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Home My WebLink About10305-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. .~][][239. ..... Date October 6 ..... . ................................ 19.8.2. THIS CERTIFIES that the building .............................................. .. Location of Propetty 2:~00 Greud &ve~ve ~ ~.~ ~p19 .Lg. ne, Hattituck House No ' ' ' Hamlet County Tax Map No. lO00 Section ... ~07 ...... Block .. ~ ............ Lot..L.O .............. Subdivision ............................... Filed Map No ......... Lot No ........... ... conforms substantially to the Application for Building Permit heretofore Fried in this office dated · 3uue. 20 ............. ,197.9.. pursuant to which Building Permit No. ~.0305Z dated .. ,~u Ly. 10 ................... 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 haued is ......... · add. a. deck. onto. a. d~el~i~ ..................................................... The certificate is issued to .. Be~,ezly. Andze~a. (owns, le~ or tenant) l~ill~) ................................ of the aforesaid building. Suffolk County Department of Health Approval .... B/K ............................ UNDERWRITERS CERTIFICATE NO... ll/A, ........................................... Building Inspector Rev, 1/81 FOI~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTJv~ENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 19305 Z Permission is hereby granted to: ~ ... - ......................... :. ................. (.. ...... : .... pursuant to application doted "J~L/£ ~ 7~"~ ........................................................ , 19....?., ond approved by the Building Inspector. Fee *..../.Z.~ ......... .................. ~<..~....-:'.'2~ ............. Building Inspector Form No. 6 TOWN OF SOUTt~LD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building 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 from Health Dept. of waker supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant, If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swi~ing pool $25.00, Accessory building $25.00, Additions tO accessory building $25.00. Businesses $50.00. 2.Certificate of Occupancy on Pre-existing Buildinm - $100.00 3.Copy of Certificate of Occupancy - $20.00 4.Updated Certificate of Occupancy - $50.00 5.Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 /-23-?£ Date ................~........................ New Construction ........... Old Or Pre-existing Building ..... ~ .......... 5700 Alvahs Lane Location of ~ .... ~. ' ~g~gg~ House No. Street Hamlet 0nwer or Owners of ~ ..... -- Estate of ~1~/. ~Mc~.i~ ICounty Tax Map No 1000, gection..~q%'.~q. Subdivision ............................... Permit ~o...........10304 ..... Date Of Permit... iHealth Dept. Approval.' .................... .Planning Board Approval ~ ..... Filed Map ............ Lot ...................... ............. Applicant ............................. ..... Underwriters Approval ......................... .Request for: Temporary Certificate ........... Fee Submitted: ~ 125.00 Final Certicate. X John ~PLIC^RT S±mch±ck~ Executor FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Name of owner of premises . fi-// (as on the tax roll or lat;~t' ~i~d) ......................... If applicant is a corporation, signature of duly authorized officer. Examined ..... . .~.~-~...~., 197.~. Application No /~e9 ~ . . ............... ..~ Approved ..... . .~?...~..~., 19 ?5ermit No [ ~ ~ ~ ~ ~"--- Disapproveda/c .~_..~ ........ ....................... ......... INSTRUCTIONS 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 Pe~it. d. Upon approval of this application, the Building Inspector will issue a Building Pe~it to the applicant. Such pemit shall be ~ept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in pa~ for any purpose whatever until a Certificate of Occupancy shill have been granted by the Building Inspector. ~PLICATION 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 Re~lations, for the construction of build~gs, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws ordinances building code, housing c~, and regulations, ~d to admit autho~zed inspectors on premises and in buildings for necessaw ~sp~ctions~ ~ .--~ (Signa~e ~]icant~r name, if a cor~tion) . ........ (M~l~g ~ess of applicant' ', State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician s License No ....................... Other Trade's License No ...................... /-v I ~ t/ ~ ~dQ~ ~ ~4 1. Location of land on which proposed wor~k will be d, one House Number Street Ham%t ~/ (~ County Tax Map No. 1000 Section ./.0../ .......... Block .e~-~ ............. Lot .~.~../.~. ,.~ ............ '~ '(~q'a~) ................ Filed Map No....~. ......... Lot . .?~./~. ......... Subdivision 2. State existing use and occupancy of premises and intended use a3tdj?ccupancy of proposed construction: Existing use and b. Intended use and occupancy~"~/'~.. ~ .~_.~ ........... -. ....................... ] ............ 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair ........ .~ ..... Removal .............. Demolition .............. Other Work ............... · ~ ,/ J. _ ~ (Description) 4. E'stimated Cost ...................................... Fee ....... ' ............................... ~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each flqor ................ If garage, number of cars ........................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ......... . ............ 7. Dimensions of existing structures, if any: Front...~. ......... Rear .............. Depth..o~..~. ......... Height .. [ ~ ........ Number of Stories ...... ~. ........... ...~.~ ................................. Dimensions of~,rne structure with alterations or additions: Front . .3 ....... ~ ....... Rear .................. Depth .. ~fl. ~. ............... Height .. ~ ............ Number of Stories ..... /. ................ 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........... : ............................................ 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................ Name of Former Owner ............................. 11. Zone or use district in which premises are situated..A .~..~. ~r .mr .~ ....................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..~. .......................... 13. Will lot be regraded .... :,../~(~. .................. Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, 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. ,Az vA L_A /vz' STATE OF NEW YADRK, . ~ ~ S ....~~o ~e ~,~ --~ ~"fi -~~'~'~'nt~'c'~'ame .......... being duly sworn, deposes and says that he is the applicant above named. He is the ......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained 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 ~/~. ......... //...~?.~.~y;f..~ ...... ,19.~/ Notary~¢l~ic, ..../'~V~~ ........ County ,, } /0 /~ , ' / o ,. .......... Sutlolk Cc;,.tnt¥ No. SZS?~2S00 ~/] // (S~gnature of apphcant) Commi~i:n ~:xplte~ M~ch 3S, 19~~ ~