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Home My WebLink About10413-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate O[ Occupancy ~.10096 No .................. Date August ~ ., 19 .~0. THIS CERTIFIES that the building .............................................. 2500 Maple Lane Oreenport, N.Y. Location of Property St~et County Tax Map No. 1000 Section 38.01 .Block .Lot .~ 5. It Crescent Bch. Oondominium .... 62 Unit 1~ H Subdivision .............................. mca Map No ......... Lot No ............. conforms substantially to the Application for Building Permit heretofore filed in ~this office dated September 18 .79. to which Building Permit No. 1 0413Z ......· ............... ,19 . pursuant ..................... dated ....~.e.~t..e .mb.e.g...~.0 ........... 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 l~emily Seasonal Dwelling w/screened Porch never to be enclosed ................................................................ ~ith..glae~- John and Marie Hughes The certificate is issued to ..................... [o~,n'o'r,'l~~ ...................... of the aforesaid building. Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO .................................................. Rev 4/79 Bmlding ~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: 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 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-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $§.00 Date...".,~...'~.. ~ :~...~.~. ...... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ....................... ~Pz~.'~ (~.~/~.//~..~... ~ ...~.~..~.. HouSe No. Street Hamlet Owner or Owners of Property , .~..(?..~. ,~/... ~...~..~'..~...~.~...~,....,~..,~,..~.z~.~....~...~.G'. ~.~.~.~,. County Tax Map No. 1000 Section . .~..~ .~. ?. ...... Block ....,..........~/ Lot..~..'~..~..'~...'~..O~./~-~ Permit NoZ~...z~.~...°~. Date of Permit ~.~.~.O.~.Z.~..Applicant .... ~.(~..~..'~...Z~..~.~. '.."~'..~-.'~, ~ ..... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ .... . .~/..d~..O. ................. Construction on above described building and permit meets all applicable codes and regulations. Applicant....~.~-~. ~/~.~~. 4 ....................... uJ X .® FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y, 11971 TEL.: 765-1803 Examined¢' / Approved .~..c.....~...., 19'~.~Permit No. Disapproved a/c ............. -~ ........... ': ........ .., ..... : ............... (Building Inspector) Application No .......... APPLICATION FOR BUILDING PERNIIT Date .S.e.p.t.e.m.b.e.r. ,1.8 ...... , 19~/~. INSTRUCTIONS a. This application must be completely filled ih 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 ttfis 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 code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..... tlotm..g .. }t.tlzl~ ~..&. :).~.£;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 LicenseNo ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done.. ,~,,. [ffl.¢.' ~.4~:t,?..(.(~ v.,,.~.(~ b.. ~ ~.x,~.) .... [Jo i.t .~. 1.5 .... .......................... ~,..,,~;xitm. ~:t.,.Zo.. & 999. House Number Street Hamlet County Tax Map No. I000 Section .~(~ .01 ............. Block ...... 21. .......... Lot.. Lh~i. l;. ~L5 .)2~ ...... Subdivision. g~.y, e~ c,o~r{~, i3,:..o¢~t. Oo~.v3,~,,&~.~t3m~ ....Filed Map No .... ~>~ ......... Lot .i3.~_t g..1.5 .I~I .... (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 3. Nature iofwork (check which applicable): New Bui!lii~g .......... Addition . I~. ....... Alteration . ' ........ Repair ~ .............. RemoVal ............ .;/. Demolition .............. Other Work ............... (Description) 4. Estimated Cost $ 1,109.00 Fee .~. 1.5,00. I (to be paid on filing this application) 5. If dwelling, number of dwelling anits ...... .~./J~. ..... Number.o.f..d.w.el. li.n.g..u.ni.t~ .o.n ~a.c.h .fl.o.o~:: ............... If garage, number of cars ..... i, · [19oo ................... 6. If busifiess, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structure~, if any: Front.. 20.t .......... Rear ./l, 6. t .......... Depth .... 2b.~ ........ Height ...1 5.~ ......... Number of Stories ...... and .............................................. Dimens, ions of same structure with~additions: Front . 9.0 ~. ............ Rear .... ~L6 ! .......... Depth ' .... }~l.~ ............ i. · Height ..... J, 5 ! .............. Number of Stories .... Ql~e, ............... 8. Dimensions of entire new construction: Front . .]. ~ ? .......... Rear .. ~.b. ~. ......... Depth ...J, 2 ? ......... Height . . ,/~.~ ....... Number of Stories .... 9.n.q ................................................ 9. Size of lot: FrontOo~maoll. 10. Date of Purchase . .. 6/.20/.~t ................. Name of Former Owner Jalaaa. P... tiuVe,n~t~ ......... 11. Zone or use district in which pr~mises are situated ....... 1/I. ~ ........... 'r ............................. 12. Does proposed construction violate any zomng law, ordinance or regulation ,,~. O. ........................... 13. Will lot be regraded . ~19. ..... i ................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises John. J....Hlll.5tla~.. · Address~ .0,..Bo~. ~.7.7 ..... Phone No. &~ .-0421.9 ..... Name of Architect ..... Non .e,.i ................. AddressE ·. l/Itxr..:~Ola...5I ,Ir.... Phone No ................ Name of Contractor .... ~lorie,.I Address .. [[~9.~ 9. Phone No. Locate clearly and distinctly alii property liges. Give street and block interior or corner lot. x~l~. 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 12' x 16' ~ooaen a~o~ wi~h ~ereenea in poroh ~ttn roof. STAT~ OF N~Wj~OR~_,/^ COUNTY S.S '.... ~-~..r.¢.~.....~7...e<~...~...~. ................ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ..................... i .................................................................... ' (Contractor, agent, corporate officer, etc.) of said owner or owners, and is drily authorized to perform or have performed the said work and to make and file this application; that all statements con,dined 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 .. ,.. .... ,~<7~day of. · .'7. ......... 1 ! ...... ,'" ............... Notary Pu lic, _. --~z'--- - - ~ ' ' ' "'2 . County , ~:.~: ~u~o.'.: ' ~,! J!!~:ff,~ ~.~ ' (Signature of applicant)