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Home My WebLink About12592-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y, Certificate Of Occupancy No. z12260 Date FEB.RUARY q4 19.8) THIS CERTIFIES that the building ..... S,O..R.Y .............. ACC~S ........................ Location of Property . .5.3.6.0. M.:...B.A.YV.I..E.W R.D... .... SOUTHOLD House No. ...... 'S'tie~[ ............................ Hamlet County Tax Map No. I000 Section 078 .Block 4 .Lot 34 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ' ,'H.B 1983 gp 12592Z SEPT[, ER 7 pursuant to which Buildin ermit No. S&~eTdgM..B.E.R' . ! .3 .................... 1983. .., was issued, and conforms to an of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... FOR AN ACCESgORY BUILDING The certificate is issued to ...... j0£.~t~kl. A... $ g.M. QU b.Z~S ................................ (owner, levee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . UNDERWRITERS CERTIFICATE NO ......... Building Inspector Rev. 1/81 FOBI~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, No Y. BUILDING PERMIT Cf HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ]2592 Z Permission is hereby grantec~\to: , ........ .... [~.'L~.ci...K ....I...~. L ~ ....................................... ...~....~...%k~,6L,.o...~.,..q. .............................. ........ .... Io~ated ....~[..[~...~...D.-' ' ' ~ at premises at ....... ., ... ~ ~.. )~....-w.~. ~.,~...'~.~ ....~ ....~.,~ .~.L pursuant to application dated ..... ~'-~~.(~,~-....~.~.. ........... , 19.~...~..," and approved by the Building Inspector. Building Irtspector 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 typewrlter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings or new use: 1. Final sucvey 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"T- 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: 1, Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling / 3. Copy of certificate of occupancy $1.00 ~ landuse--Pre-Existing C.O, $15.00 Vacant land C.O. $ 5.00 New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property .... Owner or Owners of Prop rty . ;- ........................................... County Tax Map NO. 1000 Section ..... 0 ,"7. ? .... Block ...... ~ ....... Lot .... ,~...f~, ....... Subdivision ......................... ~/,..Filed Map No ........... Lot No .............. P~rm, ~n/'~'f¢¢'~- ~ Date ofPerm t f ,/~.-?/~.%¢ A cant ......................... Health Dept Approval ........ '- .-~., ..~.. ........ Labor Dept. Approval .................. ..... ~ PI i Bo rd' App al Underwriters Approval ........... ann n§ a roy ...................... Bequest for TemporaW Certificate ..................... Fina~ Certificate ..................... Fee Submitted $ .' ....... ,0..'. ,(~¢, ·~ ......... Construction on above described building and permit meets,~[[~ applicable codes and regulations. A hcant qYNI~ 'b XDHZNZ 'X 'N HS~ NOIi¥q~SNI .£ DNIS~Rq~ (pug) NOIZ~O~ (gsL) ~ NOILYGNBO~ 'L FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined..~.~.-~.. ~. ]-~--., 19~ .~.. Approved ........ l~ , 19 . Permit No.1 ~.~ Disapproved a/c ..................................... Received .......... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date ................ 19 3 9 .. a. Tkis 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 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, a2cd regulations, and to admit authorized inspectors on premises and in building for necessary ins~ ~__~ ................. ti n ''' (M ailing ad,tress o f applicant) //fi:r~ ~/ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises~M~.o.n.~e.~a.~o, li ~}i~t~t' ~) ......................... 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 .................................................. County Tax Map No. 1000 Section .... : 17...~/. ....... Block .... .~.. .......... Lot.. · .~.....~. .......... Subdivision ..................................... Filed Map No ............... Lot ................ (Name) 2. State existing use and occupancy of premises and intended use and occu'pancy of proposed construction: a. Existing use and occupancy ................................ ..................................... b. Intendeduseandoccupancy ........ ... ..... .. ......... :.t ..................................... 3. Nature of work (check which applicable): New Building ... Addition .......... Alteration .......... Repair .............. RemOval .............. Demolition .............. Other Work ............... 4. Estimated Cost ...... ' Fee .. ,0., ............................... (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 mixeO 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 with alterations or additions: Front ................. Rear .................. D?th ................... ~.. Height ... Number of~Stofies .............. ~ 8. D~mensions of entire new construction: Front ....... > ........... ,~, t , ...,/.~ ....... Rear ............ Depth......./IP /....... ...... Height ............... Number of Stories ........................................................ 9..Size of lot: Front ......................, Rear ...................... ~ Depth ...................... 10. [.)ate of Purchase .......... i .................. Name,of Former Owner ............................. ~1 I. Zone or use district in which pr~mises are situated ....... ~,~/..~ .......................................... 12. Do~s proposed construction violate any zoning law, ordinafice or regulation: ...................... 13. Will lot be regraded ........ i~..~. ............... Will excess fill be removed from premises: Yes No 14 Name of Owne of premises ~ Address Phon No 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 property lines. Give street and blocklnumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF N~R,I~,/,/.~ ~ COUNTY ........ ? "~ I ~ · '' ~' · '~(~'~i;id~ii'~i~ct )~'~' above named. ...... being duly sworn, deposes and says that he is the applicant He is the ..................... ~ .................................................... (Contractor, agent, corporate officer, etc.) 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 contained in this application 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 ~. &~...day o[. ............... ':. :,, . Notaj~o.l~t~blic,.. ............ ~ .... .~. ~ounty .o .-~ ~' ~&.lt~,ugg~ ,gJff' ~ '/.Y~' ' ~ X' ......... 3-" .................... no~v ~t~O, sim ~' ~1~ ~l t/ / / (Signature of applicant) ; No. 52-8125859, Suffolk