The URL can be used to link to this page

Home My WebLink About10833-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z. 1.[2.3.4. .......... Date .... O.q~o.b.e.r..6. .................... 198.2.. THIS CERTIFIES that the building ................................................ Location of PropertyHouse' ' .80No..Dogwood · I~ne .&. 3200 · Kenny.~street. Road ~ · Sou thold ........... County Tax Map No. 1000 Section .. ·059 ...... Block . .02 ........... Lot .002 ............. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated · .Atlgtl~ t;. 1,4 .......... , 1 ~8.0.. pursuant to which Building Permit No...19.8.3.3.z .............. dated .Augus t;. 14 .................. 19 .8.0., 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 ......... ·..cons truct .acces aory. storage, bui lding ......................................... The certificate is issued to . . Henry. Beehl er ...... [d~,n'e'r, '/d's'~do'dr't~t~a'n'tJ ...................... of the aforesaid building. Suffolk County Department of Health Approval . .I~/A ..................................... UNDERWRITERS CERTIFICATE NO ..... ~/,A .......................................... Rev. 1/81 Building Inspector TOWN Or BUILDING Di~P~R!'/~I~i4~ TOWN HALL SOUTH'OLD, N©. 10833 BUILDING FERM!~ ?~ (THIS PERMIT MUST BE KEPT ON ~HE pP, E~I5~$ UNTIL I~ULL COMPLETION OF THE WORK AUTHORIZED) !: ~ Permission is hereby gro~ted to:/j ....... ~~..,t/...~........~ ~o ...~..q.~....~..q.~....~..cz..c.,::~.~.~.....,.,~ ......... ~i..,.,,~. .............. ~.~~., ~;~:~:'~'~' Co,,~y To,< Mop No. ~000 s~o. ~.~ ....... :.. B~~.~ pursuant to ~ppHcat,om doted .. ~.....:.~.~...;.4 ~uild~n~ Inspector. ~ ,...~..~ ..... i.~, ......... : .Lot No. (~:~..~...'. ..... ...... 19~ ~, and 'approved by the Re¥.,6/30/80 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 topographm 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 cerUfmate of Code compliance from the Architect or 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 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 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(X) ......... = rVecant Lend Location of Property . .,,~ ~% House No. Owner or Owners of Property ........ Harriet County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Health Dept. Approval ........................ Labor Dept, Approval ...................... ,.. Underwriters Approval ........................ Planning Board Approval .................. ~ .. Request for Temporary Certificate ..................... Final Certificate ....... )/. ........ - Fee Submitted $ ..... . .t~..-: ............ Construction on above described building and permit'meets all app~cable_.co.des and regulations. COMMENTS FZELD IN?~°ECTION 1. FOUNDATION 2. ROUGH FRAME & PLUMBING (2n~) INSULATION PER N.Y. STATE ENERGY COpE FINAL ADDITIONAL COMME~%S: FO]I~4 NO, I TOWN OF SOUTHO~LD BUILDING DEPARTMENT TOWN CLEkK'$ OFFICE SOUTHOLD, N. Y. Examined ~/.~--~.../..-~..o ............... , 19~..... .~'~ Appiic~tlon No. ~..~ ........... ~proved~¢...~..~ ............... , ]~.., Permit No. Z.~.~ ....... . .......... ........................... APPLICATION FOR BUILDING PERMIT ........ ............... .... 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 on premises, relationship to adjoining premises or public streets o~ areas, and giving a detailed description of layout ofproperty must be drawn on 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, 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. (Address of applicant) 4) ~5~,,~- State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ ................................................................................................................................................................... Name of owner of premises ..... .~..~..~...~......~..~.7,~./...~..~..~. ............................................................................................... If apphcant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ............... .~..~'~ ............................ Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which.~__~,~/~,,_o~,,__,,~,~,,.~,~proposed work, will be done. Mop No.' .... ~ ...... ~ ....................... Lot Nq., ....................... Street and Number ~.O......~/~.~.~.`/~/~..~`~!~.~.:~.~.`~:..~.'.~.~.~`~~.~'~- / ...................... / Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Exisiting use and occupancy .......... '.~.~..). ,~.~.~J.?.-. ~ .................................................................................. b Intended use and occupancy ............ ~...~..~..~../.~...~ ........ ~....~...~....~.~.. ..................................................................... 3. Nature of work (check whichj applicable): New Building .................. Addmon .................. Alteration ...". .......... Repair .................. Re~pval, · ................. Demolition .................... Other Work ................................................... ~ , ,~ (Description) 4. Estimated Cost ................. ~-v.. ..................................... Fee .......~.~/ ............................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............ .L ............ 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 ................ t ........... 7. Dimensions of ex.sting struct4res, if any: Front .......... .~....~. ........... Rear ......... .~....~. ................ Depth ...~...~... ........ Height ...... Z'..~..!. ......... Number of Stones ..................... ../. ......................................................................................... D~mens.ons of same structure with alterations or addkhons: Front .................................... Rear ...................... Depth ................................ Height ............................ Number of Stories ................................ Rear .......~...~.. ............... Depth ...... ~, ............... 8. Dimensions of entire new construction: Front ............ ./..~., ................. Height ....... ~. .........Numbei of Stories ..................................................... i ......................................... i .................. 10. Dote of Purchase ................ ; ...................................... Nome of Farmer Owner ........................................................ 11. Zone or use district in which premises are situated ............. .~...~'.~..../,~.~,-e~..~.z.¢~..[ ...................................................... 12, Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded ............. ,/ r, t/i .............. Will excess fill be removed from premises; (,) Yes ( ) No Of Phone Nome of Architect ............ : ............................................ Address .,;,.~ ...........~ .............. Phone No. ~', .' PLOT DIAGRAM Locate clearly and distinctly a'll buildings, whether existing or proposed, and indicate all set-back dim ;asians from property lines. Give street and block number or description according to deed, and show street names 2nd indicate whether interior or comer Io~ STATE OF NEWCYORK, ~Jr ii S S ~. +'/t ' ,.., '~ ' . ........ ........... c../¢.. ..................................... be ng (Nome'of individual signing controctO above named / duly sworn, deposes and says that he ~s the applicant He ~s the ............ ~: ........................ f ........................................................................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d~ly authorized to perform or hove performed the said work and to make and f~le this application; that all statements contained in this applicohon are true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith..~ LII4DA f, KOWALSKI~ ' (Signoture of opplican~ NOTARY PUBLIC, State cT New Y~R