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Home My WebLink About10338-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No .... :7' 9.~.~. 0. ........ Date ...ff.a.n..u.~..~...~.'1 .................. ,19 .~.0. THIS CERTIFIES that the building ................................................ Location of Property ...'l .O.~5. ~-3..b~¢O~.~ .D?~lV..e OreenDol~t~ New Yo?~k House No. ' ....'S'tie~i ................... County Tax Map No. 1000 Section 057 ...Block 01 .Lot 1/4 Subdivision..S.O..u~.h. ql..d..S.h. 9.r.e.~'' ...Filed Map No ......... Lot No...-~.~. ......... conforms substantially to the Application for Building Permit heretofore fried in this office dated July 27 19.7.9. pursuant to which Building Permit No. '10~aZ dated . .$.u .g~.~ .~. ?. ................ 19 7.9. , was issued, and conforms to all of the requirements of the applicable prov~sions of the law. The occupancy for which this certificate is issued is ......... Screened Porch addition to P--irate One Family Dwelling The certificate is issued toMichael Levison ..................... io¥?'o;, ;~~ ..................... of the aforesaid building. Suffolk County Department of Health Approval ....... ~/.1~.. ............................... UNDERWRITERS CERTIFICATE NO ............. Building Inspector Rev 4/79 FOt~I~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°., 10338 Z Dot? ..................................................... , 19 Permission is hereby granted~ to' ~g/~ ~ /~/~Z~ ~(_ .-/~, ~.~.~ .~...~~..x........./..~~ ....... ....... ~.~..~..~c~.~..~..z.~ ..... .......... ~..~.~.z~:~..: .......... ~, ,o ..... .~.~~.~.....~:~zc~.~.....~.z~L.~~.~.~ ....... ........ ~......~c~.~.....~.....~d~<~...~zZ~%. .................. ~~, ............. ~: ........................... ~., ......................... ~ ............. ~ ............................................. :~.::....~~..~~ .......... ~..~..~ ................................... pursuant to application dated ..... .~.....~.~ .................. , 19~., and approved by the BuJldJfig Inspector. ~.~ ~~. ~ ~ Bu~ldin~ In~ector 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. 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: I. 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 v Date ...~...~.~. p.~:.'.~iq,~.. New Building ~.1.~1,0~ Old or Pre-existing Building ............ Vacant Land ............. Location of Property . Z~ ~ ~. ~ P.~.~ .~.~.,... f .... ,~ ~.~ ~ ~ ~ '~ .......... Owner or Owners of County Tax Map No. 1000 Section ... ~.7 ..... Block ...... O./ ...... Lot ..... /~. ...... Subdivision. ~~. ~ .......... Fded Map No ........... Lot No... ~ ...... Permit No~'~, Date of Permit .~Applicant Health Dept. Approval ......... ~ ......... Labor Dept. Approval ..... ~ ............. Unde~rJters Approval ........ ~.. ......... Planning Board Approval ..... ~ ........... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ .... ~. ~ ............... ~ , Con,ruction on above described building an~cable codes and regulations, Apphcant .... ¥~ ~ - --=~.~,_=~ .............. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 Disapproved a/c ................. (Bujl/din~Inspector) APPLICATION FOR BUILDING PERI~ IT Date .. ?(?.~. T .... '.~.'7.., 19 ?.~. INSTRUCTIONS ~ a. This application must be completely filled in by typewriter or in ink and submitt~ed in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according t'o~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 M/kDE 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 constructior~ of buildings, additions or alterations, or for renyCVal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, btl~lfl~-~,~b4~using code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary ,in~r),~. y (Signatfure of applicant, or name, if a corporation) '?: (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... .~. ?.~..,~.....~.~?. ,~m...~m. !..'%.~- ............................................................... Name ofowner ofpremises ..... ~../.~...~/..~...??./.~./..~..~{. ~ ~d,~,~o.~ ................. ~ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ......... ./..~. -~. .......... Plumber's License No ......................... Electrician's License No....~..~...~..~ ......... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ................................................ ............. ...... l. . . ..... , ...... ................... House Number Street Hamlet · County Tax Map No. 1000 Section O ~'7 Block c>/ ........ Lot .... ~ ./. ~.~. Subdivision...-5¢.<JT'P/...~.~.D... ?..~.?-'~?.? ............. 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 ...... ' ~.~..~.~.'~..~ ~...'7.../. ~. ................................ b. Intentle6 use and occupancy ............... j'..,47~..,~. - ....... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... ! (Description) 4. Estimated Cost ............ , oc> 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 mixld occupancy, specify nature and extent of each type of use ..................... 7. D~mens~ons of exast~ng structures, ~f any: Front ..... ~..'(. ...... Rear ..... ~,.¥. t.... Depth .. ~..~. t . Height .... !.5(.. :*.'~ .... N tuber of Sto es... ! ................................................ Dimensions of same st, ructure with alterations or additions: Front ...... ~.'t'. ' Rear ~' ~'. ~. Depth ........ ¥.o. ........ '... Height ....../.¥ .............. '.'. Number of Stories ..... /. ................ 8. D~mensions of entire new construction Front Rea Depth .... /.~'. t ........... , ........................ ...ff. ..... r pf Stories' 1~;~; ............. 9. S' fl6t: ......... i ................... /.OO .......... Depth .... /..7..~. 't ............ 10. Date of Purchase ............................. Name of Former Owner ............................. 1 1. Zone or use district in which premises are situated....~-,.g$ I ~.e~,,q r/,~. .................................... 1~2.,~ Does proposed construction w01ate any zoning law, ordinance or regulation: ..... ./~.~. ..................... 13. 'Will lot be regraded ....... ./~'..o .................. Will excess fill be removed from premises: Yes 14. Name of Owner of premises 7~.z~,~',~-..fi..~./.~?.~.., Address ................... Phone No ................ Name of Architect ........ ~,. ................ Address ................... Phone No ................ Name of Contractor .jS/Jb~. ~../..~ ~.~. ~-r-./,, .~.r~..... Address ...~:.~..r-.~/~..,~.o..~. ..... Phone No..7.~.9'.': ~...oo..~.. PLOT DIAGRAM Locate clearly and distinctly ail buildings, whether existing or proposed, and. indicate ail 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. STATE OF NEW YORK, COUNTY OF. ~?.p.p..o+t.~. ...... i S.S ........... //7]/o~..~. . .~... z~ts~ ............. being duly sworn, deposes and says that he is the applic~t (Name of individual signing contract) above named. ,,< ' , agent, corporate officer, etc.) of said owner or owne~, ~d is dgly authored to perform or have perfomed the said work and to m~e and file this app~cation; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the work will be perfomed in the m~n'er set forth ~ the application filed therewith. Sworn to before me this ~/~ ~~ NOTARY PUBLIC, Stat. et N.w York ~ (~ignature et appnc~ /~ ~1 .... ~ Commis~on Exp~e~ Ma~ch ~0, 19 ~ , Ap~?~C~VI~D AS NOTED 76~-1802 9 AM TO 4 PM FOR THE ~OLLOWING {N?ECTIONS' j. ~OUNmATiON _ ~O REQUIRED ~R p~,U~CD CONCRETE 2 ~OUGH - pRAMING & PLUMBING ~TATE QONSTRUCTION & ~NERGY ¢O~ES, NOT RESPONSIBLE FOR D~I~N O~ ~ONSTRUCTION ERRORS·