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Home My WebLink About12647-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...z.~.3.993 ......... Date .; .............. ~o.¥?.m~..e..r...2.1.., 19.8..4 THIS CERTIFIES that the building ....~.d..d~.t.5:.o..n ................................... Location of Property 9.0.0 Minnehaha Blvd. Southold - Hous'e ~Vol ............................................... Street Ham/et County Tax Map No. 1000 Section . .q 8. 7 ....... Block .... 0..2 ......... Lot ...0..0 .6 ........... Subdivision...~a..ucj.h.J:.n. cj..W.a.~..e.r.s. .......... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .S.e.D .'9: ........ 2.0.., 19 .8.3. pursuant to which Building Permit No ....... 1.2..6.4.7.g. ........ dated .............. 0.9.t..' .. 1. ...... 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 ......... .... A44.i.t.i. qn., .t.o..~lri.s.t;ir~g..O~. ~.~mi%.y.. 0w~llin.~. ........................... The certificate is issued to ............ P.e..M.~¢..R.IA ~ .R!.C.H.~..R.D ............................. (owner, I~.~ae ~r-t~r4a~l~ of the aforesaid building. Suffolk County Department of Health Approval ...N./..~ .................................... UNDERWRITERS CERTIFICATE NO .......... .['l./..A .................................... Rev. 1/81 Building Inspector FOBM~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ....... Counw Tax Map No. 1000 Section ..... .(~...°9..[.~ ....... BIo~k ......~.....~'.. ......... Lot No.....~...(~.....~ ....... ~o~-~-~.~-- ~ ~ 19~..~., and approved by the pursuant to application dated ...~..~F~ ......................................... , ... Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ,~}outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted-~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. B. 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 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 / 2. Certificate of occupancy on pre-existing dwelling/ land use --?re-Ex±s t±ng C, 0. $15.00 3. Copy of certificate of occupancy $1.00 Vacant ]~and C.O. $ 5.00 Date../.~. ~..'~. / ~'~./'' ...... New Building Old or Pre-existing Building Vacant Land Location of Property ...?.~.~ ......................................... ... . ... ... House No. Street Ham/et Owner or Owners of Property .............. ~.~.~ .. /~/2 I County Tax Map No. 1000 Section ..... . :L -- ~ Block O, ~ Lot. O, ,~,, ,~, Subd v s on . '7~ · F ed Ma-'~'- -~- ' " .. ~ ...... ........ · /. ................. lJ ~u ........... LOt I~10. .. PermtNo~..~,.~.?..~'DateofPermit ~/.'~./~'.~nnicant ~c-~/~/~D · · · r' ,, .., ......... >/.. Health Dept. Approval ........................ Labor Dept, Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Tempora~ Certificate ..................... Final Certificate .... Fee Submitted $ .~4. ......................... Construction on above described building andpermit roeets all applicable codes and regulations· C-J29--~' ~OOL~ Applicant...~.E¢., .~.././., .~., ./~., .¢~...~. ..................... Rev, 10-10-78 FIELD INSPECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING COMMENTS INSULATION FERN. STATE ENERGY ODE FINAL ADDITIONAL COMMENTS FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL File No ................................ To ~C/~.~f'd~.../~'.~Z~ ....... :~. o~2. . f.~/.,~.~.~z-~ //~ .... .......... PLEASE TAKE NOTICE that your application dated . .~/:!~fi/~/~.-.~. ~t..°~ .... 19 for permit to construct ...... d .............................. at Location of Property ...c~. ! ........... Z~.~-'~../,~/X'..~. .~.~.C~.2'. J('~)..&./~.. House No. Street Ham/et o ,~ - · . .~.o. .~. .... County Tax Map No. 1000 Section . . .0..~.~. ....... Block .............. Lot ... Subdivision ................. Filed Map No ................. Lot No .................. is returned herewith and disapproved on the following grounds,,~..~./~ .f.~ .~..~.77<O.~......~./..~... . ~.o~../~ c ~ ~.~... ~.~7~.~.~...~~.. r,. . ,~d~ .'. ~..~,. ~o~o ~ .... z~c~.~>..~. ..... Bulldog Inspector RV 1/80 WIOKHAM S. 80°18 '00 N / F RIOS 114. 055_~0 AV£. AREA .MAP OF ~~ , DESCRIBED PROPERTY A r LAUGHING WATER TOWN OF SOUTHOLD SUFFOLK CO. N Y. O. ~9.2 ACRES nssooletes ~1:~ West main street york tlgOI 69-1717 (212) 746-:50~>0 Juae iOJile-~ Job NS 8~- I" = 20' PENNY' LUMBER M^~..o^o.sox ~ I,/'I FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1802 ExaminedO~. I ...... , 19 ~.~.. Approved .. ~..~'~. · . .'-~... !..., 19 ? .g. Permit No. ~ .~..(Y.[~ .").~ .~... Received.. r& ~/~-o Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by Wpewriter 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, buil.d.~g code, housing to admit authorized inspectors on premises and in building for necessary ins ,~,~as. ~ ~7 cD and regulations, and (Signature of applicant, or name, if a corporation) .... ?..~..v../..%.~.~ s.e.~ o..~.~... ~3. ¢. ~.t.9 ....... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .]? ~e~lZ0 ..~...CU../~..~...c..~....P..~...~7..~./?././.1. (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. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. / .... '/.,,.,:..~..: ~ t~ ~ ~. . .h. ,.~. o:...[3, v.y.p ................................. House Number Street Hamlet County Tax Map No. 1000 Section ... (~..~..~ ........ Block .. t~.~ .......... Lot...IQ. ?..~ ...... /.. Subdivision t,~ Filed Map No. . .~. Lot . X. / (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .............. · · .Q:2~. ~. ~.t~ ...... i ................................ b. Intended use and occupancy ....... ~.~..~-... ~....-'~......t~..~.-~. ~...~(-~.e~..~,.~ ...... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work..P,~..~ ~.. -~ -p~ ..- .--~--- (Description) 4. Estimated Cost / ~'D-279 Fee . .~.~. ,. . · . (to be paid on filing this application) 5. If dwelling, number of dwellingl units ............... Number of dwelling units on each floor ................ If garage, number of cars .... : ................................................................... 6. If business, commercial or mix{d occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. pthI ight f St ' De ................... ... He ................ ......Numbero ories ...................... 8. Dimensmns of entire new construction: Front ' Rear .............. Depth .............. Height ............... Number of Stories ........................................................ 9. Sizeoflot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase .......... ~ .................. Name of Former Owner ............................. II ' .n .... hp ' ' d · Zo e or use d~stnct ~n wh~c rem~ses are s~tuate ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: . J~.d.) ........................... 13. Will lot be regraded ........ . .................... Will excess fill be removed from premises: ~ Yes~, No 14. Name of Owner of premises . . i .................. Address ................... Phone No.7~l~f.'..~f.P. ..... Name of Architect ....... ' J. ! ................. Address ................... Phone No ................ Nmne of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly al! buildings, whether existing or proposed, and. indicate all set-back dimensions from property lihes. Give street and blockl number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NE~31~I~, ~ S S COUNTY OF .~ ...... ' ~ -- , ........... idmS. · ~c. ~..d~.lc~ being duly sworn, deposes and says thane is the applicant , (Name ofindivi ua signing contra t) above named· e is the ................. (Contractor, agent, corporate 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 application; that all statements contained in this application are true to the best of~ 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 c, "~~~ i~i~,~, "' f f ' (Signature of applicant)