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Home My WebLink About12165-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building InspeCtor Town Hall Southold, N,Y, Certificate O[ Occupancy No. Z.l.z275'. .... Date ...F.E.B. RUARY 2'1 , ..: ........ 198.~. THIS CERTIFIES that the building A.C.C. ~ $ ~.0.I~ ¥ ..................................... Location o f Property . ~ 6 6 5...W g S.T.~.t~ g L.~.A. ~ P ................. ~.~y.T..~ ? ~.C.K. .............. House lye. Street Hamlet County Tax Map No. 1000 Section .. 1.6.1 ....... Block .... .I .......... Lot .... .6 ............ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·.. ,[~I/[3RIJAt/¥. 2~ .... ,19.83 pursuaut to which Building Permit No ..... 1.2.2..6.5.Z. .......... .dated . F E.13.R U ~ R X.. 2 $ .............. 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 ......... · FO,R · ~,N. ,&DD;[,T.[ ON. ,T,O, AN, ,AC C.E,S.~ Ol~..~3[J ~.L.D.~ ~ .C, ............................... The certificate is issued to .~EOR.C,E. ~'./LXLOR..&. t4~:.F.g ................... (owner, lessee or tenantJ of the aforesaid building. Suffolk County Department of Health Approval .... N./.,~ ................................. UNDERWRITERS CERTIFICATE NO ............ 31./.~ ................................. Rev. 1/81 Building Inspector BUll TOWN:~HALI. SOUTHOIJD, N. 71 (I'HIS PERMIT MUST BE KEPT ON ~HE Pith/' COMPLETION OF THE WORK AUTH~RIZED~ Per~nissioh is hereby granted to:: /// ' ..... i...~./~.~..~...zL. ~b/~..~.~. ...... ~.....~ ~ ~ to application dat~ ........ i ...... .....:....L ~uant ~ ~ I I~spector. ~ IS ? :~:ONT LI~ ULL No . .. approved 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 tvpewriter 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 featu res. 2. Final approval of Health Dept. of water supply and sewerage disposat-(S-9 form or equal). 3. Approval of electrica{ 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 buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" ~and uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res, 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 requ ired to prepare a certificate. C, Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling/ land 3. Copy of certificate of occupancy $1,00 use --Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 ate ...... . :t ....... New Building ............. Old or Pre-existing B,uildi~ ....... . .~'~.,. Vacant Land ............. Location of Property ./~...~?. ~...~. ~..~..' .~../~'~ ..... Hou~ No. lO Street , Hamlet Owner or Owners of Property . . . ~~ · )~ .'~(~ ............................. County Tax Map No. 1000 Section . .1~/./ ........ Block ..... L ......... Lot .....~ .......... Subdivision ........... ~ .................... Filed Map No .... ~ ..... Lot No .... ~ ........ ...... ........ ......... Unde~riters Approval .~. ~.~5.]. / ........... Planning Board Approval ...~ ............ Request for Temporarv Certificate ..................... Final Certificate ....................... Construction on above described building an¢ permit meets all applicable codes and regulations, ...... ..... . ............... .... . ''' ' ' :- , ....... :' 'fi!l} - ¢-g"' ~ ' ~ - -~ ~ ~ .......... : ...... ~ -~-:.:, . . .......... ~ .... * F ~ ' . ....r~,. .. . ~&~ , ~ CODF>. -'~,-NST~U~ ~ ~" ' ' , i , , FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUT~IOLD, N.Y. 11971 c~- 0¢"~'~ TEL,: 765-1803 Examined .......... .d .'. ·., 19... Approved ........ e..it No. . (&/. .¢ :? - Disapproved a/c ...... ~ ............. (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No. //~>~ (' ~¢ ~ Date ~:-).. :~.'...~... ........ , 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 i,,nspections. ...~i~. :.~.:.~.t. : .TZ~.,~:,. ..................... (Signa~re of applicaflt, or name, if a corporation) ~. ~: ~.~,. ~.~,~.~,, ; ................ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. · ~!~.~.,,,~::... :~.~.,~.,.d/~.~,: ................................... , .................................... ( of owner of premis.s .< ................................ .Y ff (as on the tax roliFor latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate, officer) Builder's License No... ,~.~.'~.~i .................. Plumber's License No...~./-~. ~.~.**.~ .............. Electrician's License No../f.~f.Y.Q'~(.~ ........... Other Trade's License No.. ,(~( ~.'~ ........... 1. Location of land on which proposed work will be done. ~;¢~;~:~7:'t~f, (~"7~. ............... , ......... County Tax Map No. 1000 Section .................. 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 ................................. ~ .................................. . . ~ , ~ 3. Nature of work (check which applicable): New Building .......... Addition ........ . . Alteration ......... . Repair ........ ~ ...... Remo'val .............. Demolition ....~ ......... Other Work ............... .. -' i ~ / 0 (Description) 4. Estimated Cost . f), .'/?, ,,'~. ......................... Fee ...................................... (to be paid on filing this application) 5. If dwe ng, 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 Dim' 'ons of ex'sting structure~' if' any Front Rea Depth Height ............... Numloer of Stories ........................................................ Dimensions of same structure wiih alterations or additions: Front Rear Depth .................... i. · Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear... Depth ..... Height ............... Number of Stories ........................................................ 9 Size of lot: Front ' 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. Name of Owner of premises ... ................. Address ................... Phone No ................ Name of Architect ' ................ Address ................... Phone No. Name of Contractor ......... i ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all ibuildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block humber or description according to deed, and show street names and indicate whether interior or corner lot. NEW~ORK, , ~ S~ COUN~/YSTATEADF OF,~... /Z4~.~.i~t~./4._~/'~ z~- '~ / .......... being duly sworn, deposes and says that he is the applicant above :named. Heis the ............. (Contractor, agent, 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 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 ................ /.~..~..f~., .dg~r'0f~. . .~..~ ..... , 19.~ Notary Public,.,)~.~..c~..~.~.'...~ff..~.,;~,~ ..... County /91