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Home My WebLink About11800-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of OccuPancy No...g.'l..'l 7.~.q. ........ Date .......... g.u..1.~..'?. ............... 1983. THIS CERTIFIES that the building .... cl~.e.!~. Oct.d,J,~j.O~ ............................ Location of Property ....'1.65 .......... Scooted. S.~..~o~; ........ .lXT..o¥..S.~.~..~9.1.k. ......... House No. Street Hamlet County Tax Map No. 1000 Section ....~.q.~. ..... Block ..... .q.Q ....... Lot ....02.0.:~ ........ Subdivision ........... :K .................. Filed Map No... ~ ..... Lot No ..... ~. ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated .... ~..l~1~..6 .......... , 19.82pursuant to which Building Permit No....q.q.g.O. 9.g ............ dated ...... J~tlX .q ./3 .............. 19.82, 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 ......... ...... de.ak, ad.dition, on..axis.t.ing, d.~ell~tg, ................................ The certificate is issued to .......... i~UL & ]3g2~3~.P~ I4EAI~Y. (owner, ~ ..................... of the aforesaid building. Suffolk County Department of Health Approval ........... N./.A ........................... UNDERWRITERS CERTIFICATE NO ................... i~./.A ........................... Rev. 1/81 SOUTH'OLD, BUILDING ,PERMIT (THIS PERMIT MUST BE KEPT ON ~H,E P;P,~A, COMPLETION OF THE WORK AUTHORIZED) No. 1:1800 Z Permission is hereby granted IS ,UNTIL EULL ~0 ..,.....~.~..~7~.~9...... i~..~....~ .~.~..,~,.. · .~...~.-~..~.'.//'.~...-.: .............................. -~":'"' :","i"~ .... Coul~ty' Tax Map No. 1000 Section ;...../.,~.; pDrsHant, to appl cat on dated 8~ilOIng Ihspector.. Lot No. ~..~..~, ........ ~ ~and bpproved by the FORM NO, 6 TOWN OF SOUTHOLD I~u ilding Department Town Hal~ Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and subr~itted in duplicate to the Building Inspec- tor with the following; for new bugdings or new use: 1. Final sur~/ey 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 disposaJ-(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 or Enqineer responsible for the building. 5. Submit Planning Board approval of completed site plan requiremer~ts 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. Swo~n statement of owner or previous owner as to use, occupancy and condition of buildings. 8. Date of any housing code or safety inspection of buildings or premises, or other pertinent [nforme- tion required to prepare a certificate, , 1. Certificate of occupancy 2. Certificate of occupancy on g dwelling land use /5' 5.00,~' ,.' 3. Cop,/of certificate of occupancy $1.00 Date ....... New Building ...~.,. Old or Pre-existing Building(X) ......... ~/Vacant Land ............ Location of Property I ~ c'o),Jb Owner or Owners of Property ......... l"/t~-tJL: ~- . .1~, ~ .... ,L~, .~.. .~. ................... County Tax Map No, 1000 Section ............... Block ............... Lot .............. Subdivision ................................. Filed Map No ........... Lot No .............. Permit No.~J..~, .0,0, ~o, Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ...................... ,., Underwriters Approval ........................ Planning Board Approval .................. Request for Temporary Certificate ..................... Final Certificat~ ........ - ......... Fee Submitted $ ............................. ................................ Rev, 10-10.78 FIELD INSPECTION COMMENTS · FOUNDATION (1st) FOUNDATION 2. (~nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENT~: 7GS-'~802 BUILDING DEl)T, INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION REMARKS: DATE I NrSPECTOR ~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined . q~'~.ct/../..~ ..... 19~..d~ Application No. [{(.~.~..t.? ......... Approved,d.~./f~~. .(~.., ................................ : ....... (Building Inspector) APPLICATION FOR BUILDING PER~ITiNsTRUCTiONS Dar ~ .