The URL can be used to link to this page

Home My WebLink About10188-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy?;' No. Z9639 Date h¢~t..1.5 ................ 19 THIS CERTIFIES that the building ................................................ 1060 Mooz'es Lane Nori:h Location of Property ...1') 20..Imle.t .Ponrl .Roa~t' ..................... Gr. eenpo~.'~i~/e House No. ' Street County Tax Map No. 1000 Section . D.3.~ ....... Blbck ..... 2 ......... Lot ...... /+~ ......... Subd~wmo~ f~sJ;ez:n .$hrl~.es .... Sec.,..3..'.Filed Map No ..... Lot No. '99 ......... conforms substantially to the Application f,or Building Permit,heretofore filed in this office dated .... AllgUa~;..1./+ ...... ,1979. pursuant to which Building Permit No ..... ~10388Z .......... dated . g~0r;[.'L .19 ................ 19.79, 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 ......... ...... D~qe. fsmily..dwelling, w£th. accessozry, s.tz~uctur, e ..................... The certificate is issued to ....... C.' .a.r.1..T.,..a.~4. B.~th. ~7.o..Nels.~n ..................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..... / UNDERWRITERS CERTIFICATE NO ............. 4/~D~I .......... .~/ ................ / . ·' 'c'/' ~ · '/~' ·/'~ii~i~ ',;;~,it;; ............. Rev 4/79 FOEM NO. ~ TOWN OF $OUTI~OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) No. 10188 Z Date ........................................................ , 19 ........ Permission is hereby granted to: ~"'[~Z y~'"'~;;'~"~'"~; .~. ,~ .................... ~ .............................................................................................. .,.. .............................. ( at premises loca~ea ay ~. ........ ~ ......................................... : ....... ~.~ .................. .~ ............................. Building Inspector. Fee ,....~.....~.... ~... FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This apptication must be fitted 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 natu raj or topographic featu res. 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. Commemial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Amhitect (~r 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: 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 . . .7. . 2 ....... New Building~ Old or Pre-existing Building Vacant Land Location of Property ......... · .~..~?.' ,/~.../~-~. ;~, .... .~'..~./~ .... · .~..~. ,~,../, ,',~, .............. House No, Street Ham/et Owner or Owners of Property .~.. ~ .~. ,L,.....~....~... {~. ~..~j.~....~...../~../.( .~..-.~.~. ~ ...... County Tax Map No. 1000 Section . .~.4.-~. ......... Block . ,~?~ ........... Lot.....~..? ........ Subdivision ................................. Filed Map No ........... Lot No .............. PermitNo, OI Z~ Date of Permit pplicant ~ /7//4 ¢'- (~'~'~'~' ~Y~. Health Dept. Approval.. ~ .~.'..O. ~ ~ .. Labor Dept. Approval Underwriters Approval..~...~.~ .~.2 .~. · ./. ....... Planning Board Approval ....................... Request for Temporary Certificate ..................... Final Certificate . ~ Fee Submitted $....~'~ ~. ..................... Construction on above described building and permit meets all applk~able codes and regulations. Applicant ~)~ (x~ J'r///~ /'~ . .~..~.: ./~'..'~..~.~ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] RO,UGH PLBG. FOUNDATION ZND [ ] INSULATION FRAMING ~ FINAL REMARKS: I-'E'/' I~.! A / Ai~) D i 1-~ a.~/',./ /-\ L. ~0~ NO. ! TOWN OF SOUTNOLD, BUILDING DEPARTMi:NT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ............... , Permit No..ff..'...~...../....~&'.:& .... Approved Disapproved a/c .......... :7:.~'...~.. ................ ; ....... ~ ....................... / ............ ................... ............... APPLICATION FOR BUILDING PERMIT Date.... ........ ....... ,i9 ............ INSTRUCTIONS a. This application must be completely filled in by typewriter o~ 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 oh premises, relationship to adjoining premises or public streets or areas, and giving a detailed descript, ion of layout ofproperty must be drawn pn the diagram which is part of this application. 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, N~w 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. (Signature of opplicont, or nome, if a corporation) (Address of applicant) ~ ~'~;o g~ builder State whether applicant is owner, lessee, agent, architect, engineer, ntt lectrician, plumber or . Nome of owner of premises ..... C~~.~..~. :..~ ~..~. ~{ ~ ~.~....../.L ~..~.~. .............. ~ If ~is ~orate,, signatur~f duly authorized officer. ~ ' "ii ";;Vi i7i ......... Builder's Lic~se No, /O~ d W~ ......... ....................... Plumber's License No ................................................. ............................. Other Trade's License No ............................................... 