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Home My WebLink About12685-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Sept. 17 No. Z12781 Date ................................. 1984 THIS CERTIFIES that the building ...... .C.l~.$.n.e.y. ................................. Location of Property 1620 King Street Orient House No. Street Hamlet County Tax Map No. 1000 Section . 2. .6 ......... Block . .2. ............ Lot 4 0 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated ..... Se~).~, ~..~ D ....... , 19~3. pursuant to which Building Permit No. ] .2.67.5..g .............. dated . .O.c.~.:. J .2 ................... 198.3. ., 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 Burke E. Libur t (owner, of the aforesaid building. Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO ....................... .N..../A .................. .. . . Rev. 1/81 Building Inspector FOB~ NO. ~ TO~fN 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) 12685 Z ...... ...................... Ot ~re~i,,,,e located ot ...... ~.;R.. ....... Z[.,~.~.......;;~.~,¥ ......... rO..~ ................................ County Tax Map No. 1000 Section ..... .~..~,..~. ...... Block ...... ~ ........... Lot No......~.....0. ........... pursuant to application dated ..... .~)..~....)....'~c.. ............... , 19..<~..'.~, and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall ,~uthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted~,c~c;~ic:tc 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 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/ land use 3. Copy of certificate of occupancy $1.00 --Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Date .......................... New Building ~,,~lNt.l~. Old or Pre-existing Building ............ Vacant Land ............. · t ... Locat,on of Property ....~ ........ . .~. "t~..%...~'. .............................. .~ .... House No. · ~ ~,, zStr~et~ , Ham/et Owner or t~wners of Property . .-~. .................................................... County Tax Map No. 1000 Section ............... Block ........... Lot ................ Subdivision ........................ I ........ Filed Map No ........... Lot No .............. Permit No. I~,.~.~... Date of Permit~.Ot[ .'~.~.~, ?Applicant..~. ~'.~-~,~..~..~. i~..~. ~...~ ........ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... t..------- Request for Temporary Certificate ..................... Final Certificate ....................... FeeSubmitted$ .......... 5'"'~''"~"~'~'~?"~J~!~0(~'1)__1~/-- '/~ ~)~ I "~100 -~ Construction on above described building and per~e~ts all~a~p[ic~l~le~ and regulations. ~.~, (.,~4 T~4~..' Applicant, ~.,, ,~ ........ C.o.=it FIE[.D INSPECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION FER N. STATE ENERGY qODE FINAL COMMENTS ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-180:3 Approved... O.O,.~[g4-.~.}.., 19 ~.~ Permit No./.~..~..~.~..~ Application No .................. 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 prope~y must be drawn on the diagram which is part of this appli- cation. \~ ~ c. The work covered by this application may not be co4ztm~nced before issuance of Building Permit. d. Upon approval of this application, the Building Inspehs4~or will issued'a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughou~t the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupan,:~y-. 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. (Signature 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 .~.6g, .tf.~.~....~W:....~:.('~.F..~. ............................................. (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 .............. i L]~.~j ' . . "~'~' 1. Location of land on which proposed work will be done. /~./. House Number Street Hamlet County Tax Map No. 1000 Section...?. (~. .......... Block .... .~. ........... Lot.....~.. ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of propk.~ed construction: a. Existing use and occupancy ............... ..~. ........ ...... ~ ......... ~).. .....J ....... b. Intended use and occupancy ..... *~ ................................. : ~...~..c~..~ .'.'~....4~( .F.~.//.d'~.~..~... o 10, 12. 14, Nature of work (check which applicable):~New Building .......... Addition .......... Alt ~ratlom ,. ......... Repair ...... . ........ RemOval ..... \, ....... :'~Demolition .............. Other Worl(~ ............... .-9, , ~ ~, ! (Description) (to be paid on filing this ahpplication) Ifd b fd lli gl it N fdw lli hr welling, num ere we n.un s ............... umbero e ngunitsoneac ocr...., ........ .. . If garage, number of cars .... ' ....................................................... : .~ ......... If business, commercial or mixed occupancy, specify nature and extent of each type of use ............ .~ ........ e pth Dimensions of existing structur s, if any: ~Front ............... Rear .............. De ............... Height. ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. I)epth' .. ~ Height Number of Stories Dimensions of entire new construction: Front Rear Depth Height ............... Number of Stories ........................................................ Size of lot: Front .......... ~ ........... Rear ...................... Depth ...................... Date of Purchase .......... i .................. Name of Former Owner, .~ ........................... Zone Or use district in which pr~mises are situated ..... ~.: ...... ~./.'.c(.~..~.~( ............................ Does proposed construction violate any zoning law, ordinance or regulation: ... ~ ........................ Will lot~ be regraded ..... ....................... Will excess fill be removed from premises: Yes No Name Of Owner of premises Address ........... Phone No ............. Name of Architect Address Phone No Name of Contractor .......................... Address ................... Phone No ................ Locate clearly and distinctly all property lines. Give street and block interior or corner lot. PL~)T DIAGRAM buildings, whether existing or proposed, and, indicate all set-back dimensions from ~umber or, description according to deed, and show street names and indicate whether STATE OF NEW YORK, COUNTY OF ..... .&-..q.F...~,q./_]?... iS.S ........ · ~..r'..'f~. ,c..cc?....~. r...]'-. ( .~.~.~ff... YT: ........ ? being duly sworn, deposes and says that he is the applicant J (Name of individual signing contract) above named. He is the ...................... i ............... '. ................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perfbrm or have performed the said work and to make and file this application; that all statements contained in this application am 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 ....................... ~,* i ..................... ,19... Notaw Public, . ~ ' ~ ' \ LINDA F. KOW~,L~I ~ ,NOTARY PUBLIC, State o~~ . .~. ,.. , No. 52-45247T1 7 ....................... Qualified in Suffolk County g.r/ (Signature of applicant) ~ommission Expires March 30, 198,