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Home My WebLink About12157-zFORM TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z12627 Date July 23 1984 THIS CERTIFIES that the building ...... .B.a.P.n...ap.cl.. f...e.n.c.e. ......................... Location of Property . .~ .5_ J..1.. I~ 9ja.d .......................... M..a.~.g.J: ~..u.c)~ .............. House No, Street Hamlet County Tax Map No. 1000 Section 1 0 0 .Block 3 . ....Lot 1. . Subdivision..S.c.b..a.s.~.~..a.n?.s,..C 9y?. .......... Filed Map No. X ...... Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated ... ?.e.b. ,..3 ............ 19 ?.3. pursuant to which Building Permit No. 1 21 5 7 z dated ...F.e.b.:..2.3 .................. 1 ~.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 ......... Barn and fence. The certificate is issued to James and .Leslie? King ..................... .................... of the aforesaid building. N/A Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO N/A Rev. 1/81 Building Inspector ~o. ~z~7 z P~r~Tnissioh is hereby granted to: (THIS PERMIT MuST BE"KE~T ON ~H~ cOMpLETION 6F THE WORK AUT~R'IZEDi Date FORM NO. 6 TOWN OF SOUTHOLD Building Department~ Town Halt ,~uthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submi~te~..'p~icct~to the Building Inspec- tot with the foX,owing; for new buildings or new use: I. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic featu res. 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 ResiUerices and similar buildings and installa- tions, a certificate of Code compliance from the Architec[ 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/ land use --?z~e-Ex±s t,±ng C.O. $15.00 3. Copy of certificate of occupancy $1.00 / ~'~c~nt Z~c[ C.O. $ 5.00 ...... ..... Date New Building .... ...~'~'~0... Old or Pre-existing Building ............ Vacant Land ............. LocationofProperty.. .%. .... %.. .......... ...... House No. Street . Ham/et Owner or Owners of Property ...~,~..w..~.....~~/'4 ..... .~.~~,~ ....... County Tax Map No. 1000 Section . . .~, .~)..~. .... Block ..... ~ ........ Lot ...... ~, ......... Subdivision .~ .~..~¢~P~.Filed Map No ......... , .Lot No ..... i ......... Permit No. l ~.\.Sr~, ,~. Date of Permit ~, 1~.~,, l~',~.Applicant. :.~q:~, ,~r.~% .~,~ Health Dept. Approval ........................ Labor Dept, Approval ..................... Underwriters Approval ........................ Planning Board.Approval .................. '~Request for Temporary Certificate ..................... Final certificate ...... ~ ........ Fee Submitted $.. ,~.~, t ,~..0. ................. Construction on above described building and permit meets all applic~bl(~ codes and regulations. Applicant FIELD INSFECT~ON ~ 1. FOUNDATION ( 1 st) COMMENTS FOUNDATION 2, (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ~ODE o FINAL ADDITIONAL COMMENTS: J -/ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined/ .... Approved P Disapproved a/c ............. · , (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No../..C~../'.~.77 ........ 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 Regulatinns, 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 insOectio~ns. , , ,-, /~) ~ --~ ~ (Signature of applicahg, or ~fame, if~a corporat)'on) ....... ........................ ' ...... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. Name of owner of premises .... .~..*./77.e.q~. .... . .~'...~ .~'..~..4./.'.~.'......~../..~. · .~. ....................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate office) // Builder's License No ...... ~.C~.. ?.. ........... Plumber's License No .... z(J. ct ~"d .~ ............ Electrician's License No.. Other Trade's License No ...................... 1. Location of land on which proposed work will be done. House Number Street Hamlet County Tax Map No. 1000 Section . .4~ ........... Block . .~.. ............ Lot ................... Subdivision.. ~. ~.~ ~ ~ ~ .... ~.~ ~... 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 .... ~.~ ~. ~ ~.b... ~.~,~ .................................. b. Intended use and occupancy ~~ which apphcable): New Building ............................. 3. Nature of work (check ' ' ' ~ Addition Alteration Repair .............. Removal .............. Demolition .............. Other Work ............... I ~v' (D~scripti~n) 4. dC ... ............... Estimate est ...... i ...................... Fee ........................ (to be paid on filing this application) 5. If dwelling, number of dwelling pnits ............... Number of dwelling units on each floor ................ If garage, number of cars ..... I ................................................................... 6. If business, commercial or mixed occupancy, specify natum and extent of each type of use ..................... 7. Dimensions of existing structure's, if any: Front ............... Rear .............. Depth ............... i-[eight ............... Number of Stories ........................................................ Dimensions of same structure w~th alterations or additions: Front ................. Rear .................. Depth ............ i.. Height ..................... Number of Stories .......... 8. Dimensions of entire new constructmn: Front· ./.~.. ~ ....... Rear....-x-. .......... 'l~p'th ....~· ;' Height . .. ~. ~. ........ Number of Stories .... ~. .................................................. 9. Size of lot: Front ...... 2!~,$8 Rear ......... .~O~, ~ ............ ~ Depth ../ 10. [)ate of Purchase . ~'..~.~. ].. ~. ~ ............... Name of Former Owner .O..~.o.t'.&. ~....'C.o.q ~.~. ~..q fig.... 11. Zone or use district in which premises are situated .... ~..~..~.o ........................................... 12. Does proposed construction vio~late any zoning law, ordina.n, ce or regulation: ...~/...O ........................ 4/Oi 13. Will lot be regraded .................... Wall excess fill be removed from premises Yes (~qo') "'. ..... ' ~$.*L~t.~' ,c~ P n No 14. Name of Owner of premlses ,tS.~ ..... : ...... /~/..,Address ................... ho e ............. Name of Architect ....... .'-F(:-. ............... Address ................... Phone No ................ Name of Contractor ..... .-:~--7: ................ Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all! buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Gave street and blocklnumber or descnptaon accordang to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, "S.S COUNTY OF ............... ~ , ~ ~Jq~t~=. ~ tV ~.. ~/,0/ff t&~ ! ~ ~ duly sworn, deposes and says that he is the applicant · .~. ............... K ...... being (Name of mdavadual .... slgmng~' contract) above named. He is the . ........... v... (Contractor, agent, corporate officer, ~tc.) 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 ........ .~..'..,4-,~ ....... day/df.,/ .// ~ ...... , 19d~'.,~ Notary Public)/') ....... .~/;~'~,74~A~-~ .x ...... County // / ~ JOYC~M. SI<~WAR~/, .... ./~ ! No, 52-4663491I / (Signature of applicant) ~ Qualified in Suffolk Coonly Commission Expires March ~0~ 198~1. U