1. Location of and on wh ch proposed work w be done Mop, No' .~_.Z./. Z ~ Lot No </_ . ~ 'k ,'~ .... _2' .......... /'"'; ........ ~ ....., ....... Street and Number .~/~/~ ~g~/.~ ~. ~ ~ ~/~ ~/~ Municipali~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Exisiting use and occupancy ............... ~.C~.~. ............................... 3. Nature of work (cheJ~ ~v'hich applicable): New Buiidmg .................. Addition .................. Alteration ................ Repair ................ ..~, RemovalI .................. Demolition ............ ; ....... Other Work .................................................. ;,~ -- ~-, . ~/ (Description) 4. Fstimoted Cost : .~..-~.../,....~.~.. ....................... ' ............ Fee .................................................................................... (to be paid on filing this application) / 5. If dwelling, number of dwelling, units~, ............................ Number of dwelling units on each floor If ara e number of cars ....i ................................................................................................................ g g, 6. If business, commercial or m~xed occupancy, sp,~/ nature and extent,.gf~each type of use ...... 7. Dimensions of existing structures, if any: Front .................. Kear ....... ; ........................ L)epm .................... Height ~ ................. Number of Stories ........ ' .................................................................................... , ............... '. .... Dimensions of same structure with alterations or additions: Front .................................... Rear ....... ~;~ ................. Depth ................................Height ........................ ~umber of Stories .............................. 8 Dimensions o..f entire new construction: Front., .................................. Rear ............................ epth ....................... Height .................... /,,~ ~, INumber of Stones ................................... ~'~,~"a ........................................ 7,~ .................. 9. Size of lot: Front .... f...x~.....'~..,i ........................................ Rear ...................................... ..,.. Depth ................................ 10. Date of Purchase ................ > ....................................... Name of Former Owner ............................ ~ ........................... 1 t. Zone or use district in which[ premises are situated .................................................... ~. ....................................... 12. Does proposed construction violate any zoning law, ordinance or regulation.' ....... :..: ..................... '7 .................. 13. Will lot be regraded' .,'" "~",..t ...... '~ ...... Will excess fill be removed froj:D premise,%,(_) ~Yes , ( ) lng 14. 1'4ame or uwner or premi~ses .....)}....?r,.~.£:-..$ ....... v ............... ~aaress '¢Z,~;"/"2'~' ...... L,,j/_,.,,_.! rhone INa ....................... Name of Architect ...~..?C~...~....../~....~:./.~..O.~-~./.?. .............. Address .~..~?..~,~ Phone No ....................... Name of Contractor ~ ................................ ~ .......... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly dll buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and bi,ack number or description according to deed, and show street names and indicate whether interior or corner ~~ :nina c~~"'~" ~"-'~'"'~'";' .................. being duly sworn, deposes and says that he., the epplicam ~ (Nome of individual signi g ~t ct) , above named. ~~ (Contractor, agent, corporate officer, etc.) of said owner o~ owners, and is duly authorized to perform or' have performed the said work and 'to make and file this application; that all statemepts contained in this application are true to the best of his knowledge and belief; and thflt the Work will be performed inJthe manner set fo~h in the application filed t~erewith. Swam to,ore me this ; No 4~4300 ~ t . O'M"/I -i L,,'4N~ h!Or2TH % LOT 1~7 . SUFFOLK Co.' HEALTH DEPT. APPROVAL H.S. NO. STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPT. OF HEALTH SERVICES -- FOR APPROVAL OF H. S. REF. NO.: ~ROVED: ~FO~ CO. T~ ~P D~GNATION: DIST. ~. ~K OWNERS ~D~: SEAL SUFFOLK CO. HEALTH DEPT. APPROVAL '*-~ ~/~*'- THE WATE* SU~L* AND SEWAGE DIS~AL SYSTEMS FOR THIS RESIDENCE WI LL ~~~ ;CONFORM TO THE STANDARDS OF THE ~ ~"~2~' ' SUFFOLK CO. DEPT. OF HEALTH SERVICES. ..... - , SUFFOLK COUNTY DEPT. Of HEALTH {O ADDITIONAL I~IITUTIONS SU~EQUE~ ~~ ~ +~ SEAL LICENSED LAND SURV~ GREEN~R~ NEW YORK