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Home My WebLink About11775-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...~1..1.3.4.~ ........ Date December 13 1982 THIS CERTII2IES that the building ................................................ Location of Property ............. z~ .4.5..W. 99.d.c.~:[ .f f..D.U~y.e.,' . .$.a.t.~ $ .g.u.c.k; .............. House No, Street Ham/et County Ta× Map No. I000 Section 1, qr( ......... Block ,..07 .......... Lot . .Q~4, ............ SubdMsim~... ~ ........................... Filed Map No. X,' ....... Lot No .... X. ......... conforms substarttially to the Application for Building Permit heretofore filed in this office dated ...... ~. u. ~3.e' .2.} ....... , 19 .8.2. pursuant to which Building Permit No. :k:l. 7 7.5.2; .............. dated . . ~ ¢ ;]-.Y.. 3! ................... 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 ......... censtruct a storage shed The certificate is issued to ...R. 9 .b.e.r.~. $.o..Koch ........................................ (owner, .l~e.~r of the aforesaid building. / Suffolk County Department of Health Approval . NM.A ..................................... UNDERWRITEP, S CERTIFICATE NO.. ~l. ZA .......................................... Ul lng nspecror BUILDING DiPART~I//N~i 'TOWN ~HAL!. SOUTHOLD, N,.¥. BUILDING !: PERM!T (THIS PERMIT MUST BE KEPT ON ~HE PRE~IS~SUNTIL ~ULL COMPL~ION OF THE WORK A~THORIZED~ N? 11775 Z Permissior~ is hereby granted to: r pat .. ...... 19 at premises located at ................ ; Ou0ty Tdx Map No. 1000 'Section ~. BIo~ pu~uant fo application dated BUil~ling I~hspector. ~;!$.Z~,.~.~ ...... ; '"~'"; ....... ::t! ........................................ NO. ~.~.. ,~....~'./..... .;~.., l~.~ond approved by tho FORM NO. 6 TOWN OF SOUTHOLD ~3uiiding Departmen.z Town Hail $outhold, N.Y. 1197~] APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions A. This application must be filled in typewriter OR ink, and subn~itted in duplicate to the Building Inspec- tor with the following; for new buildings or new use: 1. Final sunley of property with accurate location of all buildings, property lines, streets, and unusual natural or topograohic features. 2. Fina~ approval of Heaitt~ 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 of Code compliance from the Architect br Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildlngs (prior to Apr]l 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 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- t[on required to prepare a certificate. 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 · .. ~-~:~.~,./,~ . Old or Pre-existing Building(X) .. ........ =/Vacant Land -i ............ New Building Hou~ No. S~ree t Ham/et Owner or Owners of Property ~ ~ co,~ T~ M~ No..~000 S~io, ../.~ 2 ....... ~ .... ~..7 ....... Uo~ ..... ~.~ ..... Subdivision ................................. Filed Map No ........... Lot No. ' ........... Health Dept. Approval ........................ Labor Dept, Approval ...................... ,., Undo~zriters Approval ........................ Planning Board Approval .................. ~ .. ~ Request for Temporary Certificate ..................... Final Certificate ........ - ......... Fee Submitted $ ........... Construction on above described building and per'meets all aPp~cabl~odes and regulations. ~IEL~ INSPECTION FOUNDATION (1st) COMMENTS FOUNDATION (2nd) 2 o ROUGH FRAME & PLUMBING 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' ., 19~4~l?ermit No././ Disapproved a/c ' .................................................. L~ ~ ~ ~"i i I. APPLICATION FOR BUILDING PERIVIIT 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 sh6wing 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 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 code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature/of applicant, or name, if a corporation) (Mailing add'tess of apphcant~ ') ~ ~"/~'~. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......... ......................................................................... Name of owner of premises .......... :.. c.~ /7~pF'2.' 'J .AS. ~L~. If applicant is a corporation, signature of duly authorized officer FEE ~ BY ~ ~ ~ '' - NOTIFY BU LB NG DEPARTS4, m-- ,,--' .............................................. 765d802 9 AM TO 4 PM FCP -r - (Name and title of co~orate officer) FOLLOWING INFPECT]ONS Builder's License No. .,~?, 1. FOUNDATION - TWO RFP ...... ............... FOR POURED CONCRF? 2. ROUGH - FRAMING ~ pi Plmnber's License No ......................... 3. INSULATION Electrician's License No.. 4. FINAL CONS ..... . . , ,. ...................... BE C~Mp! ':TE F~R C ALL CONSTRUCTION S~-~AI.I. * ...... Othet~'s ~Jeen~e ~o ....................... THE REOI~R~M~NTS OF TH~ ~ 1. Location of land on which proposed work will be done ........ ~'"~m~t~: ..... ~OT' ' RESPONgfS[.i:' ' ~&~ .......... }louse Number Street ~amlet cou,~y ?a~ ~,~ ~o. ~000 S~o~ion .... /.¢.? ........ moo~ .... 0.7 .......... ~ot..¢.& % ......... Subdivision .................... ~ ............... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ~. sxi,tin~ u,, a,~ o¢o~p~,o.y .... X... ~5~.4~% ...... ~{ ~¢.¢~ ........................... b. Intended use and occup~c* ~¢~/ '~'~/~ ~5 ~¢~. ................................ b 10. 11. 12. 13. 14. Nature of work (check which applicable): New Building .......... Addition ........... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............. ~f, ff~ O / D .~. ' /.t~. / (Description) Estimated Cost ........................... Fee ................................. (to be paid on filing this application) If dwelling, number of dwelling ~units ............... Number of dwelling units on each floor ...... : If garage, number of cars .... ~ ................................................................... If business, commercial or mixed occupancy, specify nature and extent of each type of use ...~-. ............... Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories .... ~ .................................................. Dimensions of same structure with alterations or additions: Front ....... Rear .................. Depth ................... ~.. HeiSt .. J ................... Number of Stories ...................... Dimensions of entire new construction: Front ..... ~ ........ Rear .... ~ .......... Depth ..... ~ ...... Height ............. Nu er of Stories .......................................... ~. ~ .......... Size of lot: Front ..... d~O. ~2 .......... Rear ...................... Depth ..... ~. ........ Date of Purchase ...~ .Z~.T. ~ l .............. Name of Fomer Owner ...~~& ............. Zone or use district in which premises are situated ..................................................... Does proposed construc~n violate any zoning law, ordinance or re~lation ~Q ....................... Will lot be regraded . ~. 9... ~ .../...., ............ Will excess fill be removed from premises: Yes ~No Nme of Owner of premises .. :~q ~/~ .......... Address ... ~.~ ........ Phone No.. ~ ~ .~¢~ Nme of Architect ......... ~ ................. Address ................... Phone No ................ Nme of Contractor ........ ~ ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all~ 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 tot. ,/ STATE OF NEW f'~R.K, ,~ COUNTY OF~M2~-~d7 .... : ', (FarCe ofir~lividual signing co/~t~act) above named. being duly sworn, deposes and says thane is the applicant ,~e is the ' (Contractor, agent, corporate officer, etc.) of saki owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application ;, that all statements contgined in this application are true to the best of his knowledge and belief; and that the work will be performed in the manne'r set forth in the application filed therewith. Sworn to before me this ~ J q~.-7~., dayo~ .~. ~. ~. ~_ ~_~~~.,~-~ ~, ...... .~. ~ ~ounty ~, ~.sz~, ~k ~./