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Home My WebLink About10510-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No. Z 9932 THIS CERTIFIES that the building ................................................ · Street Hamlet County Tax Map No. 1000 Section ....1.O.6· ..... Block .... .O.a. ........ Lot ...... 2.8. ......... Subdivision....~.a.p.} .a.t~....I~...cl.d..~..a.t;.e.~.e..s .... Filed Map No...]..6.~.~., .Lot No...3:.}.~ ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated .... N.o..v..e~.b.e..~..~.0. .... ,19 7..9. pursuant to which Building Permit No ....... .1.0fl.]:.Q..Z. ...... dated ...... D. 'e.°.e.m.b. ??..~. .......... 19.7.~, was issued, and conforms to all of the requirements of the applicable provisions of the hw. The occupancy ~r which this ce~ificate h issued is ......... One famil~ (ad~ition-ai~eve~ion) The certificate is issued t o .............. .~9.h~....m3.d..B. 9 .a.t;.v.i..o 9..1~. o..il.ale. ................ (OW/tOt, '~ - ? of the aforesaid building. Suffolk County Department of Health Approval .................. .I~. ..................... UNDERWRITERS CERTIFICATE NO. ~ ~748~5 Building Inspector Re~ 4/7~ TOWN OF SOUTHOLD BUILDING DEPARTM~:NT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No, 10510 Z Permission is hereby granted to: drJ,Z/X- ~*/ ....... ~.r~.Z***. ~,~*'..ZZ~.~. .~ ~?~.~z~.Z~;~z~,/....~.~.~. ..... /:z., ~ 7 to ...~.4,<~Z/~c.~L....Z4~.~.~.~....,~..~4~....~7~c,,'/~.x~,¢..4~r .... ...~.Z~ ~x~, ......... ~ ~ 4/zz~ ...................................................................................... pursuant to application dated ~./~,,.,,~/~/~./.,~......~. ........,~..y..., and approved by the Building Inspector. Fee $,../.~.~.. ............... 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 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. 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date .... /,. ..................... New Building~,~.~? ~ ./.~:... Old or Pre-existing Building ............ Vacant Land ............. Location of Property .?;~. ~ . .~..~../~?.-.~.4.~. .'.~...~. .... ~/~ .......................... House No. ~ Strut Ham/et Owner or Owners of Property ,~OW~ ~ ~ ~ ~/~ ~ ~Z ~ County Tax Map NO. 1000 Section ............... Block // Lot../~ Subdivision .~ ~. ~ ~[~ .... Filed Map No ........... Lot No. ~ , Permit No. ~5. ~.~ Date of Permit ./.. ;~y~.Applicant ~ ~. ~:~./~C~ ......... Health Dept. Approval ........................ Labor Dept. Approval ........................ Unde~riters Approvam ................... Pmanning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $..'~i~..~.~. ..................... Construction on above described building and permit meets all applicable c,~odes and regulations. App FIELD INSPECTION COMMENTS FOUN~AT~O~ (~ ~t ) FOUNDAmION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined .. ..... ,19r? ,-')' Application No ..... .... Approved .. ....5 ..... / APPLICATION FOR BUILDING PERi, IT ~ '' .......... ~ - . ~ INSTRUCTIONS . ,.., _. ~ ~ ' a. This agp[ication must be completely filled in by typewriter or in ink and s~bmitted in triplicate to the Building Insp6~tor,'w~th ~ sets of plans, accurate plot plan to ~cale. Fee accbrdmg to ~c~ed e. b. Plot plan showing location of tot and of buildings on premises, relationship to adjo~ing premises or public streets or areas, and giving a detailed description of layout of prope~y must be drawn on the diagram which is part of this appli- cation. c. The work covered by this apptication may not be commenced before issuance of Building Pe~it. d. Upon approv~ of this application, the Building Inspector will issue a Building Pe~it to the applicant. Such pe~it shall be kept on tho premises available for inspection throughout tke work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy sh~l have been granted by the Budding Inspector. ~PLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Building Pe~it pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Re~lations, for ~e 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, ~d to admit authorized inspectors on premises and in buildings for necessaw inspections. ..... ~eC~..~,~. 5~.