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Home My WebLink About12312-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No .... 7d .~ 8.5.7. ....... Date ............... THIS CERTIFIES that the building ...acoe~O~7~r. Location of Property . .2 .q-.~ .................... Ha House No, Street Hamlet County Tax ~ap No. ]000 Section .... .'I~.Q .... Block ..... O.'J ........Lot ...... g.Q~ ....... Subdivision .......... :~ .................... Filed ~ap No .... ~ .... Lot No ........ 7: ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated .... $.pa?~_3_./1~ ....... , lff3.~, pursuant to which Building Permit No .... .q~J 27, ........... dated ........... ~e3r..q.5 ......... 19 ~.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 ......... .............................. The certificate is issued to ................ ~Z,~. ~R~VE .............................. (owt~er, of the aforesaid building. Suffolk County Department of Health Approval .............. .~../..~. i ...................... UNDERWRITERS CERTIFICATE NO,. Building Inspector Rev. 1/81 TOWN O~ SOUTHe~ · .BUILDING DEPARTMi· TOWN HALL SOUTH01~D, N. Y~I~ BUILDING' PERMIT (THIS PERMIT MUST BE KEPT ON THj~ PRE^ ilS~S UNTIL I LJLL COMPLETION OF THE WORK AUTHORIZED) D__e ...... ?.?. .......... .~.,',~ .............//' , ............ , Perrhission is hereby granted to: ~ ~'~ ~ ............................ ~.....~,...~..~, .~ Co,0 :x ~a ' ~ ot No.~ ~ . ' . ..... ty To p No. 1000 Section ............ Block .~ ...... :,.. iL .~.~. pur, S~ant tb application dated ~, ,i; ~i....; 1,91 ~¢~'and 6pproved by the Building Irispector. Re~ ~/30/~0 nspector FORM NO. 6 TOWN OF SOUTHOLD Bu~'~ding Oapar~men~ Town Hall $outhold, N.Y. 11~71 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 sun¢ey of property with accurate location of all buildin§s, property lines, streets, and unusual natural or tooograohic featurss. 2. Fina~ approval of Hegth Dept. of water supply and seweraoe disposaf--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Unde~rwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and slmiiar building~ 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 buildinos and "pre-existing" land uses: ~ 1. Accurate sur~zey 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. - / · ' Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 ,an u ¢/ 5.00 Date.. New Building ....... ¢7~. . .~. ~.' Old or Pre-existing Bunamg~)'" r ....... -~ ~ zV~c~nz L~n~ ............. Hou~ No. Srree[ Hamlet O 0 f P ty wneror wnerso roper ..... ~ ......... _~..', .. , ,~. ....................... County Tax Map No.,lO00 Section ............... Block ............... Lot ............. .Subdivision .Filed Map'No...: ....... LotNo .......... .......... · ......... Health Dept. Approval .. ,~. ............. Labor Dep[. Approval ...................... Underwriters Approval ...~ ./~ ................ Planning Board Approval .................. ~ ,., yC Request for Temporar ertificate.... .................. Pinal Certificate ........ - ......... Fee Submitted S ....... ~ ...... , .... Construc{ion on above described building and pern~i~meets all app[~c~b ~odes and regu)ations. ...... ....... FIELD ~NSP~TION COMMENTS FOUNDATION FOUNDATION 2. ~OUGH FRAME & PLUMBING (2nd) INSULATION PER N. Y. STATE ENERGY KODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved .'~'.'.'J~..[[.- /., 1 ~. '.4Permit No.. ~./~. d './.Of~./~" Disapproved a/c ....... i. .... ~ ................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No.../.~7..' ..~. ./.~.". ...... Date .. 7/./.J~.. ........ 19~'.~. INSTRUCTIONS 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 inspections. ...... ·. . . . . . //:z (Si/nature of applicant, or name, if a corporation) ..... ....... (Mailing address of applicant) / State whether-applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .... /(']/.~...~...~. ~. ..... ~. · .~..~?. · .~..~. ..................................... (as on the tax roll or latest deed) Builder's License No Plumber s LicenseNo ......................... Electrician's License No ....................... Other Trade s License No ...................... / 1. Location of land on which proposed work will be done..~//t~ . .~/~]./?..~..~...,4..~..~..'.~ ....................... ......................... .................... .g77. ...........¢' *u ;ber Street .amlet County Tax Map No. 1000 Section .~.~... Z .~.O. ....... Block .... ............. Lot.. 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 ....... Z..~...~..'~.......~..d .,~..'~...~. ?.~....'~.. (.~.. · ~ · .~..~...~. ?. ) ....... b. Intended use and occupancy.../.: .C.,~.~ .... ~'./.4 .~..4 .(.~ ............................ 3. Nature of work (check which applicable): New,Buildipg/.~,~x...~?.. ~_ddition .......... Alteration .......... Repair.. ............. Remqval~ ~. ff~ ~ Demolition .............. Other Work ............... , 4. Est~ated Cost ............. .......... ;Q O Fee (to be p~d on filing this application) 5. If dwelling, number of dwelling Units ............... Number of dwelling units on each floor ................ If garage, number of cars ..... ~ ................................................................... 6. If business, commercial or mixe~ occupancy, specify nature and extent of each type of use ..................... 7. D~ensions of existing stmcturos, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure w~th alterations or additions: Front ................. Rear .................. Depth .................... [.. HeiSt ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ Size of lot: Front ...........~ ........... Rear ...................... Dep~ ...................... Date of Purchase ........... i .................. Name of Fomer Owner ............................. Zone or use district in which pr~mises are situated ..................................................... Does proposed construction violate any zoning law, ordinance or regulation: ................................ Will lot be regraded ......... ..,.,, ................... Will excess fill be removed from premises: Yes No Nme of Owner of premises /~.'. ~ ~ ~ ..... Address ...~ ~.~ ...... Phone No ................ Name of Architect .......... : .............. Address ....... Phone No ................ Nme of Contractor ~ ~*2j~'~.~ ..... Address ~ ~ ~ ~. ,, ,,, ,: ~ .. Phone No. .~ ~d ~ 10. 11. 12.' 13. 14. 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 ~umber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW Yt~/RK,//y ~/~ ~ ,. COUNTY OF...~.. !~'~ (Name of individual sign.lng contract) above named. He is the ....................... ~~ rp ................... , agent, co orate 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 appheat~on; that all statements contmned m th~s apphcat~on are true to the best of his knowledge and belief; and that the work will be performed m the manner set forth m the apphcation filed therewith. Sworn to before me this ......... :. ........... . . applicant) 765-1802