The URL can be used to link to this page

Home My WebLink About10876-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy July No. Z~3690 Date ., 19~..~. THIS CERTIFIES that the building ...a..d.d.5.~5:..o.n..(~9TP.~.).: ......................... Location of Property ... 52.¢75 ................. .lVI.a.5.n....R.d... ............ O..~.i.e.n.~. ........ House No. Street Hamlet County Tax Map No. 1000 Section 44- ...Block 2 .Lot 46 Subdivision ............... .x ............... Filed Map No....x ..... Lot No ..... x. ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated .... Sep~.e.r~;r..1 fl. .... 19~.Q. pursuant to which Building Permit No. ,..fl.O.8.7.6.Z ............ dated ..... ~ep.~.o.~fi~. fl 9 ......... 19~.Q., 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 ......... ...~orch .~ddi~i9~..~o. ~..o.r~e~.ami~y..~¥.e.l.l.i..rig.. .............................. The certificate is issued to . HEathY. ~....~,.~_/k~,..~OISA ............. ..................... of the aforesaid building. Suffolk County Department of Health Approval ............... UNDERWRITERS CERTIFICATE NO ................................................... Rev. 1/81 Building Inspector HALL S0uTHOI:D, N~ Y, BUILDING P~ERMIT (THIS PERMIT MUST BE KEPT ON TH,E PRE/~IS COMPLETION OF THE WORK AUTHORIZED) 10876 Z Vote ...... ;... :-S UNTIL EULL ep~em~e~ 19 60 ........... : ................................ , 19 ....... Permission is hereby gronted to: ..... 0~ ,...~.,L,..~.].~T.,......~..,.~ ~, premises loc,ted at ....... ~Z5 ~5~ ..~)~, .... ;.. ~ . · ,Y DW~bI~* County Tax Map No. 1000 Section 14 ~ Block i'. Septem~e~ 1 1 pursuant to application ,dated .......................... :..~ ............ : ..... Building Inspector. 15,00 Fee $ ........................ Rev., 6/30/~80 ~ 2, Lot No. 5 6 .i..., 19. .., and approved by the B~ddmg 'Inspector FORM NO. 6 TOWN OF SOUTHOLD BuIidtng Depar'~meo~ Town Hall Southold, N,Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY 2 9 Instructions A. Tn,~ ceol',cauon must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tot '.v~bq ~ne follo,,ving; for new buildings or new use: 1. F.n~l '~ur,,ey of property with accurate location of all buHd(n~s, property lines, streets, and unusual 2, ~ma~ ,':)~rcval of Health L)eo~. of water suoolv and se,varage msposel--(S-9 form or equal). 3, >,ca:cvai o~ e!ectrlcal installation from Bce'rd'of Fire Underwriters. 4. Commercml buildings, Industrial buildines, Multiple Residences and similar buildings and installa- toss a ceruficate of Code comph~nce from the Architect or Engineer responsible for the building, 5. Su:)m~ Planning Board approval of completed site plan reqmrements where applicable. B. For exlstmg buildings (pr~or to April 1957), Non-conforming uses, or buildincs and "pre-existing" land uses: - 1. Acsura[e ~rvey of peoperty showing all prooerty lines, streets, buildings and unusual natural or toooTra3mc features. 2. Sv. orn statement of owner or previous owner as to usa occugancy and condition of buildings. 3. DaTe o: em/ housing code or safety inspection of buiidines or premises, or o,ner pertinent informe- r[co required to prepare a certificate. / ~ $5.00 Fees: 1. Card:care of occupancy $5 O0 2. C~r ......... of occupancy on pre-existing dwetHng or land use 3 Cc~, ~ · ,. o c_.,~ ~c~ of occupancy $~.C0 ......... ~' .......... Old o o ; +' . Sudsing(X) _/t( .... :/Vacant Land Lcc~t~on of PresetW ~, No. 000 ,.. ....... ... Suoa[vrs~oa ................................. Fded Map No. ~ Lot No. -- . ...... Heahh De2:. Approval '~ ........................ Labor Dept. Approval . Under.'/r:~ers ¢~ppro,/al ...... .................. Planning Board Approval Request for Temporary Certificate ..................... Final Certificate . FIEL~ ,I~'~PEC T ION FOUNDATION (lsd) FOUNDATION 2. ROUGH FRAME& PLUMBING INSULATION PER N.Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: COMMENTS TOWN OF SOUT~aOLD OFFICE OF BUILDING INSPECTOR , P O. BOX 728 TOWN 1J, ALL SOUTHOLg, N ¥. 1 I971 TEL. 765-1802 _ m, u/, Dear _~ : This la to advise you t~-~ ~ · , . Pe ...... ' ,~ ~he Job unaer '"~ a°- ~'7~ ~ssued to ~~1 - - a f._~ ~- ,, .... ~ ~. ~~ -s ~omp_~eo and ......... p=Co!O .... ~S ~ na~ no;~ oeen ~one. co ....... e ohzs fi!e~ it is necessauy that enc!~sed =- ~ .... y be :ssuec P~-=s_ f~!l out the check fou $5.00 payable to the Town of SouEhold. inc~cate to 'whom the Ceu~!f:cate of Occuoaacy !s to be na!!ed, ~n~s office ?op an inspection date. Thank you fop your prompt attention. Very truly yours, Victor Lessard 3. dm~ ni~ tr~ t VL:ec Enclosures FOEM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIC~E SOUTHOLD, N. Y. Pem~t No ..................................... ............... ........ ................. (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ......... ~../~...../.../. ................... , 19 .L~. ...... INSTRUCTIONS a. This apphcat~on must be completely filled in by typewriter or m ~nk and submitted in duplicate to the Building Inspector b. Plot plan showing location of lot and of buddings on premises, relationship to odio~ning premises or pubhc streets or areas, and giwng a detailed descriphon of layout ofproperty must be drawn on the d~agram which ~s port of thru apphcation. c The work covered by thru apphcation may not be commenced before issuance of Building Permit. d Upon approval of this application, the Budding Inspector wdl msue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used ~n whole or m part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Budding 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 P, egulat~ons, for the construction of buildings, additions or a~terat~ons, or for removal or demolihon, as herein described. The apphcant agrees to comply w~th all apphcable laws, ordinances, building code, housing code, and regulations. ......... ........ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If apphcant is a corporate, signature of duly authorized officer (Name and title of corporate officer) 1. Locat,on of land on which proposed wgrk will b~ done. A~ap No.' ..~.~..~¢/~.>~..../..~.:~.....~..~,~ · ,~ Lot No.....~.~¢:~i ............... Street and Number ....... ..~...~...~..~..~...~.....~...~..~.. ........................ ~z...~.~..~. ..................................... Municip~/l'ny 2 State existing use and occupancy of premises and in,ended use and occupancy of proposed construction: a. Exisiting use and occupancy ...... ~ ......................................................................................... /7,. b Intended use and occupancy ........... .~...~F~..S ................................................................................. 3. Nature of work (check which! applicable): New Building .................. Addition .................. Alteration .................. R pmr .................. Removal. ................. Demohhor' .................. O~'J~er Work (Describe) ........................................ 4. Estimated Cost ......... ..~.~1~.,..~ ...................................... Fee ............ ..l....../..-~.. ............................................................ (to be paid on filing this application) 5. ~f dwelling, number of dwelllng units ....... ~ .................. Number of dwelling units on each floor ..... , ...................... If garage, number of c~rs ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structu'res, if any: Front ....~...~ ....... ~. ...... Rear ...... .~..~....:.~.. ........... Depth ~..~.. ' Height .~...~..(.~.~...~. ..... Number of Stories .......... /..~..~,~;... ............................................................................ Dimensions of some structur~ with alterations or additions: Front ........... ~...~ ............... Rear ...... ,~...~ ............ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ........ . .~....r ................... Rear ........ .~.~..../. ......... Depth ....,~... ............... Height ..... ~....4. ......... Number; of Stories ...... ~ ............................................................................................................ 9. Size of lot: Front ..... ~"'/'"'~:'""i ......... --,a--__Rear .................................... De-thp~ ...Z. Afi ................... 10. Date of Purchase ................. V..../.,~...~....~.. ................... Nome of Former Owner ..~.,....~.~.,Z~...~.,~...~..~ ..... 11. Zone or use district in which premises are situated ............. ~. ...................................................................................." 12. Does proposed construction violate any zoning law, ordinance or regulation:~ ....'...~.-~. Name of Architect ...............; ...................................... Address ............................................ Phone No ..................... Name of Contractor ............. i....~.: ................... Address ........................ r,~ ................. Phone No ........... ~ ....... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-b~ck dimensions from property lines. Give street and blo~k number or ,description according to deed, and show street names and indicate whether interior or corner lot. ' STATF OF NEW YORK, .., lSS COUNTY OF .'.~..~.,~...~..~..~.x~ ....... ~' ............ W~'~4~.~....~.......~..'.....-~...~./.....~.~* ............................. be,ng duly sworn, deposes and says that he is the applicant (Name'of individual signing application) above named· He is the .................: ...................................................................................................................................... j (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 oil statements contained in this application are true to the best of his knowledge and belief; and thor the work will be performed n the manner set forth in the application filed therewith. Sworn to be~ me this ............ ........ ................ , ? .......... ........................................ Nota of app,,cant, ~-IC, Sta~e o! IV uonlrnlsslo~ £,,..~uffolk COun ~,,re~ March