¢ .......... ~g~ture of applicant, or name, if a corporation) . . .... ~ .... ~ ~... . ~, ' ~ ' . , , '..' "(Mailing address of applicant) Il State whether apphcant is bwne~, l~sSee, agent, architect, en~neer, general ¢ontractor,.~electrician, plumber or builder. $~eofownerofpremises ~O~M ~ ~42~rC~ ~ (as on the tax roll or latest deed) If applicant is a corporation, signature of d~ly authorized officer. (Name and title of corporate officer) Bmlder's License No...~-/..~.~..~...~../? ........... Plumber's License No. Electncmn s Lmense o ...................... Other Trade's License No ....................... 1. Location of land on which proposed work will be done..~.?~. ~. r....~.~'....~'..~..4~?../~..~. ~..~.~//O~ ....... House Number ~~ Street ...... ............ .... Subdivision .................................... Filed Map No. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy. ~ .~Y...~*~.~(~ ........... ; .................... 3. Nature of work (check which applicable): New Building .......... Addi?jon . .~',~., Alteratxon .......... .Rei~air .............. Removal .............. Demolition ,~9.P~.. ~.2/'/~. ~'~//,¢ ,O. ther Work .............. (Description) 4 Estimated Cost ,~?~'o, co ..... ~. ................................ 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 .. F~/.o?d.~. .............................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dmaenslons of existing structures, af any Front.. ~. ......... Rear ~ ......... Depth Height ~ .......... Number of Stones .~.tg~ ........................... Dimensions of same structure with alterations or additions: Front ... ~. ............ Rear .................. Depth . 2, ~.( ............... i' Height . ./.~. ~..._ ..............Number of Stories , .~.~/.~.. .... .~ ........ 8. Dimensions of entire new constru,ction: Front ....~. ~. f. ...... Rear . .~.~..~. ........ Depth .,~. ;ar..~. ........ Height . ./.~ ./. ...... 7' NumBer of Stories .. ~ .A?.~ ........................... ; .................... 9. S~ze'~ of lot.' Front ...................... t'O~ : Rear .... /O~. ................ Depth d'.g ~-9 ................. 10. Date of purchase ./~..~. ~ .... : ................. Name of Former Owner ....~(: ~-. :, .~1~..~ ............ ',1;1¢ Zone or' use distrlciqnxwhich premises are situated ?.~ ................................................... 12: D~es proposed constmctaon wola~e any zomng law, or&nance or regulatmn: . .~P .................. ~, 13. Will lot be regraded ...Al..O.~..'.. ,..,....., ........ Will exces~ fill bo removed,from premises: Yes~. 14. Name of Owner of premises .,~.O..W..a~.../t(..~../('. ~.~. ~t.. Address .eS'..~. ~?.~.~'..~./~..,v.d.~.. Phone No..~. Name of Architect ........... J ................ Address .... / ............. ,.. Phone No ..... ~. ......... i. Name of Contractor .c~ ....... ,..~., ............ Address~ .................. on ............ Locate clearly and distinctly all property lines. Give street and block interior or corner lot. PLOT DIAGRAM buildings, whether existing or proposed, and~ indicate all set-back dimensions from umber or description according to deed, and show street names and indicate whether /pt> STATE or NEW YORK, cov. v OF ................. , .... :6'..e. ........... (Name of individual sigffing contract) ......... being duly sworn, deposes and says that he is the applicant above nameld. ~' ,W ~.~ ~, ~' x' · He is the .g:?..f~. ?12~:~. " .. ..... x ~ ~. .................... 1~.¥x~5.%5:.., .~..~C,.~,.~k...(~,,;~,¥x~ . · .~, x ...... (Contractor, agent, corporate officer, etc.) , of smd owner or; ~:°wners ~d ~s duly, authorized, to perform or have, _Peffomb~ the said ~orkoand~ ~ to.,m~e, , , ~d 0lo this application, that ~'11 ~tatements contained ~ thi~ application ~e true to the~s~ of his knowledge and Belief, ahd that the work will be perfomed in the m~n0r set forth ~ the application filed therewith. Sworn to b~fore me this ~ ~ ~ ......... ..... ...... 19 7 No. 30-3504128 ' ~' (Signature of applie~t) 2 ~,.P?~O,~'ED AS NOTED NOTIFY BUILDING DEPARTMENT AT 765 1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: ,1. FOUNDATION - TWO REQUIR£D FOR POURED CONCRETE 2. ROUGH -FRAMING & PLUMBING 3. INSULATION 4. FINAL ~ CON5TRUCTION MUST BE COMPLETE FOR C. O ~E REQUIREMENTS OF ~HE N Y. ~ATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR ) ~- ?'7 ./