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Home My WebLink About12728-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building inspector lown Hall Southold, N.Y. Certificate Of Occupancy No. Z12307 'Date February 29 19 84 THIS CERTIFIES that the building ...A ~ C E~.S 0E 7 ................................... Location of Property .. 13.4.5. BR.T. DLE. LANE ............ C.U,T C ~tQ,G, Ii$ ................... House No. Street Hamlet County Tax Map No. 1000 Section .. l 0 2 ....... Block .... 0B ......... Lot ., .~ J ............ Subdivision..[t I GNLAN I3. F~ST~ :rE.S .......... Filed Map No, 5.5 ~ 7 .... Lot No .... ~4.. ........ conforms substantially to the Application for Building Permit heretofore f'ded in this office dated NOVEMBER 2 8.3. 12728Z ...................... 19, pursuant to which Building Permit No ...................... 82 · . ........................... 19..., 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 ......... for an accessory building The certificate is issued to WZLLZ/IM MC NZVEN & MICHELLE TURNER (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .N/.~ ..................................... N/n UNDERWRITERS CERTIFICATE NO .................................................. Building Insp~cfor Rev. 1/1tl FO~ NO. ~ TO~N OF $OUTHOLD BUILDING DEPARTJvlENT 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: ............. ....~...~.g..~, ............................................................ ~ ~..~. ~ ...~Z.~.~.~.~.~..~ ..... ......... ;..:v.....~.:.~.~. to .....'~..~..'~<....~....~Z~... .............................' ....... ;; 't ............. '"' '; ........... ~'1':" ~ .......... .~.....~.~,~;.~L.~;~.;~..... ......................................... ~ ............................................................. u County Tax Map No. 1000 Section ..L..O......~=... ....... Block J~) ~ Lot No. ,~.~...~ pursuant to application dated ...... ..~.......0~....L~..~..~7.~....~ ............. , 19.~'~.?;~and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Soutbold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec.. tot with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, stroets, and unu~Jal 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 applicable4 For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing'C_ [and 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 bt~ildings. 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 3. Copy of certificate of occupancy $1.00 landuse--Fre-Existing C.O. $15.00 Vacant ]~nd C/,O. $ 5°00 .. .......... New ~ui~ding ............. O,d or Pre-ex~st~ng ............ Va~t ~ y ........... Location of Properly .~ ~. ~ ~.. ~. · .~~~ .............. ~.~ .... Owner or Owners of Prope~y ~ ........ L .~ .......... ~ ...................... co~x~ ~o. ~ o~o~b ......... ~o~ ............... ~o, ................ Subdivision ,/~L~~ ,- Filed Map'No X: ~ ~ Z, Health Dept. Approval ........................ Labor Dept. Approval Unde~riters Approval ....... ~.~ ............. Planning Board Approval Request for Temporary Certificate ..................... Final Certificate Fee Submitted $..1[~ .~ .................. Construction on above described building and permit ~eets all applicable code A icar t PP ........................ Rev. 10-10.7S FIELD INSPECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY ~ODE COMMENTS FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:2 Examined..~. k~O...,~ ...... , 19~.~. Approved /~..l~.... ~. ..... , 19~.~. Permit 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 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 w~ll issued a Building Permit to the applicant. Such permit shah 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 cod.e, and regulations, and to admit authorized inspectors on premises and in building for necessary insgection~,~/ ~ ]~4 " - ..... ?/:..4:~...~ ./../~.. ~.. (~:~? ............ (Signature of applicant, or ~nar~e, if a corporation) ........... iI~l'a;1;~i ~t~tie's~ ~a'pbii~&~t) .......... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. :L' ' .......................... Nameofownerofpremises , ,.. c ~, ~' ./.. ....... : ................... ........................................ ~7~c (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 ...................... ~ X 1. Location of land on which proposed work will. be done .... . .~.~.~.~. : .q¢¢..o.~.t ..... ~ ....................... ................. ........... (' .............. , , [louse Number Street Hamlet/ .......... B k ..... k_) ........... Lot ..... 6~.-3~ t: r ........ County Ta× Map.. ,No,. , O00t Section ..... t.~.~- oc '"'~ '~ | / ~.bd,*,~,o~....~q.~:.~..ES&~: ..... :,,ed Map ~o. .G 5 ~ '/.. ~ot. 2..~. -J (Name) a. :~is~ng~,seand occupancy ..... //..~.:.~.~..~.: ...... ,.. .... , ................................... .....---- ........................... b. 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair ........ ~5 ..... Removal .............. Demolition .............. Other Work ............... ~,..p (., d~ (Description) 4. Estimated Cost . ..~...o....~ ..~. ?. ....................... Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling Units ............... Number of dwelling units on each floor ................ If garage, number of cars ........................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structurds, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ................... '.. Height ..... ~ -~ - .~.t. .. Numbe.r ~f,Stories ...................... "! ~ ........ ~' ~ X~ ' .~ t 8. Dimensio~ yentire new construction: Front . .~. 6.t5 ........ Rear .fi ............. Depth ...r~. ........... Height . .~ ............ Number of Stories .... ~ i .............................................. 9. Sizeoflot: Front ....................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ............................. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect ........................... 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 property lines. Give street and block :number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NE~RK~ ~'Z S S COUNTY 0~-. .... ' (Name of indiviiilual si~ning con'trac~ above named. being duly sworn, deposes and says that he is the applicant He the ~"-~""~3/' (Contractor corl;orate'o;fficer e't~ , agent, , .) 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 conthined in this application are true to the best of his knowledge and belief; and that the work will be performed in the manndr set forth in the application filed therewith. Sworn to b~fore me this , ot . ublic ................. ,