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Home My WebLink About12175-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. ZII87I Date August 24 .................................................. 19.8.3 THIS CERTIFIES that the building .. garacj,=. (rep. l~cecl) .......................... Location of Propertv 30880 Main Rd. Cutchogue County Tax Map No. 1000 Section I03 ...Block T .Lot 4 Subdivision ........... .x ................... Filed Map No. x .Lot No. x conforms substantially to the Application for Building Permit heretofore filed in this office dated .... ~..ebru~:¥. 2.5..., 19 B.3 pursuant to which Building Permit No...I. 21.7.5~ ............ dated .... Vlarch. 3~ ............... 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 ......... New garage (replaced). The certificate is issued to JAIv~s F. HOMAN ..................... ioh;/e;,'ld, is;e'dr t33a3~/ .................. of the aforesaid building. Suffolk County Department of Health Approval .N~.R UNDERWRITERS CERTIFICATE NO. N/R Building Inspector Rev. 1/81 N? 1217~ Z (THIS PERMIT MUST BE KEPT Oh'! TH ' COMPLETION OF Date: UNT~ FULL Lot Nd. ......... by the : ,Re,v. ~6,/30Z80 ,' FIELD INSPECTION COMMENTS FOUNDATION ( 1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER STATE ENERGY GODE FINAL ADDITIONAL COMMENTS: 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 all buildings, property lines, streets, and unusual natural or topographic featu res. 2. Final approval of Health Dept. of water supply and sewerage d~isposal-(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. 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 propertv lines, streets, buildings and unusual natural or topographic featu res. 2. Sworn statement of owner or previous owner as to use, occupancy and c~ondition 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 $5.00 f / 2. Certificate of occupancy on pre-existing dwelling ~r land use ¢ [$-/$5.00 3. Copy of certificate of occupancy $1.00 ( ~ Date ..... ?.~...~.~..~. ...... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ~o.u.~e ~o.. ~, ~.~ ...... '.~...,~'- ,/J~'... ,~, · .~, ......... ~, ~,,r~, ~.~, ¢'..~..... Street~ Ham/et Owner or Owners of Property ~. ~, ..~, ~ ~7- '~ - ~z ,~,~ ~ ~ County Tax Map No. 1000 Section .... /.~, ~ .... Block ...... .(?../... Lot...(?.~.~,. ...... Subdivision ................................. Filed Map No ........... Lot No .............. PermitNol,~?,?!.'~..,~'DateofPermit ,~.~/~'~.Applicant ,. ,,~,, f~,~,~,.,~,~//~. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate~"~' Fee Submitted $ .... ~V~r(~ ............. .~.. / / Construction on above described building~it meets all a~.~pli~ble codes and regulations. App,icay /. ..................... lb' FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined .~.,~/~L.. F ..... , 19~. y Approved .'~-r~ ~. ...... 19~..fi. Permit No. f. ~[..~..~. -~ Disapproved a/c ..................................... Application No../.~'~/. 7~..7--~.... (Building Inspector). APPLICATION FOR BUILDING PERMIT Date .................. , · INSTRUCTIONS a. Tins application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, ~rel~tionship to adjoining premises or public street or areas, and giving a detailed description of layout of property must be d~rawn on the diagram which is part of this appli cation. c. The work covered by this application may not be commenced befor~ issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permi 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 p~irpose whatever until a Certificate of Occupanc~. 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 th~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of buildings, additions or alterations, or:;f9~moval or demolition, as herein described The applicant agrees to comply with all applicable laws, ordinances, bulldog Code, housing cgde, and regulations, and t{ admit authorized inspectors on premises and in building for necessary inspirit/ds. // ~,Sign'~¥e of appti~afit, or n.a~ne, if a corporation) t(Mailing address of applic~it) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · ~ ............. '*// ........ -'/ ................... / '~PPRO.VED · A'S 'NOTED Name of owner of premises .../~.~'~.~.~. ,~."~../'.~?..~...~P~....- .~.. ~'~~~ .~... ~Z~. ..... /~/ (as on the t~~t ~. ~...~~/~, If applicant is a corpora~o~, signature of duly authorized officer NoT~'FY"~"UILDING 7/~5-.1802 9 AM TO .4 PM FOR T! (Name and title of corporate officer) Builder's License No .... ...~.~. Plumber's License No. Electrician's License No.. -~--~-' FOLEOWING INSPECTIO"~S. I. FOUNDATION - T\,V:') RFO~HRED FOR POURED CONCPr_T'r-_- 2. ROUGH - FRAMING & pU.,~t,~iNG 3. INSULATION 4., FINAl_ - CONSTqtJZ-ilON MUST ' BE COMPLF:TF FOR C.O. ALL CONSTRUCTION SHAI.L M?TT THE REQUIREMENTS OF THE N.Y. Other Trade's License No ..... ~ ........... STA~E CONSTRUCTION & FN'~nC.Y or work win .......... ............ .c ::. :. .................................... House Number Street County Tax Map No. 1000 Section ..../.~..~ ......... Block . Subdivision ..................................... Filed M~p No. (Name) Hamlet ........... ........ .............. Lot ............... State existing use and occupancy o~j~e~ mises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . ./...(-r~..-..' .......................................................... b. Intended use and occupancy..~..~?.., ........ ~..C~. ~ .~ ............................ 3 N f k ( he k hi ppli abl ) ~B ildi Addition Alt ration · atureo wor c c w cha c o: u ng .................... e .......... Repair .............. RemOval .... ~ ......... Demolition ............ Other Work ............... 5 ~,0, ~ ~ 7~ .~. ~. (Description) 4. Estimated Cost .... .o ............. Fee (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 .... ~ .................................................................. · ' d fly typ 6. If business, commercial or m~xe occupancy, spec nature and extent of each e of use .................... 7. Dimensions of existing structures, if any: Front .... ~ .... Rear .............. Depth Height ............... Nur0ber of Stories .......................... ' ' ' ' ' ' ' Dimensions of same structure with alterations or additions: Front ................. Rear ............... Depth .................... i" .Height ...................... Number of S~o~fies ..................... 8. Dimensions oLentire new construction Front . . & 1.'77'. Rear ?~ /: Dnn~'h ~ 9. Sizeoflot Front ...... ~,.¢(.. .... Rear".'.' '~.~':~ ..... ;l~,,*h' .~.'/~ ~- ........... o. Date of Purchase . AZ. ..................¥ame of Former Owner ............................. 1. Zone or.use district in wh?h p.r~mises are situated... ~ ~../d .,. ........... #~ ......................... 2. Does proposed construction violate any zoning law, ordinance or regulation: . ./..~..t~. .................... 3. Will lot be regraded ..... /~./~,2 ..... .///. .... ~ .... Will exce,~s fill&0 removgd Stem premises. ~es 4. Name of Owner of prem~7-7~,~, fiv/tJ~r,~.q .... Address . ~....gff%~.~..~../~.. Phone No. 7.~. ~.' .~. )..~ 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 roperty lines. Give street and block mmber or description according to deed, and show street names and indicate whether aterior or comer lot. TATE OF NEW~OR~,/ ~ / ~ _ OUNTY OF~~ '" &'v'ififi// 'i ing contract) ~ove named. being duly sworn, deposes and says that he is the applicant e is the (Contractor, agent, corporate officer, etc.) f said owner or owners, and is dul~ authorized to perform or have performed the said work and to make and file this ~plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the ork will be performed in the manne~* set forth in the application filed therewith. ~orn to before me this ~ '. ......... · .~..~. · ? .... day ell... ~4~.., 19~ ~'~ JUDITH T. TERRY] NOtm¥ Public, ~:ate o~ H~w York i Commiaslon Expiras March pr, (Signature of applicant)