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Home My WebLink About12609-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southoid, N.Y. Certificate Of Occupancy No. .Z~ .~ 9,~.9 ....... Date ..... September.. THIS CERTIFIES that the building .. ~I~DI~T. ON .................................... Location of Property . ./-t-705.0le. 2~ule. Lane ....... ~r~i FIa~. it~ok ............ House No. County Tax Map No, lO00 Section ...'~22 ...... Block ..... ~ ......... Lot ...... ~-0 ......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated ..... -August '9 ...... , 19 ~.~. :~ursuant to which Building Permit No. ~.2.6..O~.g. ............. 'dated .~.e.p.~.e.m.t? .o.~..q.6. ~ ........... 198. 3. , was issued, and conforms to all of the requirements of the applicable provisions of the I~ tw. The occupancy for which this certificate is issued is ......... ..... ~9.~..~..d..s.e.k..a..d.~.~i..oi...~.o...~.n..e.x..~.s.~.~.n. ~...qn..~..~.a.m..~.~..4 .w.e.L~A .n~ ......... The certificate is issued to . .F_~..0..I~...~.X.L..S.B..t~.G. ............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of He~ [th Approval . .N~/3, ..................................... UNDERWRITERS CERTIFICATI~ NO .................................................. Rev. 1/81 Bt~ilc~ng Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Yo BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12609 Z Permission is hereby gronted J~oi , ~ .... ............. ,o ............. ~'~ ~,. ~,./_.~-~,.~ ...... ......... '"~ ....... ""~I" ' '" ...................................................'~".~5" '~¥~""~'" ~ ~,~ ; ..................... at premises located at ...~..~....o.,~iiiiii...-L):~Li..~....,t:~z,,~g...-/t.,~....~,.....~.i.i .~g__ ...... County Tax Map No. 1000 Section ~"~' Block ....... ..~..-~.. ......... Lot No ....... J..~). .......... pursuant to application doted .... ~.~:L~.~. ....... J,...~. ............ , Jg.'~..~., and approved by the Building Inspector. Fee $., .~...~..~. !...,~,. ......... 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: 1. Certificate of occupancy $5.00 / / 2. Certificate of occupancy on pre-existing dwelling fr land use ~/5'/$5.00 . 3. Copy of certificate of occupancy $1.00 / / / .Date.. ,~/~./.~, ~, ............. New Building ............. Old or Pre-existing Building ..., .~,, ..... Vacant Land ......... Location of Property ..... .~..7.9.;~.C ...... . .(~. ~. ~....'-~.. ~).~-¢~....~J~Q ¢¢.. ,. ~ .0~,.1~'.~-.', ~ ~j r,~, ..... House No. Street Hamlet Owner or Owners of Property ................................. .,, , . County Tax Map No. 1000 Section .... ~ ?r...~-~. .....Block ....... ~.~ ...... Lot .... ~..~ ......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No.I ~.(e.e?..=~.. Date of Permit ......... Applicant .................................. Health Dept. Approval .......... Labor Dept. Approval ........................ Underwriters Approval Planning Board Approval .... Request for Temporarg Certificate ..................... Final Certificate ......~.. ............... Fee Submitted $ ,~.. , ,C~,, Construction on above described building an,~jjit meets allt~oplicable codes and regulations. Applicant ....... ~,,..,~, ~ ................... Rev. 10-10-78 FIELD INSPECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined.. :.. !.lc. .... 19~.%. Approved....~..'~... )..~.., l~?.~. Permit No. ! ~ ?..~. · · Disapproved a/c ..................................... Received .......... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS 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 thronghout 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, b,,uilcting code, housing code and regulations, and to admit authorized inspectors on premises and in building for necessary i~,~p~tions. ¢..¢ .................. (Mailing address of hpplicant) State whetlier applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· ....... ...... .......................................................... Name of owner of premises . ..~ f~.~......C/~...[..C~...~..~...~.~. .......................................... (as on the tax rolI or Iatest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..... J..0. ................. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. · .2. ~ .o..5. .......... 0~...~'v.~. e .... ~e ............. ,nc~ .-r~...,r:..~x:. House Number Street Hamlet / £ County Tax Map No. I000 Section ..... .J..o~..~. ....... Block .... .O. ............ Lot .... /. C) .............. Subdivision ................ ,(~ ................... Filed Map No ..... .X ........ Lot .... .~. .... .~... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... 1~5./? .~.... kO..r'9. ..... .d..cO ~.,(. ~.'?..~ .................. ~ .......... Intended use and occupancy ........... .ti .... ~: ........... ~! .....'2d,//~.~7~ .%~..(~.Cff.. ~..~/.t/(~. ...... b. 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Rembval .............. Demolition ...... : ....... Other Work ............... 4. Estimated Cost , o ~ ............ I .......................... Fee .......................... (to be paid on filing this application) 5. If dwelling number of dweilingI 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 structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure With alterations or additions: Front ................. Rear .................. Depth ................... !... Height ...................... Number of Stories ...................... 8. Dimensions of entire new const[uction: Front ......... , ..... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ Size of lot: Front ' Rear Depth Date Of Purchase .......... ' ................... Name of Former Owner ............................. Zone or use district in which premises are situated ..................................................... Does proposed construction vi61ate any zoning law, ordinance or regulation: Will lot be regraded ....... .~... .................. Will excess fill be removed from premises: No Name of Owner of premises h~..t~,4'//.~ ~.~. Address . .m~ .~.6ff, ..... Phone No. ,-¢.~.q¥: Nme of Architect ...j.~, .... ~..~) .............. Afldress ............... Name of Contractor../~.~)~/"O.......~O.~.~L~C./~ddress .~..,,i.o..F--/~..Ph°ne N°Phone No. ............... 7d ~. ~&. ~./.O.... 10. 11. 12. 13. 14. Locate clearly and distinctly ali property lines. Give street and block interior or corner lot. PLOT DIAGRAM '. buildings, whether existing or proposed, and, indicate all set-back dimensions from number or descripfion'according to deed, and show street names and indicate whether (Signature of applicant) LINDA F. KOWALSK! NOTARY PUBLIC, State ef New Yet8 No. 52-4524771 iqualih~d in Suf o k County C rarmss~on Expires March 30~ 19S,a'~ STATE OF NEW YORK, S.S ....... {'~'~'/'' L.,. ~o.~. zO .................. being duly sworn, deposes and says that he is the applicant (Name of individual sign lng contract) above named. He is the... ~.~. ., ................................................................... ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have peffomed the said work and to m~e and file ~is apphcat~onl that all statements contmned m this application are true to the best of his knowledge and belief; and that the work will be perfomed in the m~nor set forth in the application filed therewith. Sworn to before me this ........... .......... day of ......... 19