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Home My WebLink About12281-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building ADDIt~ION ................ rd. .. Cu. ¢ho e .......... Location of Property I:l$use~lo. Nassau point ...... ~r'e~t' ............ Hamlet County Tax Map No. 1000 Section .... fl. Q.Z[ .... Block ..... ~ 3 ........ Lot ...... QQ.~....;..: ' Subdivision..~.a.~. @.a.u. ?.?.. .................. Filed Map No...~.5~,..Lot No .... 9 ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .A2q~..i.1' .G. ........, 19 ~3. pursuant to which Building Permit No, , ,~[228.~Z ............ dated . .4P~.5-.I. . ~ ................. 19 ~33., 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 ......... ·.. ~9~. ,~, ,d.o.:cme~e..a40-i.qS. on..qq. ~, .axis:b. in~..dwelling ....................... The certificate is issued to .. ~'~L~K..&. ~LO, P~E~IC~I .~PAIxlV~RI ............................ fowner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~/~ UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 N°. 12281 Z Pe~rnission is hereby granted to: TOW~ HAL~ SOUTHOLD, NdY~ ~HIS PE~IT MUST BE KEPT O~ :THE PREMISES UNTIL FULL C~PL~ION OF THE WORg AUTH~RIZE~) v~t, .,~Z..,~ ................... ~.. at I~remlses located at, Couoty Tax Map No. I000 Section .... ~... : .... loc pursuant to application dated .................... ~ .... Buil~ling Ih~ spector. Fee $.L~.~a~.. ............. / and bpproved by the 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 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 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 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 $5.00 ¢ 5/$ 2. Certificate of occupancy on pre-existing dwelling land use · 1 5.00 3. Copy of certificate of occupancy $1.00 Data .......................... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property .~T.f~l~ ~/~ .¢~..~l~/Mr' GO ~..~....¢~,~.....~. -}' ~-----UTCH~fl~' ....................................................... House No. Street Owner or Owners of Property ?~4.~','.~-. ~"IO~..~..C~ ~..~..l¢~,~--~r County Tax Map No. 1000 Section .. (.0..~. ........ Block ...f..~. ......... Lot....~. ........... ~..~. ~ ~V44¢ ¢ ' .Filed Map No. '~ ~. ~.. Subdivision .... .~.....- ....... .cftC....../.~.~. .... ?.~.~.! .... Lot NO ............ Permit No.'~..~..~.( o.*~. Date of Permi, ¢/~/~..~...Applicant .... ~.'..~..~.....~...* ............ Labor Dept Approval Health Dept. Approval ................................................. Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate .,~, Fee Submitted $ ...... ' .................. Construction on above described building and permit me,ets all applicable codes and regulations. Rev. 10-10-78 FIELD INSPECTION FOUNDATION (~st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING COMMENTS INSULATION PER N. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS: , ~,-~ CON, 4 FINAL - ~x,S-', ........ ALL CONSTP UC'I"~ON STATE CONSTRUCTIO~ CODES. NOT RESPO DESIGN OR CONSTRUC1 FORM NO. 1 TOWN OF SOUTHOLD - BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1801~ Examinede~Z/.. ~..., 19 .~.,~' ipprove~./i< .~...'~. ~..., 1 .~.. Permit No.//7. · .~..(4' ................ .... : ...... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No.. l. ~':..~..~../f ....... a. This application must be completely filled in by typewriter or in ink and submitted in triplicate 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 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 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 buildings for necessary in, sp~tions.,_, (Mailing address of applicant) t t q ~ 3" State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............................. FS. , ./;-, .................................................. Nmne of owner of premises !N.4-' '~--'./'f{ ~... F.~7.--.~-rt. X ......... (as o~ 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 .................................................. ....9,.t0.(.5'.. ........... ........ .... House Number Street Hamlet ' Caunt, Tax Map No. 1000 Section... kq ..~. ....... Block ...... ~...~.. ...... Lot .... g ............. Subdivision '.~. eC77.{~" ]~ ' /~}'~S~J~ /~O.~.'T' FiledMapNo 7.1.~..3~.47 /FSi. L.o,t ~ ........ "'; '. ..... ;' ............... 2. State existing use and occupffncy of. premises and intended use and occupancy of proposed construction: b. Intended use and occupancy . .qe.~'...<.~ .... ~ .C; ............................. 3. Nature of work (check which appiicable): New Building .......... Addition . ·..'~..'~... Alteration .......... Repair .............. Removal .............. Demolition ............. Other Work. {~.d ~ (Description) Fee ">- 4 Estimated Cost . '. ............................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, hum bet of cam ...... j .................................................................. 6. If business, commercial or mixed bccupancy, specify nature and extent of each type of use ........ ~, ............ 7. Dimensions o~f~existing structures~ if any: Front... ~ ...... Rear .&'~.$--. ........ Depth ., ./~-~.. ........ Height ,~_ ~.. NumUer of Stories ./. Dimensions of same structure with alterations or additions: Front ... ~--,.,/~z-~...~.--~. Rear ................. Depth ..................... ~. Height ...................... Number of Stories ..................... -. 8. Dimensions of entire new constrUction: Front ............... Rear ............... Depth ............... Height ............... Number o~f Stories ......................................................... 9. Size of lot: Front.../...~... ~.>~.: ...... Rear..~.~..~..~(. ............. Depth_..., .................... 10. Date of Purchase ............ i ................. Njlme of Former Owner ..; .,fiT. ....................... 11. Zone br use district in which premises are situated .... t~.¥~ ......... 1. ..................... 12. Does proposed construction vio_l,a:te any zoning law, ordinance or regulation: .... ...~..~. .................... 13. Will lot be regraded ..... . .~?. ~ ............ ....... Will excess fill be renmvett from premises: ,Yes '~/ 14. Nmne of Owner of premises .~'.~.. .~2~. .f'/Z~w~P.d''..... Address/~-.]f-.,,g~-,).. . ...~./.'°F...--~Phone No. ....... .. . Name of Architect .......... ! ................ Address .................... Phone No ....... , ......... Name of Contractor . ~..,(f:~) .......... Address O.-~d~.../'..~-~-....~ .... Pl~on~No..~.~. ~TqF~../..~'.. ~ PLOT DIAGRAM Locate clearly and distinctly ail 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. STATE OF NEW~O~[/~. ,./_ S S .._- ...... '~' '(~; ~ -,a ~,, .......... being duly sworn, deposes and says thaj.~e'C'~ is the applicant above named. .... ..... ,.,.. ~e is the .... ~-;~- .... ~ao ~ a ;;;:r a g;~t: ~;;; rate officer, e~c.)' .............................. of said owner or owners, ~d is duly authorized to perform or have perfo~ed the said work and to m~e and file application; that all statements contgined ~ this application are true to the best offs ~owledge and belief; and that the work will be perfomed in the m~n~r set forth ~ the application filed therewith. ~ Sworn to before me this ~ ,' . ......... ...... .... ....... Nota~ Public, . .... ~.. '~ ..... i. .. ' County ~ .. ~OI~RY PUBLIC, state ot New Vo~ NO. 52J8125850, Su[f0lk ~rm ?~kRS March 30, 19~ (Signatur~ of applicant)