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Home My WebLink About11835-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of OccUpancy No..Z 11.1.63 ......... Date ...... P..u,g~4 $.t;..3 ~ ................ 19 .8.2. THIS CERTIFIES that the building ................................................ Location of Property . 135.5 ................. &bg?.e..l~r.:L.v.e. ........... O..r.e.e.n.P. 9?J;' ...... House No. Street Hamlet County Tax Map No. 1000 Section .. ID./4.~ ...... Block .. 0~ ........... Lot ..... q2. l. ......... Subdivision... lt~.eenp.or, t. $1lo~'e~ ......... Filed Map No.. J 7.5.9..Lot No. p.a.r..t..o.f...Sj..9 conforms substantially to the Application for Building Permit heretofore filed in this office dated .... JulY.. 213 .......... 1982. pursuant to which Building Permit No...1fi. 8..3~..g. ........... dated ...... g xtgu, .t..2 ............ 19. ~12, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ·.:.. a..deck..acldl.t.~,o~..t.q. ~.t,~ ~;[p~, ql.~.o.l. 1..i,n~L.. .............................. The certificate is issued to .... Tllomia~ .&..~/.e.r~qly..lq ~..C,a.r.~y ........................... (owner, le~e~o~ of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE NO ............... I1/?. ............................... Building Inspector Rev. 1/81 TO~ BUILDING soUTHoi ~ ~ BUILDING.: PERM!T~ ~ (TH S PERMIT MUST BE KEPT ON .~HE PT~I~I~tSiUNTIL P, ULL COMPLETION OF THE WORK AUTH~RiZED~ ~ ~ ~ ~' ....~. ............ , ]~..~ Permissiorl is hereby granted to: ~,hty TdA Mop No. 1000 Section to p~lr$~ant application dated Buil~Jing 16$pector. Fee $., ./..~..~ ............ Lot NO.::O~.(. ........... ,and ~approved by the FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hail 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 featu res. 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 of Code compliance from the Architect dr 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 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. 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 New Buildin r Pre-existing Building(X) ......... ~ [Vacant Land Location of Property .EJ.~,'~. ........ ... .~.~.~ ~.e..~)/'. ................ , ........ ~ .......... Hou~ No. Street Ham/et Owner or Owners of ProperW . ~' 4 ~ ~0~ ....... .... ...... Health Dept, Approval ........................ Labor Dept, Approval ......................... Unde~riters Approval ........................ Planning Board Approval ............... Request for Temporary Certificate ..................... Final Certificate ........ - ......... Fee Submitted $ .... . ......................... Construction on above described building anc~permit'mee~s all appl~cable~codes and regulations. Appl cant '~f~ ' , u C o. I I I 3 FIELD ~NS?E~TION COMMENTS FOUNDATION {1st) FOUNDATION (2nd) 2. 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 Examined~..?. ...... , 1~.~'~ Application NO. ,~'.~.~.. ,"f~.'~. ....... APPLICATION FOR BUILDING PERMIT Date...~.1. ~ ....... ' INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitte~d ~ to the Building Inspector, with 3 sets ot~ plans, accurate plot plan to scale. Fee according to schediile. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoh'fing 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 Certifidate 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, ordhnances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for neces~cti_o..ns. ~ (Signature of applicant, or namg~/f a corporation) [J (Marling address of applicant) [ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and tide of corporate officer) Builder's License No...~ .[. ~.,~. ............. ...: Plumber's LicenseNo ......................... Electrician's License No ....................... Other Trade's License No ..... : ................ 1. Location of land on which proposed work will be done .................................................. .... ............... .............. ................. House Number Street Hamlet County Tax. M~N_o. 1000 Section .... .~., ?C. 7 ...... Block ..... -~-, ,~, .... .... Lot,., ,~,, ~ / ........ Subdivision..~.~.~....~. ~--~S ..... Filed Map No../.~.~.?..'.. Lot..~..~./.. q .... ~ (Name) 2. State existing use and occupancy of premises and intended use and qccupaney of proposed construction: a. Existing use and occupancy ...~e, ~..~..~ .~ ~-~.e~,.,... ............... ~ ............................ b. lntendod use and occupancy ..... ~'~..v~.l~.....lj~...~.. ;~.0,2~ ................ .. . . ... . 3. Nature of work (check which applicable): New Building .......... Addition ..... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (D iptio ) 4. Estimate est ................................... ee ...................................... : (to be paid on filing this application) ' 5. If dwelling, number of dwelling ?n/ts ............... Number of dwelling units on each floor .... [ ........... If garage, number of cars .... 6. If business, commercial or mixed occupancy, specify nature and extent of each ty~e of use ........ ~... 7. Dimension~ of existing structures, if any: Front....~. B.' ....... Rear .~ ........ Depth..~t~.~ . .. Height . .~ ............ Number of Stones .... ~ ...... - .............. * ............................... I)imensions o~samestmcture Wi~ alterations or addit{ons: Front . . .~.~ ....... Rear . ~ ........... Depth ..... J. ~ .......... ~.. HeiSt .... ~. ~ .............. - Number of Stories .... ~ ........ , ......... 8. I)imensions of ~ntire new construction: Front... 1~ ........ Rear ............... Depth . .~.~ ..... ~ ..... Sizet~eightoflot:' )'Front ~ ........... Nu~ber~ of Stories Rear ' ( ...................... ~ / .~. ~ ' .... .......... ........... ...................... ' .... mt~ of ~u~m~ .......... ~ .................. ~am, of Fo~,~ Owner .~C,?~ ..... ~ e~ .... 10. 11. 12. 13. 14. Zone or use district in which pr~mises are situated ..................................................... Does proposed construction violate any zoning law, ordinance or regulation: ................................ Wilt lot be regraded .......... Name of Owner of premises .. Name of Architect ,. ......... Name of Contractor; ~..e..o.~.~t ' Locate clearly and distinctly all property lines. Give street and blockinumber or description according to deed, and show interior or corner lot. .................. Will excess fill be removed from premises: Yes No ................. Address ................... Phone No ................ ·.. ~.: ........... Address ................... Phone No ................ ..... Address4~oP)l,~[a ~,~,.~. ~J ,, Phone No. ~[ ~ ~.w .~.~ ~..~. PLOT DIAGRAM buildings, whether existing or proposed, and, indicate all set-back dimensions from street names and indicate whether STATE~F NE~J'~ORI~,, "~ :S ..... (Name oPindividual si;Zi~,'c~/ ...... being duly sworn, deposes and says that he is the applicant above named. He is the ......... ~.~ ................................................................ (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, ~d is duly authorized to perform or have perfomed the said work and to m~e ~d file this applk:ation; that all statements coniained ~ this application are true to the best of his knowledge and belief; and that the work will be perfomed in the manner set forth in the application filed therewith· Sworn to before me this No~y Public, ..... ,. ~ .... County