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Home My WebLink About12163-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building inspector lown Hall Southold, N.Y. Certificate Of Occupancy No...~1,18~[.3. ........ Date ........ J~xly. 2.7 ................. 1983. THIS CERTIFIES that the building ..... acc.y.., s~able..&, fence ................... Location of Property ..... 2.345 ....... Rlum. island. .t.ana .......... Orien.t... '~/~r~/ol House NO. Street County Tax Map No. 1000 Section ..... 1-5 .....Block .... 5 .......... Lot .... 24...3 ........ Subdivision · O~zien.~ .By. The. Se.a ......... Filed Map No...616 0..Lot No ..... 1.54 ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ·.. lT~Jzt, rCar.y.. 10 ..... , 19 83. pursuant to which Building Permit No .... 1 2.1.6 3 g ........... dated ..... .~.e.b.r..u.a.r.y...2.8 .......... 19 $3. ,was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... .... a.c. ce ssD. ry. s.table..&, fer~ce ............................................... Reiner & Patricia Lollot The certificate is issued to ..................... [ohJn'o'r,'~ ...................... of the aforesaid building. Suffolk County Department of Health Approval ............ N../.A. .......................... UNDERWRITERS CERTIFICATE NO .................... N../.A ........................... Rev. 1/81 BuI£DiNG sOuTHO~D~ N~ (THI$~PE .l~t.d.T MuST BE KEpT COMPLETION OF 'THE WORK AUTH6RIZ 12163 Z P' ~r~nissior~ is hereby grant~t~)~, ~ jr~ ..... :";~'~9~' and ~pprOved by the 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 ail 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. For existing buildin§s (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: - 1. Accurate survey of peoperty showing ail 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 ~r 3. Copy of certificate of occupancy $1.00 land use $ fs-/$5.00 New Building ~ Old or Pre-existing Bui~ding(,'~) , , _- ~ ~Vacant Land -. ......... Location of Pr~rt~' ~.~7~...~ ~. ~.'... ~ ~ ~.'...~ ~ f.~ ~ ~. House N&o Street Hamlet Owner or Owners of Property ~/~.'.. ~et~'~'~__'~ P~'~t~l~ Z~.~ Countv Tax Map No. 1000 Section...~r ....... Block .... r ........ Lot :~[ ........0.~ Subdivision. ~ ~..~.~. ~...~ .Filed Map ,o. ~/~ ~...Lot No. Z~ ...... PermitNo.~*t~.~. Date of Permit ..~*~ppHcant: ............... . ................. Onde~riters Approval ............... ~..¢tannin~ ~oard A~roual ............ ~ ~. ~ Bequost for Tem~orarg Certificate ............... ......Final Certificato ............ ... .. ~ ~ee Submittad $ ............................. Construct[on on above described buildin~ and~mi~mee~s all a~bl~do~ and regulations. ............... . ..... Rev. 10-10-78 ~C:-:,N~'TII~'V BUII.iDtN~!DEpARTMEblT AT 1: ~UHDAT~O~:j ~0 'REQUIRED THE RE~ NTS ~ T~N Y. FIELD INSPECTION COMMENTS FOUNDA'TION (~st) FOUNDATION 2. ROUGH FRAME & FLUMBING (2nd) 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.: 765-1802 Examined ........ 19 --/...., ~...~ ~/.~.~.~10~;;~ermit No' foZZf ~..~ '~ - Approved Disapproved a/c ........... "~¥..-~. ..................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No. //~'~f d~ 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 beforetssuance 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. i 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 ail applicable laws, ordinances, building code, housing code, and regulations and to. admit authorized inspectors on premises and m bufldmg for necessary ~nsl~egtions. ,~; ,, .,~ ,~. .......... ..... ............... (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................... 4 of premises ~ - , · o o -~ ....... (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. '....~..~.. ................ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done. ~ t¢6~ /9/~Zd(~/ .~,S. ~/ 2/.3q S ., .... ?. : /. .................. House Number Street Hamlet County Tax.Map No. I000 Section ..... .~). [.~'~. ...... Block .. ?..~..'~. .......... Lot...,... Subdivision .~.~'?: .g~..Z .~.~.-../..t~/.~. .-.'?~ .¥P. 0~.:..'~.. Filed Map NO. ~?/~.J~. ....... Lot . .Z/.-f..~/. ........ (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: · · / OX/c 34 z_ ~z_ a. Existing use and occupancy ...~.../. ~.'. t~/...~.~.{d~.& ........ .~. ........................... b ,ntended use and occupancy ./.~.O..x./.~..q..~..o~ Z~74,.-.~..~.~,...'~...~...~..'.~'.~. ~:L. ~o~'---~- ~ . .~.. 3. Nature of work (check which applicable): New Building .k,( ..... Addition .......... Alteration .......... Repair .............. Remgval .............. Den/olition .............. Other Work ............... ' ' 7"? .2~.~.~/~j ese o 4. Estimated Cost. '~;0 ...i Fee , ~ (to be paid on filing this application) · , 5. If dwelling, number of dwelling Mits .......... 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 ./,'(/..P.~. ......... .... ! · z' / z / ........ /'' 7. D~nens~ons of ex~stmg structures, ~f any' Front ~,!/.$ Rear ~ . . Depth ~_~! · I~,/ i ..... t~''';''', ......................... Height . ~'.% ........... Number of Stories .../..~/,~,. ,5: ~/t~! :~..~ ........................................ Dimensions of same structure with alterations or additions: Fro~t ./~2~/2]~ ........... Rear ........... Depth .................... i' · Height ...................... Number of Stories ........ ; ............. 8. Dimensions of e/ntire new constm~ orion: Front.· .~.~. t. ........ Rear ~$~ .. Depth .~. ~'. . Height .../.(? .......... Num~ber of Stories··· J. ,;. , ' ......... i... 9. Size of lot: Front ../6~./ .... i .... ....... Rear ...'.~.Q4.~.~''. ........... Depth .~"~t.~, .............. 10. ,D, ate of Purchase ./..~.Z~,; .... i .................. Name of Former Owner ~.~.~-.'~-..~..~.. ~./.~..Z~.. ......... 11. Zone or use district in which premises are situated. ~.~./tT'~.~. '~. ............. ,~ ............ 12., Does proposed construction violate any zoning law, ordinance or regulation: ~.&~. ~. ........... 13. Will lot be regraded . t~J.O ....i ................... Will excess fill be removed from premises:'~/~ Yes No 14. Name of Owner of premises H.~.~.~/~.....~: .~,q.z;..~..~.. Address,~.~..~-~ ./2.~..~../'f: .7~,(~/?,,~Phone No..B~.~ Name of Architect . . ~/,2//~... 'i ................. Address ................... Phone No ................ Name of Contractor . ]//~/.~... 'i ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly alll buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block ~number or description according to deed, and show street names and indicate whether interior or corner lot. i ' STATE OF NEW YORK, COUNTY OF..-~..~..~.,ff.~.~..~. .... .~.~.~.~. 1~/.~. d~. /~ oz,~ to 7"- being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ' i (Contractor, agent, corporate officer, etc.) of said owner or owners, and i~s duly authorized to perform or have performed the said work and to make and file this application that all statements contained'ha 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 cfi...~ ,/'~ ~"'",~' ..... 19 ?,,,~ No, 52-4,524771 ! (Signature of applicant) Qualified in ~G01)lmlsslon Expires March 30,1198;.~7 NOTE '. R EVI$ ON $ S S U E S