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Home My WebLink About12379-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. 'Certificate Of Occupancy No..~.J J ?.7.~. ......... Bate ........ .O.q~; .o.~.en ..~ .............. l THIS CERTIFIES that the building ~ ~.-¢~.]3,Z.~.3~0~T ..................................... Location of Property .. 2.~.Q. ~.¢h. Re ............ ~¢~.~¢~.D.~a3¢ ....... House No. Street ................... Hamlet County Tax Map No. I000 Section ... J.C).6 ..... Block .... 5 .......... Lot ....... Subdivision ............................... Filed Map No ......... Lot No. ' ... conforms substantially to the Application for Building Permit heretofore filed in this office dated ·...~..q.~ ' , 19 .$3pursuant to which Building Permit No. q E3.7.c~$.. ' ....... dated ..... ~.~. fi.O ............... 19 .~3, 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 ......... ..... Go~:~e. acl. dS.~c ±.o<. ~..an. ezcJ. a~±n~, oz~e..£~.].;y, ct~.~Z~.:Lz~ ............... The certificate is issued to 2L~/-...0;0~. dL~O~O~OTYZ~OE ..... : .......................... (owner, levee or tenant) of the aforesaid building. ~/~ Suffolk County Department of ~ealth Approval .................................... . ...... UNDERWRITERS CERTIFICATE NO ~T/3. - Rev. 1/81 TOWN OF $OUTt.tOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS pERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 12379 Z Permission is hereby granted to.~ ..... ~.~..;..~..~... ............. ~....::..:.... ~... ................. .... ~. -~..~.~- ,:.~.;;,....~:~.:__ .............. .//./...q$- to .......... ~¢~ .7/z.~..~..... ~..~..~../..~.~ ~,....~-..~....~.~~.. .z~. ........ ~.~. ~.,~,;~.....~-~../.,~ ................................................................................... at premises located at .................. -~....../. ....... ~/..~Z~ ,.~.---c~.- .. County Tax Map No. 1000 Section .... ~.~..'.~.. ........ Block ....... ~...,,~...i .... Lot No..~..&~..~.?../... ....... pursuant to application dated ...x~..~.....~'..~... ....................... , 19..C-.~, and approved by the Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N,Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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 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 or Engineer responsible for the building. 5. Su bm it Plan n lng Board approval of comp leted site p la n requirements where applicable. 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 featu res. 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 ~/r land use ,1~/ 5.00 '/' 3. Copy of certificate of occupancy $1,00 Date .~. ~ .~... ~'~./~..-~... New Building .....O~.. ~:... Old or Pre-existing Building ..~.~.. ...... Vacant Land Location of Property ... 2.7..0... ....................................... House No. Street Hamlet Owner or Owners of Property . .~. ~'.,, . .~.qL?~t.. ~'~.~.'.T~.~..o./.P~.lcj. j~.~jj': ................... County Tax Map No. 1000 Section .... ~ ~.~. ..... Block ... ~ .......... Lot.. ,':~. ~f.'. ........ Subdivision ....... ~ ........................ Filed Map No... ~ ....... Lot No .... /~. ........ Permit No.,./~.~.?..~.. Date of Permit .(~.~./~ .Applicant.. ~. ~/.,. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval .... . .~..~ ............ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ..................... ~ .. Fee Submitted $... ~ ........ ~ ...... Construction on above describedApplicant..building and.~,d~0~permit meets all applicable. ~., .~.~..¢~.\//,~...L~...~,..cedes an,~ regulations. FIELD INSPECT%~ ~ COMMENTS FOUNDATION (1st) FOUNDATION 2. {2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE FINAL ADD~ITIONAL COMMENTS.~ ~ ~ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST []ROUGH PLBG. FOUNDATION 2ND []INSULATION FHAMING [ INAL /(~Z~- DATE .,,INSPECTOR FORM NO. 1 TOWN Ot= SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765'1803 Disapproved a/c ...... Z .... ~.f '~'' "~"f ~ '~'~' ........ i - '" ~- (Building Inspector) APPLICATION FOR BUILDING PERIV]IT IN STRUCTION S 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 plaF to scale. Fee according to schedule. b. Plot plan showing 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 issued 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 demolitimx, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to for necessary ~spection~ , ~ admit authorized inspectors on premises and in building '"' '~""' '~/~''''' "~' '/~' ' '~'~' ' "'Y'~' '(~ in' .... (Signature of applicant, or name, if a co porat'o ) ............................ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ......~.. ~..o./~../ff.....~..~/,r. ?./2t..~, .?~. ,~../-.o..J' .................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Plumber's License No. Electrician's License No ..... .~bOm~ ........... Other Trade s License No ...................... 1. Location of land on which proposed work will be done .................................................. .......... .2..7. ............ House Number Street Hamlet County Tax Map No. 1000 Section ... !.0.~ ........... Block ....,~ ............. Lot..~..~. .............. Subdivision .... ~ ~~4) ................ Filed Map No ............... Lot ............... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy....y.~,~. ...'~.~(f~'....~ ¢.~-~[z~z~ .1.~.~¢~8~..~4'.~ ',~ b. Intended use and occupancy 1,~.~,~,,,..,~ ........... ( 'w ppli ) Additi ~ 3. Nature of work check hich a cable: New Building .......... on ..... Alteration .......... ' Repair RemOval Demolition Other Work ' (D ripti ) 4. Estimated Cost .... ~..~.~ .................. Fee ............................. ~ (to be paid on ~ing this application) 5. If dwelhng, number of dwelhng~umts ...... 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 type of use ...... . ............... 7. Dimensions of existing strncturels, iffy Front ....... Rear .............. Depth ............... ~Height' . .............. Num. be~..f Stories ........................................ ':Dimensions of same structure~t~a~[te, rations or additions: Front ................. Rear .................. Depth ..... / .... Height ..... Number of Stories ..... 8. D~mensions of entire ne~nstrnction: Front ............... Rear Depth Height ......... .~.... Number of Stories ........................................................ 9. Size of lot: Front~/ ............. : ....... Rear ...................... Depth ...................... 10. Date of Purcha,~..~; .....,...: .... .. :' .............. Name of Former Owner ............................. 11. Zone Or use~, trict !n w.h. ich p.r~m, ises are situated ................................................... ]. 12. Does pressed construction violate any zoning law, ordinance or regulation: ................................ 13. Will l~be regraded ......... k .................. Will excess fill be removed from premises: Yes No 14. ~_o_~f premises ................... Address ................... Phone No ................ _~l~ame of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate ~learly and distinctly alli buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block gumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW l~rO, RKr~-- f/ SS .... ~¥. 'i .-'~.0 .~M.... ~Jq ~/~/.OOP ~ t Q.~ ..... being duly sworn, deposes and says that he is the applicant (Name of individual signlng co~tract) above named. . i (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul~ authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manne~ set forth' ih the application filed therewith. Sworn to before me this ............ . .~.~ .~. ~...day o~ ...... ~ ...... , . ILL~ .... nul'~l~y PUBLIC, State of Now Yor} (Signature §f applicant) ~o.~ 52.8125850, .~tfolk r~ i Exp,res Nfarch 30. 19~o~7