The URL can be used to link to this page

Home My WebLink About12153-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z. 1.].5. J.0 .......... Date ..... ~. C.c.~ .~. .................... 19~3. THIS CERTIFIES that the building . ?.09.f. .a.n.d.. g.c.v.e.?p..qn. 9.1.qs..uF.e' .f'. 9F..d.c. 9.k ...... Location of Property 760 Leslie Road Fe. c 9n~,C' .... h[~,s'e hio~ ............................................. street H~mie:t County Tax Map No. 1000 Section . .097 ....... Block . .09 ........... Lot ... 09.6 ........... Subdivision .... .B.ay. ,l-]gm.e.s. ................ Filed Map No. 5.7.53 .... Lot No.. 5 ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... 4a.n..u.aT.Y...27 ...... 19 .8.3. pursuant to which Building Permit No.. 1. ¢.1.5.3...Z ............ dated .... .F.e.b. ~..u,aT.y' . .1.6 ........... 19 .8.3., 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 ......... ..... a...p 99.f...a.n,d..s..c r,e.e.n...eB.q 1. 9.s.u.p. 0' [.o.p.. ~.J..~ ~.p~. qt~.c.tq ..................... The certificate is issued to ........ h O..~ .E.T.T. ~..C~fi. ~ .I.~.G.H. ¢.H .............................. (owner, lessee ~r-t~rr~nl~ of tile aforesaid building. Suffolk County Department of Health Approval .... n. ,/.a ................................... UNDERW R1TERS CERTIFICATE NO ............ .n {.a ................................... Building Inspector Rev. 1/81 BUiLD!N~ [ and, iapproved by the FORN1 NO. 6 TOWN OF SOUTHOLD 8uiidJng Department Town Hall Southold, N.Y. 1 i~7~ 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 tooogreohic features. 2. Final approval of Heaith 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 building~ 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. lB, For existing buildings (prior to April 1957), Non-conforming uses, or buildines af~d "pre-existing" land uses: - 1. Accurate survey of peopert¥ 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 i~r land use '~./ 5.00 3. Copy of certificate of occupancy Date ..... New Building ............. Did or Pre-existing Building()¢) ......... = ZVacant Land County Tax Map No..1000 Sect[on ............. Block O ~ Lot. ~ ................... Filed Map'No. ~32~ .Lot No. Health Dept. Approval ........................ Labor Dept. Approval ..................... Unde~riters Approval ........................ Planning Board Approval .................. Request far Temporary Certificate ..................... Final Certificate . ¢ ..... - ......... Fee Submitted S .~,.O.O..~ .................. Construction on bove descrlbedApphcant, buddm%and.~~p er mit' ..~s a~l app~ble~co.de s~. and regulations. Rev, 10-10-78 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL File No ................................ · ./:~.~./.~...~.. .................... · :~.~.~z.%./~.~.~: .... for pemlit to construct..~ .c~A .-~(.~. 7~,7....~/~.. ,..~..~. ~.~ ...... ~ ............ at Location of Property :..: .~.,.(.(~. ........ .~..~-'-~,~.~./.~.-~....~,'~_.~. .......... ·-/~rq~. C*~:57.~?/. ~. '....;. County Tax Map No. 1000 Section .... .(~..~...~.... Block ... ~ .~. ...... Lot ...c?.C?./~.. .... ~?~' "-~'/~ ~ Filed No. Subdivision ,~/.~./~7.~.¢~ . . Map .. · .~.:q~. ~. ..... Lot No .... ~..~. ........... is returned herewit~ and disapproved on the following grounds .~.~ ~."7....~ .~)~.. ~.~.~c...~..~./~.../7~..'~ ..... ._... ¢.. ............ .~../....~.. ?:~. .................... . . . . . .; . .:. . . . . . ~(,Z-<~ :~. ./,:'c,c~. /. .~7~ .... : ..................... . ............................ Building Inspector RV 1/80 COMMENTS FIEL~' IN%FECTION 1. FOUNDATION (lst) FOUNDATION__ (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-'1802 , Application No.../~../..~."5. ...... Disapproved a/c ........ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date..~..':~....O.' .?...,~. .... , 19 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 agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections, ~ · .,_ × --- ........... ; ...... ' 'Ix~3igna;ure ~..