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Home My WebLink About10365-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No..Z. 97fl.5. .......... Date .... 0o.t.o.~er..'1.~$ ................. 19 79. THIS CERTIFIES that the building ............................................... Location of Pro-err" 'lO00 Inlet L.a.ng.... v ' h~s~ h/o'. ................ ~b'e$i .............. Gr. e enpo. v.t... Ham/et County Tax Map No, 1000 Section ,,, 3.6- ...... Block .,..2 ........... Lot .... 2~ .......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore Fried in this office dated ...... .A.u.p~.~. ~..2.2. .....197.9.. pursuant to which Building Permit No....1.0.~65Z ............ dated ..... ~.u. gg.s.~...23 ............. 19.7.9., 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 ......... One Family .D.w.e..1.1~.n.g..w/..D..e.cJ~,, qt~lp..t:l. Ola .............. , .... The certificate is issued to ........... ~:cl>er.t .t~o. M812del ........................... of the aforesaid building. Suffolk County Department of Health Approval ............ ~/.FI .......................... UNDERWRITERS CERTIFICATE NO .................... .I~./.t~. .......................... Building Inspector Rev 4/79 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? 10365 Z pursuant to application dated .~..~.~. .............. , 19.7.~., and QpproYed by the Building Inspector. ' Buff~'ng Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall 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 buddings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Fina~ approva~ of Health Dept. of water supply and sewerage disposa~--(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. Fees: 1. Certificate of occupancy $5.00 2. Certihcate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date. ~0>7.~..7: .......... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property/..~..~...~.~......~..~. :~.% .~. ~. ~....~../~..~;~-. .... · .~-:-:-:-:-:-:-:-~'. ~.~.~.--.~. · ~..~..~../~.. · .'-'~ House No. Street Ham/et Owner or Owners of Property . .~.~..~..t~,../~..~...~...-'~. .... . .~. ~ .~..'9~...~..~.~..F_~. .................. County Tax Map No. I000 Section ...~r..~. ..... Block .. Lot ................ Subdivision ................................. Filed Map No ........... Lot No .... ~f,~. ~.~'.... Permit No/.~.~....~,. Date of Permit ~.~.~.~//~pplicant J~..~..~..~...~../'~.. · .~..~. -/(,Z/. · .... Health Dept. Approval ........................ Labor Dept, Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ~ F e, Submitted $,..~. ,~.,', .~. ~ .................. Construction on above described building and permit meets all applicable codes and regulations. Applicant ,~.~. ,,~.~.~...~ .................... Rev. 10-10-78 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N·Y. 11971 ~'3 .'~ TEL.: 765-1803 / z-. No .................. Examined ~' '-~' '" 19 '~' '7 --7 Application Approved ~. ~. ~.., 19¢TPe~it No.. I~ .~S ~ INSTRUCTIONS a. This application must be completely filled in by typewriter or ~n 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, hou_~ng code, and regulations, and to admit authorized inspectors on premises and in buildings for necessa~sp~ections~..~_)X--J/~ "~/~D~ A4/. ........ (~./(Signature of applicant, or name, if a corporation) :. .... (Mailing address of appTlcant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..... ./.~..~..~......~. '...&..'~.. ~ .................................. (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 ........................ /J~ . · Electrician's License No ....................... 62~-~ Other Trade's License No ...................... l. Location of land_on which proEosed work will be done..~./r ~/./.&.~/.~...~.~.~..~.~...~.~...~ .~..~ ........... .::. . . .............. . . .? . . . . .) House NumberStreet Hamlet County Tax Map No. 1000 Section ....... ~ .~. ...... Block ......... ~. ....... Lot. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occlJ,Pancy of proposed construction: a Existing use and occupancy / .~ ....... .......... ;.' ................................. b. Intended use and occupancy ............. : ..... t ................. 3. Nature of work (check which applicable): New Building .......... Addition .. ~ .... Alteration .......... Repair .............. Remoyal .............. Demolition ............ Other Work ............... 4. Estimated Cost ......... ~ ................. Fee ................................... ~ (to be paid on filing this application) 5. Ifdwelljng, number of dwelling ~nits ...... /. ....... Number of dwelling units on each floor ................ If garage, number of cars ..... i ......... ~ ........................ t ............................. 6. If business, commercial or mixedl occupancy specify nature and extent of each type of use'. .................... 7. Dimensions of existing structure~, if any: Front ..... .~..~.: .5' ..... Rear .... .~,.~.'.~. .... Depth ....~..O..' ....... Height ..... /?.~'~. ....... Number of Stories ....... /'. ............................................... Dimensions of same structure wi!h alterations or additions: Front ................. Rear .................. Depth ........ .~..~../ ....... i. Height ..... ./~...~ ............. Number of Stories ....... /. ............. 8. Dimensions of entire new construction: Front ..... ,5....~p-~e... .... Rear . . , .,~'_ . .'~. · · .... Depth .... /..~./. ....... Height . .~.~ ..... Number of Stories ...... ~ ~ .......................................... 9. Size of lot: Front ........ /'. .......... Rear ........ /'...~D ......... .~Depth ...... ~"9-~' ....... 10. Date of Purchase . i i~-. I. ?.~7.~ ......... Naive o,fForm.er~r O. wn~r ~..~.~.'.~ ........ 11. Zone or use districtd~which premises are situated ..... /~..~'~ ............. - .................. 12. Does proposed construction violate any zoning law, ordinance or regulation: .. }5~.~ .......................... 13. Will lot be regraded .......... '. ~.%'d.-~,. · ·, ......... Will excess fill be removed from premises: d Yes No Name of Architect .......... ' ................. Address ................ ' ... Phone No ............. Name of Contractor ......... ~ ................ Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all ibuildings, 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. STATE OF .NEW Y.~O RK~ COU~i~rlxY OF......... ·'~'~ being duly sworn, deposes and says that he is the applicant fi// (N~ividual si~ing contract) above, named. He is the .......... ontractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have perfomed the said work and to m~e ~d file this application; that all statements confained ~ this application are true to the best of his knowledge and belief; and that the work will be perfomed in the m~n~r set forth m the application filed therewith. Sworn to before me this ............. ~'. ................ County ~ ' ' ~ (Signature of apphcant) ' ¥ St,~to,_,' . ~t .,d Surveyor [ LICENSE J JOB