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Home My WebLink About12738-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z16236 Date February 19 8.6. THIS CERTIFIES that the building Foundation Location of Property .2..09..4.~..h..S.~.... 5..~.0. 99..0. a..c.k.s.o.n. .... New Suffolk House No. Street Hamlet County Tax Map No. 1000 Section ....1 .q .7 ...... Block . .1. 0. ........... Lot 17 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... N. 9y.... ~. ......... 19.8.3. pursuant to which Building Permit No. 12738Z dated ... ?.o.v..e .m.b.e.r...7 ............. 19.83.., 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 ......... Foundation under existing one family dwelling. RAYMOND CROUCH The certificate is issued to ..................... [o~n'o),~r~'~ ................... of the aforesaid building. Suffolk County Department of Health Approval ................ N/A UNDERWRITERS CERTIFICATE NO .................... N/A Rev. 1/81 FOEI~ NO. 2 TOWN OF $OUTHOLD 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~ 12~38 Z Date .......... ~ ................. , 19. .~ Permission is hereby granted to: ..................~t~c~;....:. ......................... 3, ~L~Z; ......................... ...~..~..~.~i....,~,~ ................................ ,- ~~.~.~.~.~.~....~.~. ~~......~ .~....~ ...... j.~..~.~....~.....~~..~ ..................................... ~ .,~.~..~.....~....~...,..~...~.~ ~.~.,~.(~ et premises located at ........ .~..!... , , -.~'~"~ · ........... ......... i ........ ii ................ i:i .................................... County Tax Map No. 1000 Section ...... J..(..']. .......... Block ........ !.?.. ........ Lot No. pursuant to application dated .... ..~,..~.~,~1,~.....I ................. , 19.~.,;,~ and approved by the Building Inspector. Fee $..~.... ............ Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Buildin~l Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY [~LDG. Dt~PT, TOWN OF SOUTHOLD Instructions This application must be filled in typewriter OR ink, and submitted m~ 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. Su bm it P lann lng Board app royal of co mp leted site p lan requirements where app l icable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operty 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. 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $~ .00 4.Vacant Land C.O. $5.00 $15.00 Date....~..J ~/~.~. ............... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property . , .c~., .~. .................. .~...t~..~.S.o..~.,,..~.~. ....... .~.d~..~?., .~..~.~:..~....~.. House No, ,, ~ Street Ham/et OwnerorOwnersofPropert, ..~.~~...~.J'...~..~ ............................... CountyTax Map No. 1000Section ...!~9 ........ Block ... J.~). ......... Lot ...... !.~.... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. [ .~....~.~.. ,-~;r-Date of Permit t.'./.iJ.~.~., .Applicant .~-~.O, .~¢'-.~.t~.~.,,, .C~.. [,~. ,~ .~..C.~.I.o. )' ~ ..... Health Dept Approval ~[~ Labor De ov ........................ ......................... pt. Appr al . Unde~riters Approval ....................... Planning Board Approval ...................... Request forTemporawCertificate......... ........... .FinaICertificate ,............./ ........ . Fee Submitted $..~.~ .................... Construction on above described building a~d p~mit meets all a~licable codes and regulations. FIELD INSPECTION FOUNDATION (1st) COMMENTS FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY ~- qODE FINAL ADDITIONAL COMMENTS: ENERGY FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved I0.~..~ .... 1 9 ~ 3. Permit No..I.a.~. ~, .~. ~ Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Rece±ved l! ~ 19. Date ~O.V... 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 sttall 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, buildir)g code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary insp~~.2..~.~..~.~~ - .................... .......... ; .... .... (Signature of ~Pt~lJ~a-nt, or name, if a co porat'o ) N: :1.,. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .. '.~.~. ~. vi40/q .~...Cx~.. ~..¢y.:~z...tq. ................ (as on the tax roil or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No...~..o...~...~?..~..o.~..~..wq~ ..... Plumber's License No ......................... -- ~ . . ~.q.~.~.'~..~.~....~..~.~e4...a~ Other Trade's License No...C~..q..q]..~.¥..%~..~.. 1. Location of land on which proposed work will be done. ............ .... ............ .............. ttouse Number Street Hamlet County Tax Map No. 1000 Section . [ ~ 7 Block ~ (~ ....... Lot...[7. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) Stat& existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... ~... ~. ~r'r'~...1~..u~.. 7~..t-~w.. ~../51...C-.-.-.-.-.-.-.-a~-.. ~ ................................. b. Intended use and occupancy ..... .'f~.. · · · -g~. · · .~-~- · ................................................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ...¢:'~.....'.. Repair .............. Removal .............. Demolition .............. Other Work ............... ~ (Description) 4. Estimated Cost .......... ~ ..'7. ........................ Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling Cnits ............... Number of dwelling units on each floor ................ If garage number of cars 6. If business, commercial or mixe~ occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure w~th alterations or additions: Front ................. Rear .................. Depth .................... ~.. HeiSt ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ......... , ..... Rear ............... Depth ............... Height Number of Stories 9 Size of lot: Front ~ Rear Depth 10. Date of Purchase ........... ~ .................. Name of Fomer Owner ............................. 11. Zone Or use district in which pr~mises 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. N~e of Owner of premises ......... Address ................... Phone No ................ Nme of Architect .......... : ................. Address ................... Phone No ................ Nme of Contractor ......... . ................. Address ..... : ............. Phone No ................ PLOT DIAG~M Locate cle~ly ~d distinctly ~1~ bufld~gs, whether existing or proposed, and, indicate all set-back d~ensions from description accord~g to deed, ~d show street nines and indicate whether property fines. Give street and block 'number or interioD corner lot. ( , ~ STATE____._....~....._,..,,,...O F NEXlF~-~ RK,, COUN~ .....· ~7~ -~-. ~.~... being duly sworn, deposes and says that he is the applicant (ame of individual signing conffact) above named. He is the of said owner or owners, ~d is duly authorized to perform or have perfo~ed the said work and to m~e and file ~is application; that all statements contained ~ this application are true to the best of his ~owledge and belief; and that the work w~l be perfomed in the m~n~r set forth in the application filed therewith. Sworn to before me this