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Home My WebLink About10512-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No .... .Zfi. O0~7. ..... Date ...... .~..U~.y.."[~ .................. 198.0. THIS CERTIFIES that the building ................................................ Location of Property ..... 5..I.0.0..1~.,..1~.~.~..1...lq.8.tl..~..(.R., .0...~.,. ) ..... I~I. *.'1:.~.~. ltlp.lq ~...N,.Y... .... House No. Street Hamlet County Tax Map No. 1000 Section . ...'I.Q~ ..... Block . . . .~. .......... Lot .... ,5. ........... Subdivision ............................... Eiled Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·..l~celllbel'..fi:. ..... , 197.9. pursuant to which Building Permit No ......... .'Ifs. .~ 2Z. ..... dated ....D..og.o.lllb..o.~..6. ............ 197.9.., 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 ......... ........... Op.el3. De.ak. A~d~ion. ~o. Ex~8.~ing. D~.ell~g ...................... The certificate ~s issued to .......... ~.~.]...3..:[..~...~..d..~I..~. ~ .~..O.~..K.~..]..l.~..~. ............... (owner, I~ of the aforesmd building. Suffolk County Department of Health Approval .............. $./.R. ........................ UNDERWRITERS CERTIFICATE NO ...................... I~1./t.R. ........................ Building Inspector Rev 4/79 I~01~I NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, Iq. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 1051.2 Z pursuant to application dated~,/~,~-~'~c'Z:~,.z(.~4.4,~::~;<'~....~.. ......... 19..~...~',' and approved by the Building Inspector. Fee $... z..,~r...':..~.~ ..... /BuBding Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hail Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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 alt 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 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. C. Fees: 1, Certificate of occupancy $5.00 2, Certificate of occupancy on pre-existing dwelling or land use $5.00 3, Copy of certificate of occupancy $1.00 ~ Date` , ,~, ,//. ,~,/.~.. ,C~, ..... ............. ~cant L d ...... New Building Old or Pre-existing Building ............ Vacan an .......... Location of Property..~./.~...0. ........ . .c~...~...~..l .~..~7'....~'...~P't. ?~- .... .~.~.~7~./J'~.~. House No. Street Hamlet :../Z..j LC/ ............... Owner or Owners of Property ......... ~ ..... ~ ............... County Tax Map No. 1000 Section . . .J..d_~. ....... Block ..... ~ ......... Lot... ~ ......... Subdivision ................................. F,led Map No, .......... Lot No. ............. Permit No. l .O, .~...7~-...~ate of Permit ~ .~/~./~.Applicant..'~..1 .~. ~...~ ~--~ ........... Approval ~ ~ Labor Dept Approval ' ~ Health Dept .................................................. Unde~riters Approval ....... ~ ........... Planning Board Approval ...................... Request for Temporary Certificate ....... ~ ............. Final Certificate .............. Fee Submitted $...,~ ~. .................. Con,ruction on above described building ~permit :eets :ll_:p~licab~e~at~n~ Applica~~... ~-- ~~ .... FIELD INSP~CTIQN FOUNDATION FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N.Y. STATE ENERGY cope FINAL COMMENTS FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examin: . ...... ,197.? Approve .. ..... , Pe it No../.O Disapproved a/c .... ~ .................. ,~ .......... ~ (Building Inspector) APPLICATION FOR BUILDING PERMIT - ~-- Application No.~.:->. [ .......... 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 d~awn on the diagram which is part of this appli- cation. c. The work covered by this application may not be commenced before issuance of Bmlding 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 Bmlding 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 authmqzed inspectors on premises and in buildings for necessaw inspections. .... (Signature of applicant, or name, if a corporation) (Mailing addre~ of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of of premises owner ~ (as on the tax roll or latest deed) [~xax~plicant isa corporation, signat~duly auth?rized of fi ,~'7'h · ~ (Name and title of corporate o' ~cer) '~'~B}uilder s License No ......................... Plumber's License No ........................ Electrician's License No ....................... Other Trade's License No ..................... 1. Location of land on winch proposed work will be done.~ ............................... ,¢z~.~ ............. House Number Street Hamlet County Tax Map No. I000 Section .... ~.~...~ ..........Block ... ........... Lot. dQ.AC. ........... 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 ........................................................... b. Intended use and occupancy .... :.~..(,,). ~. ...... .~. ~...~.'...~?,7~(~. .................. Locate clearly and distinctly all property lines. Give street and block interior or corner lot. 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. RemoVal .............. Demolition .............. Other Work ............... .-~ ~---~ (Description) ) oo Fee tr'/.¢ ....................... 4. Estimated Cost ............. ! ........................ · ............. (to be paid on filing this application) 5. If dwelling, number of dwelling ~nits ............... Number of dwelling units on each floor ................ If garage, number of cars ..... i .................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............ ~.~ ....... 7. Dimensions of existing structures, if any: Front.. ~ .L~.~.. ....... Rear . .t-I.~-~.. ....... Depth ...'~..-~. ......... Height . .'Z~..<? .........Number of Stories .. ~ ~ .~..~./.TT.., .~.~.t~. ............... : ............ Dimensions of sa~structure with alterations or additions: Front ~ ~ ............. Rear . .4.q~/.~ ............ Depth ... ~ ~ ............ i.. Height ...................... Number of Stories.. ~../.~J~?.. ~. ........... 8. Dimensions of er)tire new construction: Front....~...~.. ..... .Rear ........ i ...... Depth...l.~... ........ Height .... .~. ......... Number of Stories .................................................... 9. Size of lot: Front ..... /..~.q~.. ........... Rear ..... /..O.~ ............ Depth ...~.o..~/ .............. 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 pramises ..................... Address ................... Phone No ................ ~ .............. Phone No. Name of Architect . ~ ..~ ...................... Address ............... Name of Contractor .. ¢ ~. J.~.~...'.~..~..~..F~.Address .~'.~..?.~.~v~,.~ .~. · Phone No. ~ PLOT DIAGRAM buildings, whether existing or proposed, and, indicate all set-hack dimensions from mmber or description according to deed, and show street names and indicate whether STATE OF NEW yORK, ' iS.S ........... ~ ~-~.~.O .~r~.~-..'~r-.... R.~. ~.~-'.~-~ .r-. ....... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul~ 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 manner set forth in the application filed therewith. Sworn to before me this /'/NOTARY PUBLIC. S 8re of U~ew Yor ~ ] ~, It'D ~ ,.r~ . ' I~'/~' (Signature of applicant) Ho. 1~2,8125850, Suffolk County. ,/