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Home My WebLink About12711-zFORM NO. 4 TOWN OF 5OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall $outhold, N.Y, Certificate Of Occupancy No. g.1.~13¢.8 .......... Date ...~.a:r..c.h..8. ...................... 19.84.. THIS CERTIFIES that the building .............. Build±hq Accessory .................................. 520 Wabasso St. Southold Location of Property House No, Street Ham/et County Tax Map No. 1000 Section ... 7.8 ....... Block . .3. ............ Lot . :4..6 ............. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fded in this office dated October 28 8.3. p gp 12711Z ...................... 19. ursuant to which Buildin ermit No ...................... .dated .O.c..t.o.b.e..r..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 ......... Accessory Building The certificate is issued to ........... ~% 1..1 .i.a.n.~..,~.l.b.r..o. ................................ {owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .......... k'I/A ............................ N/A UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 FO~M NO. 2 TOWbl OF SOUTtlOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL .COMPLETION OF THE WORK AUTHORIZED) Date ....~. ................... , Permission is hereby granted to: ~ County Tax Map No. 1000 Section ..... ;2...~. .......... Block ...... ..~ ........... Lot No ..... .J~...~q ........... pursuant to application dated ....~...~...)....~. .............. , 19.~.~., ond approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE DE OCCUPANCY Instructions A. This N)plication must be fitled in typo'writer OR ink, and submitted in duplicate to the Buifdin9 Inspec- tor with the following; for m~.w buildlngs or new use: 1, Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or' tope,graphic feah~res. 2, Final approval of Health Dap1. 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 et Code compliance from the Architect or Engineer responsible for the building, 5. Submit Planning B~a~d approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" ~ ~.ln fJ 1. Accurate ~Jp/ey of peoperty showing ali property lines, streets, buildings and unusual natur~J or topographic featu res. 2..~wo~ n statement of owner or previous owner as to u~, occupancy and condition of bud ngs. 3. Date of any housing code or safety inspection of buildings or premiss, or other pertinent informa- tion ~ equ ired to prepau~ a ce,-tificate. 1. CernfL:ate of occupancy $5.00 2. Certificate oI' occupancy on pre-existing dwelling/ land use 3, CoDy of certificate of occupancy $1.00 N,~w Y, mh¢,:g ............. Oki or Pre-existing Building ............ W~cant Land ............. .. ............... ............. ............. F'ou~ No. Streel Hamle l County '[ax Map No, 1000 Section ............... Block ............... Lot ................ Subow~s ou ............................. Filed Map No ...... Lot No, ~.~ App HrCalth Dept. Approval ................ Labor Dept. royal Unde~.¢riters Approval ...... ~ ~ ......... Plsnning Board Approva~ ....................... ~equost ' ~ '' Final ~ortiflcate for Iom~or~rg Cor~hcato ............................................ Construction on above de~:r bed b ~ drag a0d pe[~f/meets all ~pph~ c~dy~ and regulation:,. FIELD INS PE~TIO~ COMMENTS FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION FERN. STATE ENERGY ~- C,pDE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined ~.~..~.~..., 19~.~. Approved ~.q.,~..~,....~.~..., 19'~..][. Permit No. ~..~..-I. ! ! .~... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in inl~ 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 regulation_s, and to admit authorized inspectors on premises and in building for necessary inspections. ~/v v~ K~. ~ .~, .NF.. ff't~./.-.. / A,'~. (Signature of applicant, or name, if a corporation) .~..~.,4.,. .e ' ' ' (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................... .,:. ......................................... N~me of~remises ..W.. ......... /~/~r., ...................................................... / / f'~//,-j (as on the tax roll or latest deed) IffilSplic~ature o~.f)duly authorized officer. /' - Builder's License No..~.,.~i.-. ?..]..~, .... ./t.7~..~..-..."f~../2 Plumber's LicenseNo ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done ............... $.~..~... ~. (.t..~.~. ~'..~..~.. ..... ::: ...... i .......... ..67.~..~. ~:.? .... , ................... : House Number Street Hamlet {] ~ .. County Tax Map No. 10O0 Section ..... ~..~. .......... Block ...... .~. .......... 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 ...... /....,~.~.~../~. t.....~./~...../~....~...: ................................ b. Intended use and occupancy .... ]......~.-~..('27'.: .... f.~C.~. V-:~...t?. [ .~..qo .~.~).w..~,...~ .~ ....... Natur ofwor (check which a plicable): .7 ........ Addition..': ....... It Sation .......... Repair .............. Removal .............. Demolition .......... Other Work ............... .~ (Description) 4. Estimated Cost ......... .?~1.~?..q~...1~..,.-7 ............... Fee . fl. ~.: i (to be paid on filing this application) 5. If dwelling, number of dwellingI units ...... /.:~ ..... Number of dwelling units on each floor ............... If garage, num her of cars .... I ....... A/~9/'W~'- , . ........ 6. If business, commercial or mix0d occupancy, specify nature and extent of each type of use ............. i ...... 7. Dimensions of existing structurbs, if any: Front .... .c~.O.t ....... Rear .//.~!J .......... Depth .. · .'~..d'~. ........ Height ..... /.--~-/?:. ....Nu*ber of Stories ....... /. ................ i .:. ............................. Dimensions of same structure with alterations or additions: Front . ./~.¢t.. ~.~¢~1?.~7~.E' Rear .................. Dept ................... ,... Height ...................... Number of Stones ......... ~. .... ~ ....... 8. Dimensions of entire new const,ruction: Front . . ./.~7 t. Rear /-~- ! ...... Depth .,..Zt'.ff ....... Height .... /,.~ ........ Nu~/ber of Stories ........ "/' ........ t' ................. , .,,. ,.4) ........... 9. Size of lot' Front / ' ~ . ..... /¢27_~! ............ Rear ......... /.t¢.~.~. ....... Depth .../... f. ............ 10. Date of Purchase .......... i ................... Name of Former Own, er .............................. I1. Zone or use district in which p!emises are situated ...... ~Y~..'r.~..~,~.,~. ~..).c/./. .............................. 12. Does proposed construction violate~aj~y zoning law ordinance or regulation: .... ~.O ........................ 13. Will 10t be regraded '. ....... .../.V.~. ~ ~. ........... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises.(~'.i/P[~{ ...... Address ................... Phone No ................ Name of Architect .. ~_ ...... i .............. ..,.. Address ................ Name of Contractor ¢777./,¢Q/IL&/¢,4'~./...,d=.. ZOO. Address . '.t'~'.' Ct?,O../. iff, .... .." PhonePh°ne Nc.N° ................ ,7.. ,4..¢..'7..¢?.Ff. PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing"or proposed, and. indicate all set-back dimensions from property lines. Give street and bloc} number or description according to deed, and show street names and indicate whether interior or corner lot. rr STATEOF NEW YOCRK.// /// i · .'~/.--7)X~.~-'~.-~./7../~..-fE~.O ~,~-~ '-'q .~ ~. r-~.L: ....... being duly sworn, deposes and says that he is the applicant -- (Name of individual sigr~ing contra'et) above named. of said owner or owners, and is duiy authorized to perform or have performed the said work and to make and file this pphcation; that all statements contained m th:s apphcatmn 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, cz¢ ......... : ............... day of ......... , 19..~.---~-~ Notary Public .................... nty (SignatRre of applicant) C~mmbsion Expires March $0~