The URL can be used to link to this page

Home My WebLink About10902-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ....Z ! 970.5. ....... Date ...S.o.p.~.~. ¢.b.~.r...29 ................. 18)1... THIS CERTIFIES that the, bmldmg .............................................. Location of Property ...Url.~,t~. ~..4..i~l~pJ.e.. b~Ia.o. ....... l~.t..~r'.i.q~ ,..I,I.~..Y.qr.k. ...... House No. Street Hamlet County Tax Map No, 1000 Section . . .3t~ ....... Block . . .'/. ........... Lot .... ~.-,I, .I./~ ...... Subchvis~on...C.r..e~.c.~p..~..B.~.~.91a..C. oB.d.o. ., .Filed Map No ......... Lot No. ~..I..1.4. ...... conforms substai~tially to the Application for Btdldmg Permit heretofore filed in this office dated · . .S.o.p.~..e .m.b.e.u. J .8 ..... , 1 ~B.0.. pursuant to which Building Perlmt No..1.0.99.2. ..Z ............ dated . .09.~.qb.o..r 6. ............. 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 ......... .......... Addi. tl on..at. Scneene.d. in..Eorch., t,~o..Glass.) ..................... The certificate is issued to ...Dav.i6 .G~..an~i- Gl.~'la...~ ~ · K.om~ne.~, .................... of the aforesaid bmlding. Suffolk Connty Department of l:Iealth Approval .... UNDERWRITERS CERTIFICATE NO ...... Nijtt ......................................... Building Inspector C~Unty Tax Map No. 1( pai~suant to application BO Id!ny Inspector. /~'~ F~e $ ........................ Building 16spe~tor (THIS PERMIT MUST DE KEPT ON ~H,E PRE'ISiS UNTIL EULL COMPL£TI(~N OF TH[ WORK AUTHORIZED) N? 1091)2 ;Z Date ..,..r.:.~....: ............ , ........................... 19 ....... Permission is hereby gra~ted to: ................................. ..................................... ? ................................... .................................................. ,,...,. ................ ,.~.,~. ............ ~ .... ~ p~o~, ~o~t,~ ~,..~ ....... ~.../.~ :.>, ........ :.-..~ ........ ~ · ......... tOO 'Section ~.~ ~*d 1 ..... .., ~nd ~pprov~ by the FORM NO. 6 TOWN OF $OUTHOLD 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 alt buildings, property lines, streets, and unusual nature{ or topographic 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 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pm-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.O0 Date ........................ New Building '~. .... Old or Pre-exist~ng B~uilding ........... Vacant Land ............. Location of Pr .... ! ........................................................ House No~ , ~,) [ Street Owner or Owners of Property Ic~Z./~ ~.k ~.. ~-~ .~. ~,,. ,(~...~...~.'.~....~..: .~.~.~..~..~..~ ..... .......Ham/et County Tax Map No. 1000 Section ,. {).,~.~ ........ Block ... ~. ,~. ........ Lot .... ~../. ~..- ..... Subdivision .~.~. ~.~?. ¢.~.~...' .~..E.~,~ ~. ~ ~.~..Filed Map No ........... LotNo .............. PermitNo. 10q0~ .'~. Date of Permit l[~/~/~0~,Applicant ~'~CE ~. ................ .................. . .... Health Dept. Approval ........................ Labor Dept. Approval Underwriters Approval ........................ Planning Board Approval ................. ~equest for Temporary Certificate ..................... Final Certificate ........... Fee Submitted $.. ~9.: ....................... Construction on above described building ~lpermit meets ~ applicable codes and reguJations, Rev 10-10-78 ~Otm~A~IO~ ( ~ ~-~) o~ FOUND^TIO~ (~d) , I ROUGH F~E & ~BING INS~ATION P~ N.Y. STATE EN~GY CODE FINAL ~DITIONAL CO~TS: 1 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved · :'~"_ ..... '~' '~'~" 52LLLL~-.:z:::: ..... Disapproved a/c (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No .................. 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 drown on the dmgram which is part of th~s 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 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. .............. (Signat(fre of applicant, or name, if a corporation) .t3~v. ~.