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Home My WebLink About11618-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.Z13376 Date April 19 19 85 THIS CERTIFIES that the building Deck addition Location of Propertv 12680 Main Road East Marion County Tax Map No. 1000 Section . .3. ~. ........ Block 14 .Lot 13 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·.. M~.~.c h. 25 ........ , 19 13.2 pursuant to which Building Permit No..q.q..6.1.8. Z. ............. dated .... .Rp.~. ~..~..1.5. .............. 19 .8.2., 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 ......... ~.e. qg..a.~.d..i.t.i.q~..tp, existing dwelling The certificate is issued to ....N.a.r.~. ¢la.e .B..eFl.~.ere Maiorana · ............ of the aforesaid building. Suffolk County Department of Health Approval ..... ~ ./.~ ........................ UNDERWRITERS CERTIFICATE NO ............ ~ ././1 ................ Building Inspector Rev. 1/81 I NO. I, TOWN OF SOUTHOLD BUILDIN~ I)F, PArrMINI' TOWN HALL SOUTHOLI), N. Y. Cfi'liS. PERMIT MUST BE KEPT ON TIdE P1a, EMISES UNTIL FULL COMPLETION OF THE WORM AUTHORIZED) No. 11618 Z Building Inmpector. Fee $... .................... P~v. 6/30/80 FORM NO, 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY BLDG. DE~L~ TOWN OF SOUT~OLD 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 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 buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~'operty 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 $15.00 New Building .... -- .~.. .... Old or Pre-existing Building ............ Vacant Land ............. Location of Property... [~.~..~.Q .... -- cN~~ . .~., .(~... , . .~.... ............. ~ . .~..~ .... House No, Street Ham/et Owner or Owners of Property ....~.. ~.j~L..~. ~ ........... County Tax Map No. 1000 Section ..... ~.~ ...... Block ...\..~ ......... Lot.. 1 .-~.. ........... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. I).{~{.~...~. Date of Permit ~/l~./~.~ .Applicant..~., .~. ~.~. ~?3~fl(~L?... Health Dept, Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporarg Certificate ..................... Final Certificate .... ~ .............. Fee Submitted $. ~ ,.~ ...................... Construction on above described building and permit meets all applicable codes and regulations. Applicant.. ,~.. ! ,0~..~,..~....~. ~ ................... FIELD INSPECTIO~ . FOUNDATION 1st) FOUNDATION 2nd) ROUGH FRAME & FLUMBING INSULATION FERN. STATE ENERGY ~ODE FINAL COMMENTS ADDITIONAL COMMENTS: · OB,M NO. 1 TOWN OF ~OUTHOLD EUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E amin .......... .,gF " Approved ¢~' ~" 19./.L ....Permit No./..~'~/'~..~......~... Disapproved a/c ............ . .............. .~ ......................... ~ .......................... · ........ ................................. -- Application No./../.~/'~...~... .......... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a.' This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Buildir 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 areas, and giving a detailed description of layout ofprpperty must be drawn on the diagram which is part of this applicotia 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 issue a Building Permit to the applicant. Such pern' 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 Occupan~ 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 tt Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances ~ Regulations, for the construction of buildings, additions or a~terations, or for removal or demolition, as herein describe The applicant agrees to comply with all applicable lows, ordinances, building code, housing cede, and regulations, and ~ admit authorized inspectors on premises and ir~ buildings for necessary inspections. ....... · (Signature of applicant, or name, if ~'~o~rationi ...... (Addr;ss of opplico~i (T ..................... State whether applicant is owner, lessee, agent, architect, er~gineer, general contractor, electrician, plumber or builde Name of owner, of premises ........ ~ .~.....~....~ ....... .....~.~ ....... ~..~..'..~....~..~ .................... ~ .................. If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .............. .~Z .~...*. .................... Plumber's License No ................................................. Electrician's License No ................................... '.. Other Trade's License No ............................................... Subdivision Location of land on which proposed work will be done Map No .~..--~.~..~: '~ Lot No .~, Street and Numbe, r ....;..~.....,~.~,~....~.& ............. .'~7~,~.....,~,, .,.~..~.~ ..................... .~C'- y ~ / ~Z~ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ................ ..~., ~.,.v~... ,,.~,. ...... .q~.~.~... ,, .~...GF:fj~..E..~.,c~, .,,: .............................................. b. Intended use and occupancy ........... ~..~..~....C~,~'~.~-~'./.../.~'...~.~ ........ .-:. ............................................. County Tax Map No. Dist· 1000 Section Block / ~' Lot 0 ~ 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteretlon ................ Repair .................. Removal .................. Demolition .................... Other Work ..... ...~...~.k ............................. . ~ { (Description) 4. Estimated Cast ............ ,~J~ ....................................... 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 .......................... ~ ............................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use 7. Dimensions of existing structures, if any: Front ........ .~0. ............... Rear ............................ Depth ................. Height ........... ..~.; ......... Number of Stories ............. ~ ........................................................... / Dimensions of same structure with alterations or additions: Front ............ .~.0.. .................. Rear Depth ............ ~ .............. Height .. ......... ~ ............ Number of Stories ......... ~ .................... 8. Dimensions of entire new construction: Front ............ ~ .................. Rear ...~.~,..~. ............. Depth ....... .~ .............. Height ...n'~..~J ...... Number of Stories ................ ~ .......................................................................... 9. Size of lot: Front ........... i...~..[~...~..,x. ...................... Rear · .~, .~..~..J ......... Death 10. Date of Purchase ............. U...~....:...~..,....~.u~..~..~.....Name~o, I~ormer .Owner .~'C'~'.q~)..~.~"?'~F"~C'~'.'~,:'Ns".~ 11. Zone or use district in which premises are situated ............. .~..%...a~......~.. ~..~ ........................................................... 12. Does proposed construction violate any zoning low, ordinance or regulation: r~ 0 13. Will lot be regraded dO. ..........Wi, II excess f be removed from premises' ( ~ Yc-- (' ) No -. 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 property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. .~1 r~oT ~¢ SCP~L~ /~[' [TAT~ COUNTY~ ~OF ~~...J~'~. .~ '~ , ~~ j (Name of individual signing c~t~c above named. is ........... ................................................................................................................................................ (Contractor, agent, co~rate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to ~ke 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 ~t fo~h in the application filed ther~ith. Sworn to before me this ...... ~.(. ....... day of ............. ~/ .......... , 19..~. ~ , . ~ , ~ , ................... .......... ..... .......... ................ (~ignoture of a~plicant) ' NOTARY P~BL/C, Stet~ Y~ i ~o, S2-4SI24~4 Suffol~ ~ew