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Home My WebLink About12297-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall 5outhold, N.Y. Certificate Of Occupancy No. Zq.1792 Date .July..q9. 1983. THIS CERTIFIES that the building ...~oroh. ad~i~io~ ............................ Location of Pronertv 225 Oak Road New Su££olk County Tax Map No. 1000 Section '1.10 .Block 8 .Lot .10 Subdivision x .Filed Map No. x .Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... A.p.r.i.1.. ~..2.., 198.3.. pursuant to which Building Permit No ...... ~ .2.227.5 ......... dated ....... .Yi.a.y..~. ............... 19g3., 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 ......... ........ ~o..~9.h..~. ¢~5~.¢.o.~..q~.. ?.z.~.s..~.~.. ~.~.~.z.z..~.n?. ............................ The certificate is issued to VAUGE]N i~SEY & WI~E ..................... ?oYn'&, :~:~& ~':i.;b;':';I ...................... of the aforesaid building. Suffolk County Department of Health Approval .......... .N./.A. ............................ UNDERWRITERS CERTIFICATE NO. Rev. 1/81 TOW. Or SouV"~(. BUILDING DEP~,R?M~N~ TOWN HALL SOUTHOLD, N. ¥, BUILDING PERMI~ (THIS PERMIT MUST BE KEPT ON THE PRE~ISJ~S, UNTIL EULL COMPLETION OF THE WORK AUTHOR ZED)' ' ~2~s, z Oa,e.:~: ~. ........ .................... , is hereby granted to: /? ,, .... } : Permission ././//7 · - .......... ~.~.r~z.:~..~.. ,o ..i.....,~.~.7..~.¢.-~~ at p~emlse$ ~'ht ty TaX Map No. 1000 Section .~;~../../..(-~.......~ ,BIo~k; .i'....~ co.! .Z;... ,o, ~o .... .,:~. purs0a t t, application dated ... '~..g./.....;../d.,.....':;...::i...., 19:J ~and approved by the Building Inspector P. ,...d~....; .... Rev. 6/30/~80 n,S~cto~ FORM NO. 6 TOWN OF SOUTHOLD RuildJng 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 buiMings, 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: I, Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topo graph ic 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 J / Certificate of occupancy on pre-existing dwelling er land use $ !~'/ $5.00 2. 3. Copy of certificate of occupancy $1.00 New Building ............. Old or Pre-existing Building(Z) .......... ~/Vacant Land ......... Location of Property ........................................... Owner or Owners of Property .... ~ ~. '.'. ...................................... County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ' i ........ Filed Map No. ~ Lot .... PermitNo. I.'~.~"7 '~' Date of Permit Applicant ~'~l~'~"r~ Health Dept. Approval I~J~T ~'~'~ '~ ............. ................. . ...... Labor Dept. Approval .' .1~?,~..~'~ Underwriters Approval .d?...~..k'.~.~&.~ ."( .~ .~.~$~ . .Planning Board Approval .'~. ;~.7. tg .~.~'?:~ .... ~,., Request for Temporary Certificate .................... Final Certificate ........ Fee Submitted $ ...... .~. .................... Construction on above described building and permit' meets all des and regulations. A cant '/~,~ /I~ PP ...... ~/.-: .:..~...,,.. ,~_. z ."/T.:. ,~."~,~4 ....................... Rev, IO-10.7e FIELD INSFECT~ON ~ COMMENTS ~, ,,,~ FOUNDATION (1st) F'OUNDATION 2. (2nd) ~OUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved ., 19~..fl~. Permit Disapproved a/c ...... .,~ ..................... (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 insp~tio~ns.~ (Signature of applicant, or name, if a corporation) . . . ./il t .... ...... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. c{ ,£. Name of owner of premises . k';" ................ (a eta oil 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 .................................................. · ....................... ............... ..................... House Number Street Hamlet County Tax Map No. 1000 Section ....~.~.0).' ........... Block .... ~ ............ Lot...L@ .............. Subdivision ...... ~. .............................. Filed Map No .... ~. .......... Lot /[' (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . .~B.~..'~.c.l~.' l (~[..(TgM'.~.e.v>.c.&- ................................ b. Intended use and occupancy ...(2?.~...~.'.?~...6(~...~..~.~t.~..e~..'.cq~.. '~)/,;t...~Fi~.~'..~.~ .... 3. Nature of work (check which applicable): New Building .......... Addition. ~ ..... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work tim~tedC tf.,~'..O.O. ' 4. Es os ~ .... Fee : (to be paid on filing this application) 5. If dwelling, number of dwelling lunits -- ' Number of dwelling units on each floor.. 7 ............. If garage number of cars ; ' 6. If busine~s,'commercial or mixed occupancy, specify nature and extent of eac,h type of use ..................... ons?o tm ¢ ~ .' ~. pth ~'.' 7. I)imensi fexistings ctur s, ifany: Front ............. Rear ............. De .............. Height Nunlber of Stories -- Dimensions of,same structure with alterations or additions: Front ...z..~.: ........... Rear ... ~.' ..... Depth .... f .............. '.. Height ...... 7~.-. ............. Number of Stories .... 8. Dimensions of entire new const~ction: Front .... .z.t..' Rear ...g6~ ........ Depth ...4 ........... Height ..... v ......... ,Nun}ber .of Stories .... --:....~.~_., ............................................ 9. Size of lot: Front ....7.. }- .....: .......... Rear ... ~ .................. Depth .. J .5. q .' ............... 10. !)ate of Purchase ........... i .................. Name of Former Owner ............................. 11. Zone or use district in which pr~mises are situated...~¢~0~ .~2..( ........................................ 12. r)oes 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 tJ%t,~ .... .~,~. qq Address,~.g Y..O+. t~. ¢.&../~q~./g-Phone No ................ Name of Architect .. ¥ ....... : ................. Address ................... Phone No...) ..... :. ...... Name of Contractor .~k ~.q .w~¢o...~ ~o~-.X .......... Address ¢9.. { .~r*¢~l~. ~.-c/'Phone No.' ~.X. .2.5 2X. } ..... PLOT DIAGRAM Locate clearly and distinctly all: 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~RK .... '~ SS COUNTY_OF ~-"~:.~., ' ...... ~- · ............... .~ '~. ..... ~ O.. being duly sworn, deposes ~d that he is the applicant (Name of individuhi sign,ng cont~¢t) says above named. Heis the ...................... ~....~ .................................................... ( (~ra¢, agent, corporate officer, etc.) of said owner or owners, ~d is du(~u~)o~d to perfom or have perfo~ed the said work and to m~e ~d file this application; that all statements contained ~ this application are true to the best of his ~owledge and belief; ~d that the work will be perfomed in the m~ner set forth in the application filed therewith. Sworn to before me this .......... ...... ....... ............................ ~[' ~' ' (Signature of applicant) ~o~585~ SeMk re~m Expires March 30~ o