~:... ~. '.&/~~. ~..~,. ! .~.~. ?. ~ .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· ......... ~,~..c~:.~..~T~v ...... , ....... ~ .... i .................................... Name of owner of premises...~.. ~...~.....1%~~ ..... ~'. ............................... ~ (as on the tax roll or latest deed) If applicant is a corporatmn, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..... ~ .'] ..~ ............... Plumber's LicenseNo ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done. (<~;~..~... ~.: ............. :~..t..,-/. .............. ~..,.,¢¢~.. ~...~:,:~.. ~'~..ox~,,.~..~M..; ¢/,. .... ~ ~i;e;i .............................................. --" House Number Hamlet County Tax Map No. 1000 Section ..... ~..~.'.o..O. ...... Block .cp 7 .(90 Lot__(-~'. ! Subdivision...~../?~.. (.~-~d, Filed ... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... ~-q~.~e~,d~..~.. w.ffO,-Z/l~.,~.~. .................... b. Intended use and occupancy .......... '.t ........... (: ...... ...~.... ~ .-.~?. C.~.~..'.~5-.~.~. ....... , i 3. Nature of work (check which applicable): New Building Addition ....1~. ..... Alteration .'.~. ....... Rephir ......... .; y... Removal .............. Demolition .............. Other Work ............... ~/ ..- ' , ~'~ (Description) 4. Estimated Cost .",/...~..D.. ?.. ~ ....................... Fee ....... ./.'.~. ............... (to be paid on filing this application) 5. If dwelling, number of dwelling units If garage, number of cars .......... ,<om-an~. .................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .... ~.~.. .............. 7. Dimensions of existing structures, if any: Front... 5. ¢.. ~.. ..... Rear ..3. ?.. ~ ........ Depth .. ( ?...~.. ....... Height' . ./.0. ........... Number of Stories .... ! ............ , ............ ,.,. ~ ...~; ................ /...., . . Dimensions of. same structure with alterations or ~tdditions: Front . '.~.~...~. .......... Rear .~..&...~ ............ D ' lq ' 3" lo epth ...................... Height ....................... Numbertof Stories ............ ~ ......... 'm .... I 8. D] ens~ons of entire new construction: Front .... /.3- ......... Rear ............... Depth ............... Height ..... ( ?. ....... Number of S~.... ~..~. ................................................. 9. Size of lot: Front .fi-A~.. ,oA-~.~ .... a~Uo~z/a,~,~ ...................... D~epth .... ..; ........ , ..... 10. Date of Purchase .............................. Name of Former Owner . .(j~,/rm~. ~ .... 11. Zone or use district in which premises are situated .... J~ .~.../ .............. .U .................. ~ ........ 12. Does proposed construction viol'ate any zoning law, ordinance or regulation: ........ /t(. p. .................... Will lot be regraded ......... ... ~ ............. Will excess fill be removed from premises. Yes No 14. Name of Owner of premises ~.i Name of Architect ........................... Address ~ ............ P~one No ................ Name of Contractor .. ~: .~.: .:.~...~... ......... Address t~q~.¢. ,~.3....'f~Ax~/l~t~one No...~. 7.7..0..[.7. ~.... PLOT DIAGRAM Locate clearly and distinctly allI buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block humber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW ~O~RIi&, ,'/r~ .~ o ....... (Name of~gtividual ~igning contract) above named. ' being duly sworn, deposes and says that he is the applicant the . tract agent, corporate officer, etc.) of said owner or owners, and is duly authon~'~d ~o~-erform 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 ~~~ .......... /.~..). ...... day o .'~-.'..., 19~..~ No. 52?125850, Stg~olk T~rm, F~p~res March 30, (Signature of applicant)