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Home My WebLink About12471-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z~13755 Date August ~- 198..5 THIS CERTIFIES that the building accessory. · fl 800 Village Lane Orient Location of Property ............................................................... House No. Street Hamlet County Tax Map No. 1000 Section 2/4' .Block 2 .Lot 22 Subdivision X p N x x ............................... Filed Ma o ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated ...4~..1¢-..2.? ........... 19~. .~. pursuant to which Building Permit No ....... ? .2.P-.7..~..~ ........ dated ....g?. ~.u.~.~..9. ............... 19~.~.., 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 ......... · ?.qe. 9.s.s.q~. 7..~.u.$.l.d.5.~.S.. ........................................................ The certificate is issued to .. DOROTHY DORFiAN ................... ..................... of the aforesaid building. Suffolk County Department of Health Approval ................. .N/.~. ..................... UNDERWRITERS CERTIFICATE NO ......................... fl./..A ..................... Building Inspector Rev. 1/81 FO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. N°. BUILDING PERMIT (THIS pERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CC~MPL~ON OF ~'HE WORK ,',U-rHO~ZED~ 12471 Z Date ..... ~-..~.3~...~..,....3 ............. , Permission is hereby granted to: .......................................... ..~.~ .~...,~....~. :..~ / ! ~ '.~.~ to ........ ~ ............ ~ ....... .0~ ..... at premises located at ...iL~.~..~.........~..~'~..~.~ .................................... County Tax Map No. 1000 Section ..... t..~...~.. ........ ......... Block ........ .~.... Lot No. .~.....~ ......... pursuant to application dated ........... ~:~.~......~...~j ' ............. , 19.~..~., and approved by the Building Inspector. Re~ 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 ia ~ 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, Industriat buildings, Multiple Residences and similar buildings and instalia- 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~"operty showing alt 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. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $15.0 0 3. Copy of certificate of occupancy $1.00 Date .............. New Building ... / Old or Pre-existing Building Vacant Land Location of Property . l .~ ~.0....~.~! !*~...'..L.~...~. ~., ....... t ................ .0. :f.,'.~ .~.~. ...... House No. Street Hamlet Owner or Owners of Property..r~. ~..~ p~,~ .... . .~....O.~..v~¢...~.~,~ ........................... ~, ~L,_ County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................ Filed Map No ........... Lot No .............. Permit No ........... Date of Permit ).~-.~'. ~7. ~. ~ .Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $.. ~.Ob ~J ~ Construction on above described building and permit meets all applicable codes and regulations. .,. ................ Rev. 10-10~78 DATE COMMENTS .< ADDITIONAL COMMENTS: FOUNDATION (~st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING 3. INSULATION PER N. Y. STATE ENERGY 4. FINAL TOWN OF SOUTtIOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL $OUTHOLD, N.Y. 11971 TEL. 765-1802 Aug. 7,1985 To Whom This May Concern, We are unable to complete your Certificate of Occupancy because .of the following reasons. /~/ An application for Certificate of Occupancy is not on file. /~/ The check is ~u%da%~ not on file. /~/ No final inspection has been made° Please contact our office on this matter. Thank you for your cooperation. Building Permit # 12471Z Expiration Date - 2/9/85 Building Dept. Sincerely yours, Building Dept. Sec. '~ '~ FORM NO. 1 'b ~ TOWN OF SOUTHOLD ~"(> BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1802 Approved...~...~..~.~..~..~ 19g.~ Permit No.]. ~..~.:.~. J..~.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUcTiONs Received .......... ,19... 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 remova! or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regu!atio[t_s, and to admit authorized inspectors on premises and in building for necessary inspections. ..... ............. (Signature of applicant, or name, if a corporation) t= .,. .¢ ,, t,t.¥., . . .I.t SZ . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................. .................................................................... Name of owner of premises ....tT~..o.r t>.~V .... ~.,..~..o.~.~,~tk .................................. (as on the tax roll or latest 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 ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. C. ................. ~;e ~;~r' ' Street h;,~'l;i ........................ ~:::)~ff;: ,M ~ ~.. 1.~0 Se ct~n ...... ~ ........ Block ~ Lot ~ "" ~ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... ~.q ~.~.C ....... ~.[[ ~ .~ .~. b. Intended use and occupancy ....... ~;~{~...~hE.& ~ ......... ~ ........................... 3. Nature of work (check which applicable) New Building .... ~... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... .~.t ~ ~..0.-o (Description) 4. Estimated Cost ............. ~ · .'.~. .............. Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units.., a ......... Number of dwelling units on each floor ................ If garage, number of cars .... ~ ....~.o ........................................................... 6. If business, commercial or mixed occupancy, specify nat~r¢0 and extent of each type of use ............. ~ ....... 7. Dimensions of existing structures, if any' Front ~ .71~.¢, ! Rear . l ~ ! , Depth ~ ~.r Height,~R ~ g//. ~. ........ Number of Stories ....... ~' ............................................ Dimensions o~re with alterations or additions: Front ................. Rear .................. Depth ...'.. ~ ....... Height ...................... Number of Stories ...................... 8. Dimensions of.e~tire neff construction: Front .... .~. t..,. . Rear , .~ t ...... Depth . .~:~..t ........ Height ....~. ~a*..I.O ~}. Number of Stories ......... ] .............................................. 9. Size of lot Front ..... C.. i .... Rear De,~th 10. !)ate of Purchase . .&¢~.O.~ ~. ¢. ~.~.~ .~ .......... Name of Former Owner . .~O,~,qk~,.~.~...'~",~YX $... 11. Zone or use district in which premises are situated ..................................................... 12, Does proposed construction vio~e any zoning law, ordinance or regulation: ..tNfta .......................... 13. Will lot be regraded '. ....... .A/vO ................ Will excess fill be removed ,fro_r~ premises: Yes No 14. Name of Owner of premises ~o¢.w~a.~.r~.~to~/q ~ddress . .~. ~[I..Xg.g..LP....O.f.t?.~'~l~one No. Nmne of Architect ......... i ................ '. Address ....... .~ ........... Phone No .............. '.. Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly al1 buildings, whether existing or proposed, and, indicate all set-back dimensions from iPnrt(~.ieor~icnoe:~e~ril*oetS, treet and block!number or descripticI according to deed, and showy street names and indicate whether ~(Name of individual signing'contract) above named. : lie is the .................................................................................. .: ..... (Contractor, agent, corporate officer, etc.) of said 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 contained in this application are true to the best of his knowledge and belief; arid that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this~ cqotary Public, ,¢~:,~. ~...¢-~..; .~.'.~. County ' ~ JUDITH X. TERRY ~ ' : f ~ ~t'l. 'i.~ ,q A ,- ,~.. No*cary Public, State o~ Now' Yo~ .[¢¢X~...L'~3 ............ No 52-034¢963 Suffolk Coun~[/~ ~) (Signature of applicant) ~ C,~mmisslon Expires Ma!ch 30,