The URL can be used to link to this page

Home My WebLink About11765-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..g ~ ~ .~.¢ 1 ......... Date ..... Se~.t,~mb.~.~.. ~ 6 .............. 19 ~. THIS CERTIFIES that the building ................................................ Location of Property . 5.6.5..0 ........... ~9.v~.h .Rp.~d '~v .B.a.~'.v~.e.E ........ .~.o.u..t;.h.o.l.d. .... House No. ' ' ' ' '~'treet Hamlet County Tax Map No. 1000 Section . 07.9. ....... Block .. 02 ........... Lot .... .0. Q~ ......... Subdivision ...... X ........................ Filed Map No.. Z ...... Lot No. ;< ........... conforms substantially to the Application for Building Permit heretofore Filed in this office dated .... 4¢~.e.. ] 5 .......... 190..2. pursuant to which Building Permit No...~fi. 7..6.5..g. ........... dated ..... 4¢rLe.. $ O ............... 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..o.~.k..a..a.a.~.~. ! .o.n..~.9..~.n.. e..x.~.a.~. ~..n.R .dy..e.Z.~.~.n..~: .......................... The certificate is issued to ....... ~?oJaevg. ~1.,. &. I~IO~&. ,R,. ~I.e.Ga~ ~:INE. .................. {owner, leesee~t ~rre} of the aforesaid building. Suffolk County Department of Health Approval ...... tl~/l~ ................................. UNDERWRITERS CERTIFICATE NO .............. n da ................................. Building Inspector Rev. 1/81 Peri BUILDING sOUTHOL BUILDINQ~ (THIS PERMIT MUST BE KEPT ON; ~HiE ,15 S UNTIL ~U'LL cOMPLETION OF THE WORI~ ACITH~RJZEDi 11765 Z ~issio~ is hereby granted at premises located at ..~,,~... co~tv r~× Ma~ No. ~000 Se~t~o~ p?s~ant ~to appilcation dot .., ..) ........ ;.., 19~ LO~ NO' r .O~ ........ approved by the 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- tor with the fo{lowing; 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 disposal-iS-9 form or equal). 3.Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, lndustria~ 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: I. Accurate survey of peoperty 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 $5.00 3. Copy of certificate of occupancy $1.00 Date. .............~'~- _~-~ .~J,~ ~-~ ~'.-~ ,~OId orlPre-exi~g Bui,lding(X) ..~..~-.. - =/Vacant Land ............ New Building Hou~ No. // ~ ~~ ~Street , ~ ~ . ~ , . Hamlet Subdivisioa ................................. Filed ~a~ ~o~ .... __ .... kot ~o .............. Health Dept, Approval ........................ Labor Dept, Approval ...................... ,,, Underwriters Approval ........................ Planning Board Approval .................. , .. ~ Request for Temporary Certificate ..................... Final Certificate ....... .- ......... Fee Submitted $ ......................... ./~ Construction,pn above described building and p.e/rmit p~q~s all ~{;ivM~abJe.codas a)~regula~ti.~s. FIELD INS?E~TIO~ FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION FERN. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS FORM NO, 1 TOWN OF SOUTHOLD " BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1803 ..... _ ....... DisapproVed a/c.. .... :"7........~'. ................... ......... ......... : ................... . . .g p .. APPLICATION FOR BUILDING PER~IT .~.~ " INSTRUCTION8 a. This application must be completely filled ~ by typewriter orin ink and submitted ~ triplicate to the Buildin~ Inspector, with 3 sets o~ plans, accurate plot plan to sclc. Fee according to schedule. b. Plot plan show~g location of lot and of buildings on premises, mlations~p to adjoining premises or public streets or areas, and ~ving a detailed description of layout of prope~y must be drawn on the diagrm which is part of this appli- cation. c. The work covered by this application may not be commenced before issuance of Building Pe~it. d. Upon approv~ of this application, ~e Building Inspector will issue a BuQding Pe~it to the applicant. Such pe~it sh~l be kept on the premises available for inspection throughout ~e work. e. No building shall be occupied or used in whole or in pa~ for any pu~ose whatever until a Ce~ificate of Occupancy sh~l have been granted by