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Home My WebLink About12108-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z~q875 Date August 25, 1983 THIS CERTIFIES that the building ..... a.CCO~S.q~y. ~.~Q2?~ge..~.L1,Q~.u~.o. .......... Location of Property . 5 5./4:.0 .....................~.q~.t..~..B.~.;[Qr..i.e.w....R.d.: ...... S. 9.~.~.~.o..i.d' House No. Street Hamlet County Tax Map No. 1000 Section .... .7.9 .....Block ....... G. ....... Lot ...... 2.,.? ....- .... Subdivision ........... ~ .................. Filed Map No .... .x....Lot No ..... .x ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... Dec. embe~..29 .... 1982. pursuant to which Building Permit No ...... ~..2~.0.~..~ ......... dated ....... ff~B.~a~Cr...q.g- ......... 19 .~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 ......... ...... ~cess~y. s.tora~a, s~r.uctur, e ......................................... The certificate is issued to ~]?~LIT/g .T~L~U~LI. [owner, ....... · ....... ) of the aforesaid building. Suffolk County Department of Health Approval ................. ~/.R ............... . ...... UNDERWRITERS CERTIFICATE NO ......................... ~/.R ..................... Rev, 1/81 Building Inspector T~NOF BUILDING N°. ~12108 Pe~r~'nissio~ is hereby BUILDING~ IqfltMi~ [ :, (THIS PEP. MIT MUST BE KEPT ON THE PP~/~IS,~* UNTIL:~ULL cOMPL~ION OF THE WOE~ AO~H~EIZED) {: ~' ~ FIELD. INSPECTION COMMENTS FOUNDATION (lst) FOUNDATION (2nd) ROUGH FRAME & PLUMBING ]iNSULATION PER N. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Disapproved a/c .................. ~ .......... ~ ..... J (Building Inspector) APPLICATION FOB BUILDING pERMIT Application No...~..~/....~..~. ..... 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 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 a~rees to comply with all applicable laws, ordinance~,~-b~i~ilili~g code, housing~Lqde, and regulations, and to admit authorized inspectors on premises and in building for necessar~i_n._st~ ,gffttr0ns. /~,~ -'~ _ _~ (Signature of applicant, or name, if a corporation) .... ling address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . . .~.~,z/.,7 ................................................... (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 ...................... 1. Location of land on which proposed work will be done .................................................. 8,. rz.' ........................... ¥...:...,.,/. House Number/ Street Hamlet County Tax Map No. 1000 Section ... ~..'~.. ~. ......... Block .... ~. d .......... Lot.. ~..~..-~-~../ ....... Subdivision ........... .' ~ ........................ Filed Map N9. .: '~ ;c ......... Lot .... ~ ....... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .............................. ....................................... b. Intended use and occupancy ...~. ?'...x3...,~..?.~..~.e~:....'7~..~.~. ~_.~. ............................. 3. Nature of work (check which applicable): New Building ...~....... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4. Estimated Cost..~t ~ Fee .~../f..~. (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 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 e~tire new construction: Front ....... ~ ...... Rear ...... frS. ....... Depth .../..O. ........ Height .... ~. ......... Number of Stories ... ~g.~.-: .............................................. 9. Size of lot: Front .......... i ........... 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. Nmne 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 inumber or description according to deed, and show street names and indicate whether interior or corner lot.. STATE OF NEW YORK, COUNTY OF.. $~. F..~.*..~..~... · S.S (Name of individual signing contract) above named. ........ being duly sworn, deposes and says that he is the applicant He is the ...................... i ................................................................... (Contractor, agent, corporate officer, etc.) of saki 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 manne? set forth in the application filed therewith· Sworn to before me this ~ · 5'. ............. day .... ,19 i ....... Ho 52.4024771 ~ ' ' ' (Signature of applicant) qualified in Sutfolk County '~ ~, Commission Expire~ [larch S0, 108~ 765 9 AM,TO 4 PM FOE THE l, FC.,~N ......... -,,:- T~/O REQUIRED eO~ P':U::D CONCRETE 2. ~0~:7.-~ - FRAMING & PLUMB NG THE ~EQU~REMENTS OF THE N.Y, ~CON s~UCT~ EN ~R_GY CO~ NOT RESPONSIBLE FOR DESiGneR CONSTRUCTION ERRORS. ........ APPL ,'~ A,. '~!hm application ~Ust be filled',ifl ~jpew,riter 0Fi tor with ':,:;' 1,,'Fine su,~ey'of property w th accu 'ate' ,: , natural ~,; ' ,2. Final approval of Health ~' ~' 3. Approvol of eloct~ ca ,~," ~ 4~ Commercial ' '"~' tions a,rcer'tifi~at~,of C0de;d0m~li~ ',, :5. $~b~t ~lahning'~oard ap0rgvat of corhp B. For ex~stmg bud~mgs {pno(:~o '' 'l.'Accu~at'e sur~ey:'of peope~y,'sEowin~'a ' topographic'features,' ' 2: Sworn'statbmen~ of owner 6~'pre9 ous owner as . , 3: Dat~ of any housing code or safety ~nspect~on of :; ,, , tmn r~qulred to prepare a ceftific~te. C. Fees: ": ',',,' , :'1.' Ce~ifica~e of ,, '2. Cert f cate New'Buildi'n~ :,:~.,:',, Old"~k~pr~_exis County Tax;~P N6'L' ,-,.,, ,,' ,,, , ,, %, H ' "" ealthDept.-A .... ., Beque}t ~or Temporary'¢ertificat~ Fee oubm tted $ "C°nStr~¢ti°d°n'abO~e'de~ ~ d ~g ,: ,;',:~, ~pplicabl ~hebu~d and;unusual,