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Home My WebLink About12400-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate O[ Occupancy No... ~.1.~99 ........ Date ................ .5.u.]_.y.. ].7 ......... 19 .8.4. THIS CERTIFIES that the building · · · ft.c.c.~,..d.~.q ~ ................................. Location of Property .... ~ ~ .0 .........~ 9 .n.s.e. ~..1..~.a.n..e ............. .~.q t. 9 .h.a.~u..e ......... House No. Street Ham/et County Tax Map No. 1000 Section .. ,9.7. ....... Block ..... qB. ........ Lot ..... 2. 1. ~ .2,2, ...... Subdivision ............. :~ ................. Filed Map No... ,x. .... Lot No ..... .x ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ J.t~a~..a(} ...... 1993. pursuant to which Building Permit No ..... ] .a.q.qq z. .......... dated ............. AB v..i ~..1 ....... 19q ~., 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 ......... ........... ~.c.q ~ ~ ~.o.~ y..d.e.q 1¢., ................................................... The certificate is issued to ........ ~D.hb$. N.... ~. ~l.q I~ [~ .~..4 ~..B.U.T.L..E .R ..................... (owner, ~ of the aforesaid building. Suffolk County Department of Health Approval .............. .N/J{. ........................ UNDERWRITERS CERTIFICATE NO ...................... iq/.tt ........................ Rev. 1/81 Building Inspector I~OF, M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING FEF,~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 12400 Z ...... .~..' ' . .......... .~.~ lX~ ....... ~o~n~ To~ Mo~ ~o. ~000 S~t,o~ "-'~":'7" ........ ~,o~ ...~.~. ........ ~ot ~o...~..).~2._ pursu*nt to oppli¢~tion doted ........................................................ , 1~ ........ , ond ~pproYed by th~ Building Inspector. Rev. 6130/80 FORM NO· 6 TOWN OF SOUTHOLD Building Department Town Hall ~ ~outhold, 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 a~ 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. 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. C. Fees: 1. Cert ficate of occupancy $5·00 [// 2. Certificate of occupancy on pre-existing dwelling land use --?re-E×ls ting C.O. $15.00 3. Copy of certificate of occupancy $1.00 Vacant. land. C.0. $ 5..00 Date New Building ......... Old or Pre-existing Building ...... Vacant Land ............. Location of Property . ,~, ¥,(~, ........... /'/~C//'~...~,~-- ...... House No. ' · Street Hamlet Owner or Owners of Property · .~.~. ~.E~. ,~.. ,?. ~/./,~ .~...~.~..~..~..~. ...................... County Tax Map No. 1000 Section .... ?.~ ........ Block. .............. Lo .............. Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. /?. .¥. .~.~. .¥. Date of Permit .~//.//~.~...Applicant .~.4(~../'~ O~..~. ............. Health Dept Approval Labor Dept Approval ........................ Underwriters Approval Planning Board Approval ...................... Request for Temporary~rtificate ..................... Final Certificate · · .)~ ................... Fee Submitted $ ' '~'~ ......................... ' on above described building and permit meets all applicable codes Construction Applicant ,.~ ~,~~ ...... · COMMENTS FIELD IN~P:EC~ION 1. FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 ,~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:3 Disapproved a/c ..................................... Application No..~A .~. ~..~-~ · (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 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 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 building for necessary inspections. (Signature of applicant, or name, if a corporation) .&.x. .... ................ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. ....~.t~...W. 7¢ ~ ............................... ,~ ................ AI~PRO~fAD 'AS~' NOTL~ ............. Name of owner of premises ~7.~../ ~ ~..~..~../. ~..~. ~ .... ~A~..P,~/.,ff~ .~/~. ~. ~-, ..... (as on the tax ~ ~t~t ~ g ' ' If applicant is a corporation, signature of duly authorized officer. NO~F~ 'CURDING DEPAR~M~MT AT 765-1802 9 AM TO 4 PM FOR THE (Name and title of corporate officer) Builder's License No .... /~/VT~...... .......... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... FOLLOWll~IG INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBIN~ 3. INSULATION 4. FINAL ~ CONSTRUCTION MUST BE COMPLETE FOR C. O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENFR~'~' CODES. NOT RESPONSIBLE 1. Location of land on which proposed work will be done .......... .D.E.S!G..N. OR. GONS. T. RUCTION. U~[ZO,2S~ ......... ........................ (., ....................................... House Number Street Hamlet County Tax Map No. I000 Section ....... ~..7. ........ Block ...... ~ ~ ....... Lot....~../...'~..'.~..'~-..... Subdivision ..................................... Filed Map No. ./..~. ?.,..5~. .... Lot . .~.~. · · .'~. · ./. · . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed constr~tction: a. E~xisting use and occupancy ....... q'~..'f~. · .....~.-q.~.~. :qJT.. .... ~..~..~...~..~'..~.~..~-. ................ b. Intended use and occupancy ..... ?../V..,~, .......PT.~../~./.e.~ ..... .d~,..,~. ~ .~. 4~..to_.~ .~ .~.?. .............. 3. Nature of work (check which applicable): N~ Buff~iing .......... Addition ......... Alteration .......... Repair .............. Removal . .'...' ....... Demolition ....~ ....... ?. Other Work ............... /~.j i /~..,~. ! (Description) 4. Estimated Cost ...................... t (to be p~id on filing this application) ' ' 5. If dwelling, number of dwellin~ units ............. Number of dwelling units] on each floor ................ If garage number of cars . .. ......................... I .... ....................... 6 If business ' ' ~ specify nature and extent of each typ~ of use · , commercial or mixed occupancy, ................ 7. Dimensions of existing structures, if any: Front ............... Rear ........ i ...... Depth ............... Height ............... Number of Stories ............................. i ........................... Dimensions of same structure with alterations or additions: Front ............. I ....Rear .................. Depth ................... i. · · Height ...................... Number of ~tories ...................... 8. Dimensions of entire new cons[ruction: Front ............... Rear ......... ] ...... Depth ............... Height ............... Number of Stories ............................. i ........................... 9. Sizeoflot: Front .......... ~ ............ Rear ...................... ~epth ...................... 10. Date 0fPurchase .......... ! ................... Name of Former Owner ............................ /l Za 11. Zone or use district in whic emises are situated ........ ~n. ,. ............................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... 13. Will lot be regraded ............................ Will excess fill be removed ]from premises: Yes No 14. Name of Owner of premises . .. .................. Address ................... Phone No.~.$.~r.. Name of Architect ......... : .................. Address ............... ,... Phone No .............. Name of Contractor ........ . .................. Address ................ i' · ' Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and~ind~eate 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 NEY~ Y.O]~K, (Name of individual signing contract) above named. He is the ................... .t~......~.... ............................ ~ ......................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the sail work and to make and file this application; that all state~nents contained in this application are true to the best of his khowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this Nota Public / fi'' ~z'~~~ ............. - ' ry , .~,Z¢-~~P~.. ......................... County being duly 'sworn, depos~ s and says that he is the applicant