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Home My WebLink About12706-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z16187 Date. January 29, ................................................. 19 .~.6. THIS CERTIFIES that the building ..... ~ e..c.~ ....................................... Location of Property ... ~..7.3.5. ......... .B.P.J:..g.a.n.~.~..n ?..?~... ............ .S.o.u.t..h.o.~.d. ....... House No. Street Hamlet Couuty Tax Map No. ]000 Section ...7.9 ....... Block . .4 ............. Lot .... 5. .9 ........... Subdivision ....... .~.e.c..~ ~p.q. ~3 ............. Filed Map~lo4. 7 ........ Lot No..~ .9 ........... conforms substantially to the Application for Building Permit heretofore flied in this office dated ·. (~ ¢.t.... ~ 3 ............ 19 .8.3. pnrsuant to which Building Permit No.. ~..2 .7.0.6. Z. ............. dated .qq .~ ....2.8. ................... 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 ......... .~o.c.~ .~¢3. t..~.~.n..~..o..e.x.~..s.t3.n.~, ??., .e.a~.~. ~. ~.~. e..~.~.~.n..~: ....................... The certificate is issued to ... M]~CHAEL DAWS01q .................. 'fffq i .................... of the aforesaid building. Suffolk County Department of Health Approval ...... ~./.6 ................................ UNDERWRITERS CERTIFICATE NO .............. .~./. ~ ................................ Rev, 1/81 Building Inspector FO~M NO. 2 TO~N O~ $OUTHOL~ TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12706 Z Permission is hereby granted to: ......~-,b~.~......)...'~..%. ........................................... ..~..~~L,.....~..:~,~ ........................... ,,,..~.~..~..~.....C~~....,~....~...~,.....~, .......... .................................. et premises located at ...L./..'.~..,~.,~. ....... ).~.~:~.~..~....~-~.......~..~ ...... County Tax Map No. 1000 Section ...... ..~...~. ......... Block ....... .L-/. ........... Lot No. ,....~...~. ............., pursuant to application dated ....~..~ ....... ..c~..~ ............. , 10.~.~1,., and approved by the 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 Instructions 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. 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 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: Certificate of occupancy $5.00 1. / Certificate of occupancy on pre-existing dwelling/' land use 2. 3, Copy of certificate of occupancy $1.00 ~ --Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 .......... New Building ............. Old or Pre-existing Building .P~..~[~... Vacant Land ............. Location of Property . .~.~.~ ~ ..~ .... 0~/~0~ ~ Hou~ No. Street Ham/et Owner or Owners of Prope~ ............................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ / Planning Board Approval Unde~riters Approval .............................................. Request for Temporary Certificate ..................... Final Certificate ..... ~ ............ Fee Submitted $ ............................. Construction on above described building and permit meets aH.pl~icable codes and regulations. Applicant. _~ ............ Rev. 10-10-78 FIELD I NSP E C~T;I ON FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION FER N. STATE ENERGY DATE COMMENTS ADDITIONAL COMMENTg: FINAL ? /v/41~ o~'. L.07; 69 Tow~ c~ 6ouz-~._o~ ~.y. c;~ ~m/~j~d ~.u~.D~, 1977. . · IK)D~WCK V*I¢ TUYLo .. C. LIC LAND SURVIYOR&GIREENPORT, N. Y1 STAMP ~ . SUFF. CO. bi, Fr. OF.HEALTH II.~l~ ~A~ME~ OF IN~NT ~OR APPROVAL OF GON~U~ON ONLY ~ ~E WA~ SUPPLY AND SEWAGE : DENGE WILL C~F~M TO ~E H. S. REF. No.= ....... ' ~AND~D~ OF ~UFFO~ Co. D~. - OF H~LTH. SERVICES, A~ROVED: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined .0~..~.'.~..., 19~.~. Approved C~.~...~-.~...., 19~.'.~ Permit No. }..~..D.~...~.'~.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERI'lIT Date /0 ~(~, 19 <~ 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 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 Builcling 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 reg~atio_n_s_, and to admit authorized inspectors on premises and in building for necessary insp~ections~ (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· ...... ..O. .............................................................................. Name of owner of premises ./7../~./f/..A~.~G~f.....V: .......................................................... (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 .................................................. · .............. : ........ ......... . ...................... House Number Street Hamlet County Tax Map No. 1000 Section ...... .~..c] ........ Block ......... ./~. ....... Lot ..... .~..~. .......... Subdivision... ?.~.~..~p..t?...~. ..................... Filed Map No. '~'/'~' 7 ........ Lot..(.Z ......... (Name) 2. 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 . ...~.P../7.~. .......................................................... property lines. Give street and blockinumber interior or corner lot. 3. Nature of work (check which ap!plicable): New Building .......... Addition ......... Alteration .......... Repair ............... Removal .............. Demolition .............. Other Work...~'.,~.&./.( ....... ¥/ 4. Estimated Cost ~Z'.. Fee. .......................... (to be paid on filing this application) lli ~ / N fd lli hflo $. Ifdwelling, number of dwe ng nits ............... umbero we ngunitsoneac or ................ If garage, number of cars ..... i .--.; ................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures if any: Front .... ~'.J. ......... Rear . ~/~. .......... Depth...~.~ .......... Heighti ............... Number of Stories .... ~w. ................................................... Dimensions of same structure w~th alterations or additions: Front . .'nj. ............ Rear .. ~. ............. " q~.. " H 'ght fSt Depth~ ................. i ' ' el ...................... Number o ories ..... ~ ................ .~. ~.~. pth 8. Dimensions of entire new construction: Front ...... , .... Rear ............ De ............. Height .../.~ .......... Number of Stones O . . ...................................... 10. r)ate of Purchase .... /.~.g..ff~..; .................. Name of Former Owner .~.~?.~....~.~..~.~ ............ 11. Zone or use district in which pr~mises are situated, ff.,7.~.,?.~ .~./.~.../< ...................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: . .~f.P. .................. ;.. 13. Wili lo~ be regraded ..... ./~?.~ ................... Will excess fill bg removed [;on~'~remises: ' ' Yes Name of Architect ......... i ................. Address ................... Phone No ................ Name of Contractor ........ ~ ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing Or proposed, and, indicate all set-back dimensions from or description according to deed, and show street names and indicate whether STATE OF NEW YORK, i S.S COUNTY .. ...... .~./?.N../q.~.~-....~.,~..~. ;97. ~ .................... being duly sworn, deposes and says that he is the applicant (Name of individual sigqing contract) above named. . He is the..: ................ ~ ................................................................... ' (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duiy authorized to perform or have performed the said work and to make and file this application; that all statements con(ained in this application are true to the best of his kno{vledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ......... /..~. ........... day of ....... ~.(7~.."'/~.. ....... 19~'.~. Notary Pub~lic, .. . No. 4695650 , Ouahfled in Suffolk Couety .~t--' (Signature of applicant) ; Commission Expi es March 30, 191~