The URL can be used to link to this page

Home My WebLink About10803-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.Z.q ~ .69.0. .......... Date ............. ~7.2.&. ............ 1983. THIS CERTIFIES that the bmlding ~d0~-.t.5. q)~ ...................................... Location of Property .,~.7fl.~5. ~OLl~.e. .lkS. Greenport t~ouse mo, Street Hamlet County Tax Map No. 1000 Section ... ¢,¢. ...... Block ..... .2 ........ Lot ....... 2 ......... Subdivision .............................. Filed Map No ......... Lot No .............. conforms substantmlly to the Application for Building Permit heretofore filed in this office dated · . .J.~Y. ~.9 ......... 19 .$0pursuant to which Building Permit No...'10.~303Z ............. dated ...J.~Y. ~.9. ................ 19 .~30, 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 ......... ... ~ddi.t. io~. t.o ar~ .exis.~ing..one. £.amily..d~aelling ......................... The certificate is issued to .AGN~S. FID..GLrN~.IG~E ..................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...N/~ ................................... UNDERWRITERS CERTIFICATE NO ........... ~I../?. ................................... Building Inspector Rev. 1/81 N°. TOWN BUILDING TOWN~HALL; SOUTHOI.~D, (THIS PERM. IT MUST BE KEPT oN T.E ~gmS s UNTIL COMPLETION OF THE WORK AUTHORIZED) 10803 Z Permission is hereby gror~ted to: ~ULL '~ l/., BOck ;,.,....;.~ ...... ;...~ Lot No ......................... County Tax Map No. lO00 Section ................ ?~.,; .... y ~0 pursuant to application: dated ... t 't ............. ': ........... ;'V'" '""*~ 1~....~...~ and approved by th Building Inspector. ~ , ~ '~ii~F~;i ~' ~;; ...................... ~eY 6/30/80 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 buddings or new use: 7. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2.F=nal 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 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 3ertinent 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.. " New Build,ng ........... Old or Pre-existing Building(X} ....... ~/Vacant Land House No. Street ~l ' ~,/ Ham/et Owner / ................ '/' ..... ~¢' ' County Tax Map No. 1000 Section ..... 2'. ........ Block ...... ¢ .--~. ......Lot...c~...-. ......... Subdivismn ................................. Filed Map No ........... Lot No .............. PermJtNo./O ~ ~3 Date of Permlt ........ pp tcant .................................. Health Dept. Approval ........................ Labor Dept. ~pproval ...................... ,.. Unde~riters Approval ........................ Planning Board Approval .................. Request for Temporary Certificate ..................... Final Certificate ........ - ......... Fee Submitted $..~_~. ~. Construction on above described building and perm}~meets all ap~cabl~oCes and regulations. ............. ... ................. TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR ' P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-I 802 - Applicant This is to advise you that the job under Building Fe[mit No.)o~o ~ issued to on 1 a~ go ----~~, ~[~'~ )~ is ~ompl~ted and a :xna± mnspection has/-7~ na~ not~ been done. In order to complete this fzle, it is necessary that a Certmf~cate of Occupancy be zssued. Please fill out the enclosed form(s), return same to the above office with a check for $5.00 payable to the Town of Southold. Please indzcate to whom the Certlf~cate of Occupancy is to be and arrange with this offmce for an inspection date. Thank you for your prompt attention. Very truly yours, Victor Lessard Administrator VL:ec Enclosures mamled, Ai~) D t T I c_~ t,J A L-- USE IS UNLAWFUl ~ITI~OIJT CERTIFICATE I~F OCCUPANCY APPROVED AS D^TE:~i~:p' NOTED ~NOTIF"'Y BUI LDI-NG , 765-1802 9 AM TO 4 PM FOR THE -. 'FOLLOWING INSPECTIONS: ~L FOUNDATION _ TWO REQUIRED _. FOR POURED CONCRETE 2. ROUGH - FRAMING 8, PLUMBING 3/INSULAT!ON · ' FINAL CONSTRUCTION MUST - BE C"V,,~f.F:TE FOR C, 0 ' A~.LL CONqTRiJCTiON SHALL MEET THE REO~nP~MENTs OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRoRs. 0 iooo-~4 q - MAP OF Pr4OP,E'P. Ty~ AGNES MOGUNNISLE A~SHAMO~A~UE N~W Yo~ 5,.;,:d,% : 60'= I" C; ~. ZT TI1,LE No. $'1884Z0 ' FORM NO. 1 ' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TE .:^pplication o.? . ....... Disapproved ~ ......... "~'i ....................... (Building Inspector) a. Tins apphcation 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 t6 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 dia~am 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 isme a Building Pe~it to the applicant. Such pemit shall be kept on the premises avadable 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 sh~l have been granted by the Building Inspector. ~PLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Pemit 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, ~d to admit authorized inspectors on premises and in buildings for necessa~ inspections. I,'~Q~[ c:~ ~ '~ "~ '"(Si~ature of applicant, or name, if a coffporation) . State whether applicant is owner, lessee, agent, architect, engineer, 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.. ~.-~L~..°~.-.~f ........... Plumber's L~cense No ......................... Electrician's License No ....................... Other Trade's License No ..................... ~f ~ 1. Location of land on which proposed work will be done..~...~..~:'.~ ?. ~..~./?.'.~ ?.~.f. ~ ~ ~.~.}~.~ ~.. · ' : House Nu~g;r' ~ ........................ 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 occupancy of proposed construction: a. Existing use and occupancy.., i .~.'[~:. :c~..1.. ~...~..~.\ .-i [-~ ..................................... b. Intended use and occupancy ............................................... .~. ) ............... ., 3. Nature of work (check which applicable): New Building .......... Addition..../~.. .... Alteration, .... : ..... Repair ............ '.. Remoyal .............. Demolition .............. Othe~ork ............... 4. Estimated Cost ............ 4 ........................ 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 ..... i ................................................................ 6. If business, commercial or mixed~ occupancy, specify nature)nd extent of each type of use ..................... 7. Dimensions of existing structure~ if any: Front .... {~...c~'. ......Rear ....~..~./. ..... Depth .. e,Q~-. ~ .' ...... Height . . .~/..~. ' Number of Stories ~ ................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... t ' Height ...................... Number of Stories ...................... 8. Dimensions of entire new constr~ction: Front ..... ~/. ...... Rear .... ~ ........ Depth ..~./,~ .......... Height '. ............... Number of Stories ........................................................ 9. Size of!ot: Front . ,~/.. ~. ?../. .......... Rear ,Z..~e~..~?..~. ............ ,~Dep.th . '~--~ ~..~.../ ........... 10. Date of Purchase . ~<,../. L¢9. ~.. ~ .......... Name of Former p~wner ~,. ....... 1 1. Zone or use district in which pre~nises are situated. ~ .5~ .......................... 12. Does proposed construction violgte any zoning law, ordinance or regulation: ................................ 13, Will lot be regraded_ ........... ~.:..., } ..... :~ ......Will e.x~ess fill be removed from premises: Yes No 14. Name of ~"~.-;~ 5~r~i~[es ~ ~.~]ga~t-~.. Address~ .g./~] .2~-~. ~p~-'~. Phone No.~..~. ~7.~. 7~(..fi-7. l.. 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, STATE OF NEW YORK; COUNTY oF ~'/u~.__~.~kl~.. ~'~ ......... t~...~'~ .... ~.'.,./~..~ ............... ~/~/[] iSX JT~ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) 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 b~ performed in the manner set forth in the application filed therewith. Sworn to before me this. ' i /~15#'o~1 £xpi~,,r;O~/kr~hO~ (Signature of a~plicant)