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Home My WebLink About10511-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. CertiFicate OF Occupancy No ..... .Z9.9. ! .~ ....... Date ..... ~. pr.:[.1.../4 .................... 19.8.0 THIS CERTIFIES that the building ............................................... Location o f Prop erty .. ~5. I5.~rl12~t.~.8.. Pon.~.. I,,.811.o. ............... .~1~.~..~.:[ .~.14.o..k ,..~. ,. Y. ,. House No. Street Ham/et County Tax Map No. 1000 Section ....~.1.~. ..... Block ....'1.~. ......... Lot .... JR ........... Subdivision .~..~P..off...B.~.II.I~. ~..~.~.8..?.o.rl.~ ...... Filed Map No.. 5../4.~.~...Lot No..~ ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated ....D.~. 9.~.~.1~.O..~' .6. ...... 19~..9.. pursuant to which Building Permit No ...... ~..0.5.~fi.Z. ......... dated . . .D.o.q .~.~l.b.O. XT.. 5 .............. 19~..9.. , 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 ......... ................................... .~..,.. C..~.v..q,r.~.g~. ........................... The certificate is issued to FI'ed L:[lldl'lel' ..................... ?o¥.'~;~j ...................... of the aforesaid building. Suffolk County Department of Health Approval ......... I~I/R ............................. UNDERWRITERS CERTIFICATE NO ................. .I~./.R. ............................. Building Inspector Rev 4/79 FORI~ NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTM, ENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON -THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 10511 Z Permission ts hereby granted to: ......... ~..':/~'::/~...~.~.v.,,~./'.~'.z:~.. ......... ~,~ ................. ~,o..x'.....,.:Y./. ......... ~4,~,..~,../..:.,.,~./c ........ /.,~,.~. to .... ~x..~,~,.~.~..'./.~Oc.?.Z. ....... '~4c"~'~'~'~'~"rz" ........ ~ 7 f~, .~¢a...~'.,~9.,,.'ff-.~... ..................... ......... e:?.,~.,~5'~ "'7 ~ ;~ ' ............. z'z':~t, .............................................. ~" ' at premises located a / pursuant to application dated .~,,~/,?.~,.Z..,...~. .......................... , 19~?.,'.~., and approved by the Build,ng Inspector. Fee $ .~. ~.!.. ~.~Z'~ ....... BuJ'Iding Inspector 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: I. 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 disposaI-(S-9 form or equal). 3. Approval of electrical installation from Board of F~re 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 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 required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 :2. Certificate of occupancy on pre-ex~sting dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 ~ Date New Building ...~. ........ Old or Pro-existing Building ............ ' Vacant Land ............. Location of Property H~o,us~e ~'~o,'' ~~~~ ~ ............................... County Tax Map No. 1000 Sect.on . Z~.~ ........ Block . .//~ ......... Lot.../.~ ......... Subdivision .U~. ~./~~/~F.led Map ' / No,~. ~Lot No ............. Permit No~ ~. Date of Permit ~ ~Applicant .~~ ............ ~ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ..... ~ ............. Fee Submitted $... ~ ~.~.. ................. F IELD~_INSPECT I ON COMMENTS ..... ~ FOUNDATION (1st) FOUNDATION 2. ROUGH FRAM~ & PLUMBING INSULATION PER N.Y. STATE ENERGY COpE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 , xam,n . ..... ApplicationNoZ -->.--./. .. ..... Appro; . . ....... , .l 7 *'e,mit No. XO. ,,,,,row, ........... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .... ~'~. ~ ....... , 19 Z~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate 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 issue 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 co/C/e, and regulations, and to admit authorized inspectors on premises and in buildings for necessarf4~ction~/,~/ J f.~ · '' (S~'~~ 'c~;~;a'tion) .... ~,.I .... e..o..x...~.,9)..H .................. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .., O.~./q..~.~.~./.A.. ~c'. ............ i -x- ~'~ c 7C'. ............................................................. Name of owner of premises . .. {--. I?.e._,~ ..... .L.'I..~..B.~...~..R¥ .............................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) 0Builder's License No .... /f..~..~. ............... Plumber's License No ......................... Electrician's License No. [ ~ ~~52~ Other Trade's License No ...................... 1. Location of land on which proposed work will be done ..... . .3. 2. ~ .................. ~.e: .',"X'4..e'. ~.r./~: .~. o. · · ..*/..~ .'~. ·-w'· ....... ./7..~..-ew... e ..e:..~ .c~: ......... House Number Street Hamlet County Tax Map No. 1000 Section .... //'~. ......... Block ...... ./~. ......... Lot ..... /.~. ........... ~/~ce~,/,,r'~ ~ 7-. ..~.': ~ ./~ . Filed Map No...4'7~-~..~.~ ...... Lot . ../. Subdivision ............... (iq'me)' 2. State existing use and occupancy of premises and intended use and occupancy~of proposed constructi°n: a. Existing use and occupancy.. O/X~/~'.~.. ~e',--./-~.?.~...~.-.4X/.z~..7 ................................ / t b. Intended use and occupancy . . .~...~y/~ ¢?o...q . .~..~.../~...~q. ~..c~... ............... Locate property interior or corne;, /3. Nature of work (check which applicable): New Building ... rd/..... Addition .......... Alteration .......... Repair .............. Rem6val .............. Demolition .............. Other Work ............... 4. Estimated Cost .... ~ oo 9 ......................... 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 .... O.,'hg.~", ............................................................. /6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structure's, if any: Front .... ~ ........ Rear ... ~ ....... Depth.. &~: ......... Height ............... Nu'nbar of Stories ........................................................ r)imensions of same structure with alterations or additions: Front ................. Rear .................. Depth ' Height Number of Stories ~8. Dimensions of entire new construction: Front .... d.c.' ........ Rear .../.4: ........ Depth .... ,a..¢: ....... Height .../J .......... Nu er of Stories ... ~. '/~ .................................................. .9. Sizeoflot: Front ./.~...~,~Z/../ .......... Rear ~' Depth ,2<~.o.~.~.'Y.)..~'../.~--d.'.q~..(,~.,) ,11. Zone or use district in which promises are situated... ~.ed. < .~.~..,~. ?7.<~.~Z.~'. ................................ ,42. Does proposed construcbon violate any zoning law, ordinance or regulation: ... ,~,40 ......................... -13. Will lot be regraded ..... d.l,Z. ~ ................... Will excess fill be removed from premises: ~ No 44. Name of Owner of premises . ~..f~.e~...g ~ .~.l~.O.e.~Address ~..¢..~..I~} .~r$.i~,~q.e~hone No..~.'~.': ?.?~. . Name of Architect " ' ' .......... ................. Address ... t~ . Phone No ...... Name of C~ntractor ~,' '~ .:. Address ... ~' .. Phone No. ~ ~ PLOT DIAGRAM and distinctly all: buildings, whether existing or proposed, and~ indicate all set-back dimensions from and block ~umber or description according to deed, and show street names and indicate whether STATE O ..... ~S.~ ~7~ COUNTY ( ............ .......................... being duly sworn, deposes ~d says that the applicant (Name of individual ' " mgnmg contract) above named. He is 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 b~fore me this ~ ........................ day o~ ..................... ,19: .!./ ~ No 52'452477, v Yotl~ ................................ ~ ~ v~,~l,t <., s-- ' (Signature of applicant) , ~arch 30, J3oO h x~ Ct~1,]_1 ixiG- ~Tc) ls~-~s