[a~plicant,~me, if a corporat'on) (Mailing address oka~plicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nmne of owner of premises . ~. O..~..~.T. ~F/.4 ..... C M.~'...a~,.t..a~.~../-~.~. ~ ...................................... (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.. d~}~z/.~. -.. [/.6 .s...~..c'.e..,?. Plumber's LicenseNo ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. .?.¢..o .......... .... ......... ......................... House Number Street Hamlet County Tax Map No. 1000 Section ~..o.~ ~.. Block .... .Q.~. .......... Lot......~....O.~..~.. · . Subdivision...~..~.¥....~.O..~.¢.~ .................... Filed Map No...~..~.~..-~. ..... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ' a. Existing use and occupancy . .~?.*.....t~.~..~? .y.....~. ?.~..~.~/. . .~,..~..~..~.~ff....~..e.a. ~.~.~.~..~ ...... h. Intended use and occupancy .................................................................... property lines. Give street and block humber interior or corner lot. 3. Nature of work (check which a~plicable): New Building ..... : .... Addition .......... Alteration .....t~....... Repair .... ~ ......... RemOval .............. Demolihon ....... ' ....... Other Work... ~. q.~.. c. ~.. i oa, o,~/~t,~,c $~,,.., ~Oec~' (Description) .3 3"go i o Estimated Cost ...... Fee .. o ! (to be paid on filing this application) I.f dwelling, number of dwelling ~nits ...... ~ ....... Number of dwelling units on each floor .... /. If garage, number of cars ..... Li/." ......... If business, commercial or mixed occupancy, specify nature and extent of each type of Use ..................... r)imensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories .... /. ................................................... Dimensions of same structure with alterations or additions: Front ................. Rear .................. ~ /~.~ N fSt ri .~. Depth .................... 'i. · Height ................... umber o o es .................... 8. Dimensions of entire new constrUction: Front .... /~ ....... Rear ...//~. * Depth /¢... Height .../.,~ ......... Nura~er of Stories ..... /. .................. ~ .............................. 9. Size of lot: Front ...... /.~..~. ........... Rear ........ AIl~l~.t./..~.3.'.'7.... Depth ...3. J..~ .............. 10. Date of Purchase . .,ff/.oH .... 7.ig ................. Name oftFo~rr~er Owner d.4~ .%a~. ?Y....cp..~..,?.....~.o..~x..~:... 11. Zone or use district in which promises are situated / .. 12. Does proposed construction viol,ate any zoning law, ordinance or regulation: .... ~...~ ........................ 13. Will lot be regraded ...... .4~.O ................... Will excess fill be removed from premises: Yes No 14. Name o f Owner of premises g~.~..'~... ¢.~.~Y..~*]~..~ddress .7'.~. q. ~ ~.~¢ ~...~q :. Phone No. 7?..~."? .g. ?..~ ?.... Name of Architect ....... ' ........... Address .................. Phone No .... Name of Contractor ~.o..~...~..~tq,"/il'~ i ' ' i '~'.~2"0 · . . . .~' ........ Address ~..t~.,, .~$.~t.~:, ./C-~: Phone No .............. PLOT DIAGRAM Locate clearly and distinctly ale buildings, whether existing or proposed, and. indicate all set-back dimensions from or description according to deed, and show street names and indicate whether Oec/(' t~,/ 760 , ' oec/c 'Th /3e ~e,o~ceo STATE OF NEW YORK, COUNTY OF . . $.S ....~..~.~.g..JC.~'.~...~ .~..~.~..t.~.i' ~.~..% ~ ........... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. (Contractor, agen~t, 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 3!1! statements contained in this application are true to the best of his knowledge and belief; and that the work will b~ performed in the manne~' set forth in the application filed therewith. Sworn to before me~is ..... 17~ ~:~. · ·5 .... ~I~.7 ....... 19... Notary Public, . . ~ . ] .'.~;~-4.M-s_-~.... ..... County ,,w .... .............. Residing in Sultel~ Count~ re of applicant) j ~o, O431O3 ,Expires March 30,