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Home My WebLink About10199-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y, Certificate Of Occupancy No .... Z.'102/*~ ....... Date ...... No.v. emb~.~...'10 .............. 19.8.0 THIS CERTIFIES that the building ................................................ Location of Property .... 52~0..MatlO..Road. ........ ~r'e~t' ......... House No. Ham/et County Tax Map No. 1000 Section .... ,063 .... Block .... 0.~ ........ Lot ...... '[. ! ......... Subdivision ............................. Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... ~I.eqg .9 ......... , 19 .?gpursuant to which Building Permit No ...... 'J0.'Ig. gZ ......... dated ...... F~?.~/: .9 ................ 19.7.9, was issued, and conforms to all of the requirements of the applicable provismns of the law. The occupancy for which this certificate is issued is ......... ............... One. ~.aml.~-7..D~.e;k~.J. ng .v~.l;l~ .a~'e.enhou.~.e..A..d.cl~.l. 0.n. ............ The certificate ~s issued to ........ Ro.he~'~;. ~rld. B.ale. bal".a .lJa~'12J, llg.~.o, ll ................ of the aforesaid building. Suffolk County Department of I~ealth Approval ............. I~./R .......................... UNDERWRITERS CERTIFICATE NO ..................... I~1/~{ .......................... Rev 4/79 Building Inspector l~O~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, bi. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 10199 Z Permission is hereby gronted to: ..... ~x~.....~-~.~,.....~,~..~-~.x,..~,v~.i ....................................................................... at premises located ot-~l~l~.i~.e~l~.,..../t~.~;~.~./.....~.....~-~r'~..~_,~.~.,~{,. pursuant to application dated ......... ,~,..-T..~... ................................ , 19l~..., and approved by the Building 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 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 disposel-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwr!ters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect orEngineer 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. 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 $5.00 /./.-. ..:. Date ..................... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property . . .~., .'~..~..J-~..? ..... ~.,...~...,. .......... .~., . .¢.,~..~.d./.~. ....... House No. Street Hamlet Owner or Owners of Property ........................................................ County Tax Map No. 1000 Section .. ,~, .~. ,-~. ...... Block ... ,~.4,~,, ...... Lot.../. ,~. .......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No.//?./.~,~.. ~-~ Date of Permit ..~.~. ...... Applicant ..~.'. ~,; .......... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and permit meets all applicable codes and regulations. Applicant ........................... TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN HALL SOUTHOLD, N. Y. 11971 TEL. 765-1802 October 10, 1980 Robert E. Harrington P. 0. Box Southold, New York 11971 Dear Sir: This is to notify you that Building Permit No. 10199Z issued May ~ 1979 to R. & B. Harring~'~n will expire on November 9~ '196o If mere time i~ required to templets the Certificate of Occupancy, you may apply, six (6) month exteasion. Job and obtain a kY letter, for a If the work is not completed and the,Certificate' ' of Occupancy not issued after the six (6) month extension period, you are than required to apply for a new building permit. Very truly yours, · FISHER ~ Sr. Building Inspector GHF/mw FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ; SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined.. .-... Approved...4.--:.. Disapproved a]c ......... q .............. ~ ...... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No..Z'..~. ff~..~. · ...... 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 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 apphcaut. 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 Or&nance 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 mspectors on premises and in buildings for necessary inspections. . ............. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) [I State whether applicant is owner, lessee, agent, architect, engmeer, general contractor, electrician, plumber or builder. (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...5~--~: .............. 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~..~. f'Z../~..'3~. · · .x~. i ·'~. . ~td~.~.~. . .~x-~. ~ .~'. .~;~.c. .c.Z~ ~'~ ~-' .* · · ................. 7 zg.,c .............. .,d .................... House Number ~'7~ ~,5'-O Street Hamlet County Tax Map No. 1000 Section .... t~. ~..3. ........ Block .... O. ~ ......... Lot... [ J.'. ............ 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 . ..~.~j~.'~.~. ~..~ ~ ~c ~ k.~ 3. Nature of work (check which apphcable): New Building ................ Alteration ........... Repmr .............. RemOval .............. Demohtmn ..: ........... Other Work ............. 4. Lstnuated Cost .. :~;-~. ,~ ........ t ..................... 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 mixed occupancy, specify nature and extent of each'type of use ..................... ' h 7. Dimensions of existing structures, if any: Front....., .......... Rear .............. Dept ............... lte~ght . Number of Stones....~..,)x ............................................. Dimensions of same structure w~th alterations or additions: Front ~ ............... Rea~,,~ .~.~.. ........... Depth ................... ... Height ...................... Number of St nes . ( ....... ! .......... 8. Dimensions of entire new construction: Front .../~.r. ......... Rear ............... Depth 7 .............. Height ............... Number of Stories ......... ;; ...... . ....................................... 9. S~ze of lot: Front .. ~ ...... , ............ Rear .o~2~ ................... Depth ,5.:.xzP~[..: .............. 10. Date 0fPurchase .~"./.~. 7.~. ............... N~me of Former Owner 7'L~,q<.~ ~.......,w-~.. ...... 11. Zone or use district in whlch plemises are situated ..................................................... 12. Does proposed construction violate'any zoning law, ordinance or regulation: ??. ........................... 13. Will lot be regraded . .'7~L~P.. :~ ...... ., ............ Will excess fill be r, en3pved~ from premises: ~Yes N~ Name of Architect ......... I' · ~' ............... Address ................... Phone No ................ Name of Contractor ........... : ............... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~stmg or proposed, and, mdmate 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,YORK,, , ' o ~ · --~~ .~"'~......: ..... being duly sworn, deposes and says that he is the applicant \ (Name of ififlividual sign~hj(contract) above n~med. He is the ..................................................................... (Contractor, agent, corporate officer, etc.) ~. of said owner or owners, ~d is duly authorized to perform or have perfomed the said work ~d to m~e and file this application; that. all statements coni~ned ~ this application are true,to the best of his ~owledge and belief; and that the work wffi be perfo~ed in the m~er set forth in the application filed therewith. Sworn to before me this ~~J~/~, ......... ........ ~ ,~,~0o (Signature of applicant)