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Home My WebLink About12657-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...~.q.2.Q3.'J ......... Date ........ N..oy.e.m.b..e.r...2. ........... , ] 9.8.5 THIS CERTIFIES that the building . .A.D.D.Z.?.I.O.N. ..................................... 23a5 s±g ' Location of Property ......... .s.b.e..e..R.d., ......... .M.a. 3.t.i.t.u. 0.k ..................... House No. Street Hamlet County Tax Map No. ]000 Section ...q./!/J ...... Block .... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Pemfit heretofore filed in this office dated .... ~.e~.t~ O~]~.o.~. a0 .... 19 ~ 3. pursuant to which Building Permit No..q.2657~ ............. dated ..... 0C.~.QbO:P..q ............ 198}., 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 ......... .... FO~: .a. clack, l.cld±t~a=. ~o..a~. ax±a~Smg, oae .£ara±ly. &well.~.ng ........... JACK ROSCHELLE The ce~ifica~e ~s ~ssued to ................................................... (owner, le,~ee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO .................................................. Buddmg nspector Rev. 1/81 FOBI~ NO. ~ TO~IN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 1265~ Z ..~.~..~....~.~....~.~..~....~..~ ................. ~o ~ o, prem,~s ,~oted o, .~.~.~.....~..~...~...~......~.~ ...................... County TaL~/x Map No. 1000 Section ...... i...~...~. ........ Block ....... ~. ......... Lot No.......~...~ ......... pursuant to application doted .......~...~..~......~....~.. ......... , 19..~....~, and approved by the Buildin0 Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instrudtions 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 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 unusual natural or topographic featu res. 2. Sworn statement of owner or previous owner asto 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 3. Copy of certificate of occupancy $1.00 use--Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Date,, ~/. d,~.z'../~ ,, ~ ~..~ ........... New'Building ...~..~..'Old or Pre-existing Building ~ Vacant Land Location of Property X .~..2: .~. .... 2/, ~J.~.~. ..... .~...~.' ........ ~../~.Z,/'/.X'.~.~'. C -"[~. · ........ House No. Street Hamlet Owner or Owners of Property..(x~..~/.(::: .~....~. ~.~ .~.~. ¢~'.~- ~.~-.~ ............................... County Tax Map No. 1000 Sectio~..../..~.~. ...... Block .... ~ ........ Lot.., .2-.-...~-. ....... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No /~' ~5'~7 ~- Date of Permit /.~/~..~.~7.Applicant Health Dept. Approval ........................ Labor Dept. Approval ........................ Unde~riters Approval .... '~/. ~ .......... Planning Board Approval ...................... Request for Tempora~ Certificate ..................... Final Certificate ...... ~ ................ Fee Submitte ............................. Construction on above described building and~it m~ll applicable codes and regulations. Applicant.. C/~.. ,. ~-~¢~..~'-~......~ ........................ Rev. 10-10-78 FIELD INSPECTION FOUNDATION (~st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY QODE FINAL COMMENTS ADDITIONAL COMMENTS: Exam{ned--..) .... Approved .~..~... FORM NO. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ., 19'~.~. ., 19~.~.. Permit No..J Received .......... , 1 9 · ·. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tlfis 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, buil3$ing code, housing code~ and regulations, and to admit authorized inspectors on premises and in building for necessary in~p/~x~tions. (~/// ...... · ..¢. ......... (Sigi~/a~(ure of applican~t~o?~,~if.i corporation) ./. . . . (Mailing address of applicant) 5tare whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... ......... iiiii iiiiiiiiiii Name of owner of premises .... .~4.4~ .d'. tx-.. ................................... (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 ...................... Location of land on which proposed work will be done .................................................. ............. ................... {louse Number Street Hamlet County Vax Map No. 1000 Section ...... /...c/.C/. ...... Block .. ~'- Lot ~--'~---~ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises/gaud intended use and occupancy of proposed construction: b. Intended use and occupancy ~. ~. . .............. 3. Nature of work (ct~eck which applicable): New Building .......... Addition /-'/" Alteration Repair ............. : Rem?val ............. Demolition .. ............. Other Work ............... 4. Estimated Cost .......................... Fee . . . :;'. ............................. ~ (to be paid on filing this application) 5. If dwelling, number of dwellind units ............... Number of dwelling units on each floor ................ If garage, number of cars .... i .......................................................... i .......... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structurhs, if any: Front .... ] .......... Rear .............. Depth ............... ~ N mb fSt ri Heigh .... : .......... u er o o es ..... Dimefisions of same structure With alterations or additions: Front ................. Rear .................. Depth ................... !... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ......... .: ..... Rear ............... Depth ............... Height .......... Number of Stories ................................................ '.. 9. Size of lot: Front .... '"~'~'i ............ Rear / ~ ....... Depth ,/ .~.O... . 10. Date of Purchase .,d.,~':d~.~'..: ............. NameofFormerOw~;;'. ...... iiii.:.i.i..iiiii:i.ii I 1. Zone or use district in which premises are situated ..................................................... 12. Ddbs proposed construction violate any zoning/aw, ordinance or regulation: ................................ 13. Will ldt be regraded ...~ ..... ) ................ Will excess fill be removed from ~>remises.: Yes No 14. Name :of Owner of prermses ~,,,.~..~.~.,~.c.' .~?.'~.' .('~. ................................ .~ .......... Name of Architect. · .~ · · '/' '~g,~i~i~.. i;; i i i; i i Address~/.~.f ................... Phone No. Name of Contractor Address ..~. ~/..~.~.. ~?~'. [. V'.~'.. Phone No. ~-~. ~i .~ ~17.' ~.' ~ PLOT DIAGRAM Locate .clearly and distinctly all buildings, whether existing or proposed; an& indicate all set-back dimensions from property lines. Give street and blockl number or description according to deed, and show street names and indicate whether interior or corner lot. )2-: / .7-MX ~ STATE OE NEW YORK, iS S COUNTY~F ............ / .... · ~' (Name of ind~idual~igntng contract) ........ being duly sworn, deposes and says that he is the applicant above honied, u ( (C ffi ) I- ~ ontractor, agent, corporate o cer, etc. of said owner or owners, and is dul~, 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 his 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 Notary P~ublic ................ ~ ...... County //5.0 / ,/ iR RT BODDY -,-,....a ~Uai,f,ed in 8uff01k County _O.~' ,,/ ./ // (Signature of applicant) ~EE: ~-~;. NOTIF'¢ m UL:%Ih!~ ~EPAP..TMFNT AT 765-1¢*0 9 AM, TO 4 PM FO¢. 1. FOE?'~A~ION - ~/O p¢~ ~1~ CONCRETE ~. Rok.rc'a - FRAMING & PLUMBING Br ~' ''*~ 7u~ FOR C.O. ~LL C*~'~-~p' lC%iON 5HALL MEET ~UE ~u .... 5TAm~ CONc%RuCTIQN & ENERGY COMES NOT RESPONSIBLE FOR DESIGR ~E C'~RS%~U~TION ERRORS. 8F OCC P^NC ~C )/