the Building Inspector. ~PLICATION IS HEREBY M~E to the Building Departmenf for the issuance of a Building Pe~it pursuant to the Build~g zone Ordinance of the Town of Southold, Suffolk County, NeW York, and other applicable Laws, Ordinances o~ Regulations, for ~e construction of build~gs, additions or alterations, or for remov~ or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordnances, bujldin~ co~e, housing code, ~d regulations, ~d tc admit authorized inspectors on premises and in buildings for necessa, ~nsp~J~.:~ x::~ ~'~ x~¢ ~ ~ ' . ..... ....... ~gn~re o~~ ~---- --applicant,N~name,.if a co~oration) State whe~~ owner, lessee, agent, ~chitect, engineer, general contractor, electrician, plumber or builder. J~ applicant is a co~o~ation, signature of du~y authorized (Name and title of corporate officer) Builder's License No ........... ~ ..... Plumber's License No ......................... Electrician's License No ...... . ................ Other Trade's License No ...................... I. Location e/fiand~on~, whi.cl~propo, s~l w%rl~ v/ill be ~h~e.. ~. . ..., '~ ~0ouse~ Number Street/~ Hamlet Subdivision ..................................... Filed MapNo ............... Lot ............... (Name) 2. State existing use and occupancy of prffmises anti, intended use and,Og-~upa~cy of prop(~sod~construction: a. Existing use and occupancy .. ' .... . .... -b IntenSe~ - · u u use ana occup~cy ......... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ...... ..... il epair .............. Removal ...... : ........ Demolition . m' ........ Other Work ............... 4. Estimatea Cost ........... ................ Fee .................................... (to be paid on filing this application) : './. 5. If dwqlling, number of dwelling, units ............ Number of dwelling units on each floor ................ If garage number of cars ~ , 6. If business, commercial or mix~d occupancy, speeifynature and extent ofeachtypeofuse ....'7:. ....... ? ...... ..... - ' ~..~ 15_ 5 7. Dlmenmons of~.exi,~irtg'structures, if any: Front...._~.~ ...... Rear .. : ...... Depth ......... Height .... ~'. ......... Number of Stones ....... ~ ..................................... Dimensions of same structure With alterations or additions: Front Rear Depth ...................... Height .i ........ ~ ........... Number ~f Stories ............... · ' ' ' · " /..~.' ~'~: pth ~.'.': ' 8. Dunenslons of entire new construction: Front .......... Rear ........... De ........ Height ............... Number of Stories ........................................................ 9. Sizeoflot Front ;.~ .... ,,, Rear ................... .... rle~th ................... / '-'--- .~. .. .,r:. ~. ~. .~.j':.~ .,~. .~. . ' ~ '"' I0. Date of Purchase ....... ,'. ..... .,~qam~ of Former Owner ' ' ' · · 'i/~s .~z...~.~.¢~.~.~.~ ............... 11. Zone Or use district in which prem are situated ................................. 12. Does proposed construction violate any zoning law, ordinance 6r regulation: ..~..~. ..................... F'~ l ~. - wi~ lot be r~graded ...... ~fi~2 ..... ~ ........ ~ill ex°es, fill beremo~d fro~ ~r~mises: .~ ~es ~o 14. Name of Owner of premises~'0~'~f2{~.. ~?.~.~d. ress/~flf~...~.t~FT/~one No.~.~,,,~... ~,~. ,O~. o o. Nme of Architect ......... :., .~., ~ .. .......... Address ................... Phone No ................ Nme of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate cleariy and distinctly Mi buildings, whether existing or proposed, and. indicate all set.back dimensions from property lines. Give street and blockl number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK . _ ~ . ~ ~ (Name of indl~idug~l~igning contact) above name .d~ ~~. He is the...~~~. ~.~ ................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authored to perfom or have perfomed the said work and to m~e and file application; that ail statements contained ~ this application am true to the best of his knowledge and belief; and that the work will be perfomed in the m~ner set forth ~ the application filed therewith. Sworn to before me this