~ ....... , a. Tb~s a~plicatio~ m~st be completely fi]led ~ by ~ypewr~te~ o~ ~ in~ a~d s~bmitted~ to tee I~spccto~, with 3 sets of plans, accumt~ p]ot pla~ to sclc. Fec ~cco~di~g to b. Blot ~hn show~ loc~fio~ of lot ~d of bu~d~n~s o~ p~emises, re]at~o~sh~p to adjo~ p~m~sos o~ punic o~ areas, a~d ~iv~ ~ deta~ed desc~ptlo~ of layout of pmpe~ty m~st be drown o~ the dia~m whlc5 ~s part of this c~tion. c. The work cove~cd by this appI1c~fio~ mey ~ot b~ commenced b~fo~ issuance of Bufldi~B Befit. d. Upo~ ~ppmv~l of th[s ~pp]~cation, the Bufldi~ Inspecto~ wiI1 ~ss~e ~ Bufldi~ ~it to the applicant. Such permit sh~I be kept on th~ ~emiscs ava[Nble for inspection throughout t~e work. e. ~o buiIdi~ sha]l be occupied o~ used [~ whole o~ in ~a~ fo~ mW pu~ose what~ve~ ~t~ a Certificate o~ Occupancy sh~t h~vc be~ ~mntcd by 1bo Bufld~ I~spocto~. ~P[[CATION IS H~BY ~AD~ to the Build~ De~tmo~t for tho ~ssua~ce of a B~di~[ Pe~it pu~s~a~t to Buildin~ Zon~ O~dinancc of t5c Tow~ of Southold, Suffo]~Cou~t~, New Yo~k, a~d otbe~ a~pl[cab]e ~aws, O~d~a~ccs ~o[u~tio~s, fb~ thc co~stmcfio~ o~ buildings, additions or alterations, o~ fo~ ~omov~ o~ d~mot~fion, ~s hcrei~ The ~pplic~t a~m~s to comply with ail appiiceN~ laws, o~d~a~ces,~ cod~, bousi~ code, ~d rc~uhfions, ~d to admit autho~ed ~spccto~s o~ pmmis~s a~d i~ bufld~s fo~ ~ecessa~ msp~o~s. ~ (Signature of app i , ~r~ame, i~ a~ ' ~ . ............. ~. . .~4.¥ .............. ~ ~ (Mail~dd~s~ of ~p~cant~ t 2 State whether applicant is owner, lessee, agent, ~chit~ct, engineer, general cont~lum~/or builder. .... ................................................................................= N~e of owner o~ premises...~, ~..~.~S .... ~-~&.. ~ ~. ............................... (as on the tax roll or l~test 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 ....................... Off, er Trade's License No ...................... Location of land on which proposed work will be done .................................................. .../. ................... ........ ...... ............... House Number Street Hamlet County Tax Map No. 1000 Section .... {!.?. ......... Block ..i..!.0 .......... Lot..0..'..~..'.'.~.-~'. ....... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy...~....'¢J~. I~. {~71 .'~".. .... .O67r. ?.... 'i .~--(~... t .L: .,~....~..k~...~..k,.~j.~ .~.~ .......... ' b. Intended use and occupancy ......................................... ; ............................ .'. Nature of work (check which applicable) New Building ................ k~,~,,,,,~,~a~. Alteration · * Repair ........ Lvrt"' Removal .............. Demolition ..~..~...~. ....... OtherWork ...... :.iiiiiiii~ ~.. OO ', g/ (Descnpt]o~l) Lmmated Cost ..... ...................... l ee .. ] ................................... (to be paid on filing this application) If dwelling, number of dwellingiunits [ 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...tto ......... Rear . .B b. ......... Depth .~.~ ........... Height ............... Number of Stories ..... I. ................................................... Dimensions of same structure with alterations or additions: Front .... .~3~ ......... Rear . ~/o .............. Depth,...')w. ~ ~ Height Number of Stories ' Dimensions of entire new construction: Front ............... Rear ............... Depth .............. Height Number of Stories ' Size of lot: Front .7.°. ' Rear '].o. Depth ,~ .~ O Date of Purchase .. firff&l.~i. ~'! J~.~;~ ........ Name of Former Owner .~..&9. I~tfftt$~ff..¢.4(kt.~..~.0g..C.. Zone 6r use district in which premises are situated ..... [~3d.0¢'~T1/~.. ¢-... ~ ........................... Does proposed construction violate any zoning law, ordinance or regulation: ....k/lO ......................... Will lot be regraded .... Ix].o. i ................... Will'~xcess fill be removed from premises: 3 'YeL"] ~ ~ Name of Owner of premises ..; .l~/htdM.. ~/).. Address .Z44.0..~.~.-"J= ...... Phone No..'7...cL~ ...ci/~ ~. Name of Architect .......................... Address ..... Phone No ................ Name of Contractor ........................ Address ................... Phone No ................ PLOT DIAGRAM Locate ,q~eariy and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lh~es. Give street and blockinumber or description according to deed, and show street names and indicate whether interior or (~orner lot. 72.0 COUNTY OF~ ~ .... ................. ;~ ....... ;..: .... eMg duly sworn, deposes and says that he is the applicant (Name of individual s~gn}ng contra~ above named. : (Contractor, agent, corporate officer, etc.) of said owner or owners, ~'is dul~ authorized to perform or have perfomed the said work and to m~e ~d-file ~is application;' that all statement~ contained ~ this application are true to the best of his knowledge and belief; and that the work w~l be perfomed in the manne~ set ~th in the application filed therewith. ........................ day o~ ........ ,1 .. C0un ,