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Home My WebLink About12643-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 ...qr..e.e,n.t~.o..u.s.e..a, .d.d.~.~.$9.n' .~9..a, qc.y:..s.h..e.cl.. ..... Location of Property .. ~[ 2,0.Q ............... .~.a. 5,..n. gg,a.4 .......... House No. Streer Hamlet County Tax Map No. 1000 Section . . Q 7.13 ....... Block . .. ,0.7 .......... Lot... 9 .1.9. .......... Subdivision .... ~ .......................... Filed Map No. X .Lot No. X conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... ~U~.tl 8 1;. 2.4 ..... 1 9 .~ 3 pursuant to which Building Permit No .... .~.2. 6. ,4 .3..~. ......... dated ... $.e[?terahe~:. 2.9. .......... 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 ......... ...a~ .rJr..e.e.r~h. 9.u.s.e,..a.d.d,.~.g~9.n..¢9..a.c. qe..s.~.°.r. 7, .s.h.e..d.. .............................. The certificate is issued to ........... .~.~.I,~[..h[~I.. F,-..&.. ?.~.~,R..I .C.I.t...Dr..~.I..I~.~.O.R.D, ......... (owner, le~ee~e~-ter~et) of the aforesaid building. Suffolk County Department of Health Approval ..... ~/.g ................................. UNDERWRITERS CERTIFICATE NO ............. .~1/.25 ................................. Building Inspector Rev, 1/81 FOEM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, No Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12643 Z Permission is hereby granted to: · ...................... ~~.~..~..~.~ ...... ).J.~..~ .............. ,o..~....~......~~.....~~. ~ ~ ........ at premises located at ....L~. ............... ~.. ..~.4,~,~,~1 ........... County Tax Map No. 1000 Sect~:u~-...~...-l....g. ........ Block ....... .~....~ ........ Lot No ...... .~.1..~. ......... pursuant to application doted .~:3~......~..~ ................... , 19.~...~, and approved by the Building Inspector. Fee $ ......~ ............... Rev. 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 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 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 unusua~ 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/ land use -- lYre-E× i s t~±ng C. 0. $15 · 00 3. Copy of certificate of occupancy $1.00 Vacan% land C.O. $ .... - .... Date Il...~'. ........... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ..... 0~l~r~ · ¢. House No. '' [ ........... Owner or Ownersof Property ....~. ,f., ~...~..[f.' .... ,~..f~).,...~. ..... .~..;.\ .~. · .~.~ ....... County Tax Map No. 1000 Section ,.. O..'~. ~. ..... B Dock ... ,~..~. ........ Lot .... O, l .~ ...... Subdivision ................................. Filed Map No ........... Lot No .............. PermitNo.12. . /. .. Date of Permit .~.;~,.1-t~ Applicant .~('~{)(..O~. J~...t,.Q.~...~..,,3~.¢-~L Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ...... ~ .%r~... ......... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ............ Fee Submitted $ ..................... ~ ~/'~..,~. Construction on above deseribed building/d~~d regulations. Rev, 10-10~7e FIELD INSPECT] FOUNDATION FOUNDATION ROUGH FRAME & INSULATION PER STATE ENERGY FINAL ION DATE COMMENTS (1st) (2nd) BING ' ' R N. Y. RGY ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined....~.~Ym,~4,,&.¢~, 19~1~. ApproveS....<~. ~ .k.~ 19~.. Permit No./..~.(~ ....... Disapproved a/c ..................................... ................................ ..... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No .................. a. This applichtion 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 inspections. o".Z7.../.A/..c.,. ....... (Signature of applicant, or name, if a corporation) . .d. & . .Ale. . .-. e. c o /¢ / c. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......... .................................................... Name of owner of premises..~..~'.. ~..//.~.~'AtgZ2. ..... (..~...fy)......~., .... .~.. 1:.! . .~.d. ~...ci.D.t.'..-~. ) ..... (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..~f.~.': .2..~ .~.... F.~. q~.. ?...~..J'-d'-~o Plumber's License No ......................... Electrician's License No ....................... House Number Street Hamlet County Tax Map No. 1000 Section ..... .~...r~ .~. ...... Block ....... O.~. ....... Lot ..... ~..[ .~. ........ Subdivision ................ ?. ................... Filed Map No ..... ~. ........ Lot ..... ~)~ ........ (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy...~...~~~..~.. :'-~ ............................ b. Intended use and occupancy ....................................................... ~-- · ........... 3. Nature'ofwork (check which applicable): New Building .... Addition .' ...... Alteration Repair ............... Removal .... ' .......... D~molition .............. Other Work ............... (Description) 4. Estimated Cost ..... q>./~F57.~:>.{2:~,...'-A-. .................. Fee ; (to be paid 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 mixed occupancy, specify nature and extent of each type of use ..."~.~ ~ 7. Dimensions of existing structure~, if any: Front /.O Rear . ! O Depth .... ~'~ '! ....... Height..... ]~ ........ Num~ber of Stories ...... [. ............................................... Dimensions of same structure with alterations or additions: Front ....... [~ ....... Rear ... ~.~. ......... .. Depth ....... .~ ......... :.. Height .......... /..~..--. ........ Number of Stories ....... ]. ............. 8. Dimensions of entire new construction: Front ........ /.~. .... Rear ..... /.o~. ....... Depth .... ~ ......... Height .... /~.. ....... Number of Stories ........ /. .............................................. 9. Sizeoflot:Front. ./~.~.~.'~...... Rear ...................... Depth ...................... 10. Date of Purchase ........... .................. Name_of Former Owner .............................. 11. Zone or use district in which pr~mises are situated ........ [.. ~}'. ....~.~. ~,.,~ .J-~..~.~...~. YPoJ .,-. .............. 12. Does proposed construction violhte any zoning law, ordinance or regulation: .... 2~/~ ....................... 13. Will lot be regraded ......... i..]N~.~ ............. Will excess~ill be~removed from premises: Yes No 14. Name of Owner of premises ~.,..~,. y4~t ]P'~d .... Address .. Z((-g~4 .~4. .... Phone No ................ Name of Architect .......... !. ................ Address ....rl~ .............. Phone No ................ Name of Contractor . Yff../)/ff/F.~y'O g~...¢~?...~.,. ~.t~.. Address . .L.~°.~A~Z:...Y~.,~ Phone No.7~.qY.... ~..~..71~... PLOT DIAGRAM Locate clearly and distinctly all! buildings, whether existing or proposed, and. indicate all set-back dimensions from propea~y 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~ Y~)~ R~/~ S S COU~.TY OF..~ ,-.~z',~. ~ .... ' A .... I.~. ~. ~ .~ ......... being duly sworn, deposes ~d says that he is the applicant (Name of individual si~¢g contract)~ above named. .... : ra ent, corporate officer, etc.) of said owner or owners, ~d is duly authored to perform or have peffo~ed the said work and to m~e and file this application; that all statements conthined ~ this application are true to the best of his ~owledge and belief; ~d that the work will be perfomed in the m~ne~ set forth ~ the application filed therewith. Sworn to before me this ........... ~ ........... day of~ .... , 19 _ ~mi~n ~pir~ ~r~ ~0, '5~~ ~ ~ [~lgna~ure ~ app,lc~)