Inspector. Fee $../....:...../... ~ ........ Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Depa,;.~,ent 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 buildings, property lines, streets, and unusual natural or topographic features. · 2. Final approval of Health Dept. of water supply and sewerage disposel--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriter~ 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings 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 peopert¥ 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 3. Copy of certificate of occupancy $1.00 $5.00 Date ..... New Building ............. Old or Pre-existing Building(X) ......... = tVacant Land Location of Property .~.~,~.0~.. ................... ~ .~... ~.~... ....... Owner or Owners of Property .. ~ .' ................................. County Tax Map ,o. ~000 Section . .l..~./. ........ B~ock ...O. ~ ...... 'ot..CJ./. ~ ..... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./t/. ~7~..z~..~ Date of Permit .......... Applicant ~ .~.,..~.~4~. ....... Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. Underwriters Approval ........................ Planning Board Approval .................. ~ .. ~ Request for Temporary Certificate Final Certificate - Fee ~ubmitte~ $..~----~70~. ................... Construction on above described building and permit'meets all apl~c,a, ble_,co,de; and regulations. ,..,e.,~,, CoSP2. D.c~- ~-.~ p.o.~ III ~ · F_IE~D INSPECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY ~ODE FINAL DATE COMMENTS ADDITIONAL COMMENTS: D D Fo.r~ .o. 1 BUILDING DEPARTMENT TowN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c * · Application No.. I./..?. ,~.~.,~ (Building Inspector) ~ APPLICATION FOR BUILDING PERMIT '" INSTRUCTIONS . a. Tiffs application must be completely filled in by typewriter or in ink and submitted in triplicate to the Inspector, with 3 sets of plans, accurate plot plan to scale. Fcc according to schedule. b. Plot plan sho;ving location of lot and of buildings on premises, relationship to adjoining premises or public stre or areas, and giving a detailed description of layoUt of property must be drawn on the diagram which is part o~his 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 per, shall be kept on the premises available for inspection .throughont the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Oecupa~ simll have been granted by the Buildin~ Inspector. APPLICATION IS HEREBY MADE to the Building Department for th~ issuanca Ora Building Permit pursuant to Building Zone Ordinance of the Town %f Southold, Suffolk County, New York, and other applicable Laws, Ordinanee.~ Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein deserib 'Fn.e applicant agrees to comply with all applicable laws, ordinances, building code, housing eerie, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. (Sti~6ature of al(~llcant, or name, it' a corpomtlon) ..... "' ..... ~ailini'" ' ;d~;,;,' ' ;,~"ai$lig';6' .......... ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build "; .. . ...' . .. .. . ....... ...... G/ . G/. (as on the tax roll or latest deed) ' If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) ' ' ' Builder's License No ~. Plumber's License No ......................... Electrician's License No.' ...................... O/her Trade's LicenSe No ...................... 1. Location of land on which proposed work will be done ' .................. .................... ................. House Number Street Hamlet County Tax Map No. tom Section .. l--~.ff. .......... Block . ~.~...~. ..... Lot...~ 1~ ...... Subdivision ....... ~ ............................ Filed Map No ............... Lot ............. (Name) 2. ~ate existing use and occupancy of premises and intended us~ and ~pancy of prop~d construction: a. ~xisting u~ and occupancy ~~ t _:;~:~l~u~d~p~q . 'ff~ .................... ' .... '..::........,...,.,~ .... ."X. -~~.~:~, . ~,, . .~,.,,., -,_,, . ~ ~ ~. Nature of work (check: whi¢!, applicable): New Building .......... Addition A ........ Alteration ........ Repair .............. Rcmo:'al .............. D~'molit.;on .......... Other Work ............. (Description) st . ,a,ed Cost.. 0. :0, Fee ................. (to be paid on filing this application) S. If dwelling, nu,nber of dwelling units ............... Nmn her of dwelling units on each floor .............. If garage, number of cars ...................................................................... ~. If business, commercial or mixed occupancy, specify fiature and extent of each type of use ................... 7. Dimensions of existing structures, if any: Front ..... .' ......... Roar .............. Depth ............. Height ............... Num b,:r of Stories ................... ................................... Dimensions cf same structure with alterations'' or additions: Front . . J...~.' ............ Rear .. ~ ~: .......... Depth ...................... H,:i~tt ...................... Number of Stories .................... it. Dimensions of entire new constrt,ction: Front ............... Rear ............... Depth .............. Height ............... Number of Stories ....................................................... 9. Size of lot: Front ............. '... ........ Rear ...................... Depth ...................... 10. Date 6fPurchase ............................. Name of Fom~er Owner .......................... {I. Zone or use district in which premises are situated.., i ............................... ' ................ I 2.Does propo'.ed construction violate any zoning law, ordiaance or regnlation: ............................... I~. W' · ...... dl lot bc r.o.ad.d .................. ,~/ ........ Will excess fill be removed from premises: Yes ~4. Name of O,,.'~r oC pre,n~,es .,9,'~ .~. ~r/~-. Address kC. ~. Name of Architect ......................... -.. Address ................... Phone No ............... N.'m~e &Contractor .......................... Address ................... Phone No ............. PLOT DIAG RAM Locate clearly -,:.ad distinctly ail ot iklings, whether existing or proposed, and, indicate all set-back dimensions fro: pro;~erty lines. Give street and block nun:her or description according to deed, and show Street names and indicate whath~ ;ntcrior or corner lot. ~TA'TE OF ~ (~e of ~dividual signing contract) being duly sworn, deposes and says that he is the applic~ abov.? named. - is the ......................... (Contractor, agent, Corporate officer, etc.) said owner or owae~, mid is duly authorized to perform or have performed the said work and to m~e and file ~i a/aplication; fliat all statements confessed in this application a~ true to the best of his knowledge and belief; and that th ~'ork will be performed in the manner set forth h~ the application filed t?erew'th. ~om to before me this Mota~ Public, F%E~D INSPECTION 1. FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY G,ODE FINAL DATE COMMENTS ADDITIONAL COMMENTS: