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Home My WebLink About12269-zFORM NO. 4. TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z13802 Date. August 28 ................................................. 19. $5.. THIS CERTIFIES that the building ...... .A.c.c.? ~..~.o.~.¥ ............................... Location of Property ........... 9.0...~ .~.s.~...R 9.a.d. ......... C u t c .h.o ~ ? e House No. Strset Hamlet County Tax Map No. I000 Section . . ~..~ .0 ....... Block ...0..7 .......... Lot ..... .0.~.5. ........ Subdivision ............................... Fried Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated .... ~p.p..5_.1..1 ........... 19.8.3. pursuant to which Building Permit No. ].2..2.6.9.Z, .............. dated ..... A.p. ~..~.1..2. 0 .............. 19 .8.3., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... .... ~.c. ~ .e.s.s.o. r y..s.~ 9.p.a.~e., .b.u.5. ~..d ~.n.~ ............................................. The certificate is issued to ........ J..o.hfi..~.,..J.e.~..~ .u~0 ................................... (owner, I~p~ 1~1~( X X X of the aforesaid building. Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO .................................................. Rev. 1/81 Building Inspector BUILDING DE~.iRT~N~ TOWN ~HALL' ! SOUTHOLD,' N. Y. i BUiLDiHG pER~iT L (THIS pEPd~IT MUST BE KEPT ON TH~ PREAI$~S ONTIL I~ULL COMPLETION OF THE WORK ~UTHORi~ED~ Permissio~ is hereby granted to: ....... ~:~..~.~....~ ~. ~ ..... ~ ... .......... .............. .................................................................................. ~...,...--.. ....... put'ant tO application dat~ ... ff~ -~ ; nd OppmV~ by the Building I~spector. Fee FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ia ~ to the Building Inspec- tor with the following; for new build[rigs 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, 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: I, Accurate survey of p~"operty 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3, Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 $15.00 New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ................. ~ ............ owner or owners of Property .................................... County Tax Map No. 1000 Section ...~./~ ....... Block ....~ ....... Lot..~.~.~ ~ ...... Subdivision ................................ .Filed Map No. ..~......LotNo. ~ Permit No. ~.~ Date of Permit ~ .Applicant..~.,....~........,.~~. ....... Health Dept Approval Labor Dept Approval Unde~riters Approval., ,~., ................ Planning Board Approval ...................... Request for Temporary Certificate ,, ,Final Certificate / Fee Submitted $ ...... ~ ................... ~,~n codes and regulations. Construction on above described buildin d p~.meets all a~plica~ 474¢ ? FIELD INSPECT20N ~ COMMENTS ...~w~ FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS~___j____ --4 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Disapproved a/c ........ i_' ......... i i i i i ~/~~.....~7~.' (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No.~?..7.~. j~.. ...... a. Ttfis 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 PermiL 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 info, lb7 __~ ~ ' ~~a'~ i~opo~ration) ..... -- - (I~Iailing aeddre'ss of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......... . .~..-k~. 64- ..... ~ ....... ~ .....) ........................................... ............................................ (J ~ V (~W~on the tax roll or latest deed) If applicant is a corporation, sig'rfature 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 .................................................. ........... ....................... , ............... House Number Street Hamlet (~ County Tax Map No. 1000 Section .... //~...~.. ....... Block... V ............ Lot ..... .~. ~. · . . ...... Subdivision ......... .~. .......................... Filed Map No ..... )(. ........ Lot .. ~ ........... (Name) 2. Stateexistinguseand~ccupancy~fpren~esandinten~deduseand~ccupancy~fpr~p~sedc~nstructi~n:// __ occupancy ...... 4~t/~/~_~ ....................................... ~ .......... Existing use and ..... ...... b. Intended use and occupancy 3. Nature of work (check which applicable): New Building ...........e~ff.... Addition .......... Alteration .......... Repair .............. RemOVal .............. Demolition .............. Other Work ............... /0 (Description) 4. Lstnnated Cost. t~ .t29.. ........................ Fee ...................................... (to be paid on filing this application) 5.If dwelling, number of dwelling iunits ............... Number o f dwelling units on each floor ................ If garage, number of cars .... i ................................................................... 6. If business, commercial or mixe~ occupancy, specify nat?e j~n~d extent of each type of use .......... .__..~/~..... 7. Dimensions of/~xistjta~.[ructures, if any: Front .... ~.. Rear .............. Depth.. ~.~.... Height .... ,~ .... Num. bar of Stories ........ /. ............................................... Dimensions of safne structure with alterations or additions: Front .......... ....... Rear .................. Depth ................... :.. Height ....................... Number of Stories ...................... 8. Dimensions ofj~nti~e~n~ew constrUction: Front ..... Ff. F_2z///.~T'.. Rear...f.~.~/.~'7.... Depth ....~.~ .... tleight .... ~..///~. ·. ~ . Number of Stories ........ .~/..'Y. ~ ..... ~. ............ 7.~. ........ 9. Size of lot: Frofft ....... ~. tl.o./. ........ Rear ....... .~.t-/4/~ ~.,/ ...... De;th ... i .~2~-~; ./.~ ...... 10. Date of Purchase .......... : .................. Name'of Former Owner ............................. 1 1. Zone or use district in which pr$mises are situated ..................................................... 12. Does proposed construction vioiate any zoning law, ordinance or regulation: ...~ .................. 13. Will lot be regraded .......... ~' it' · · '~Y' "~ ...... Will exc~ fill be removed fr. on) premises: ~ No 14. Name of Owner. of premises . Name of Architect ....... ~. ..... £/...,~/.... C/.. Address .......... ~.. ...... ~iSh~ne No ................ Name 'of Contractor ......... : ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly alll buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STAT~ OF NEW Y~ORK/~ A,~ ~ . COUNTY OF ~~e~S'~ ............................. '. ................... being duly sworn, deposes and says that he is the applicant (Name of individual sign!ng contract) above named. He is the ...................... ......................................................... ,: ......... (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 manner set forth in the application filed therewith. Sworn to before me this ..................... dayof2: ........ ,19.. JUDITH T. TERRY i .......... Notary Public, State of NeW York ~ nt) I No. 52-03449~3 Suffolk Count~ COmmission Expires March ~0,