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Home My WebLink About10903-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.Z13316 Date April 3 1985 THIS CERTIFIES that tile building ..... D..e.c.k. ...................................... Location of Property .5. Qg..Priv.ate Road #1 Stephensons Road I-louse No; ..................... 's'~/~i ....................... County Tax Map No. 1000 Section ... 1 7 ....... Block ....... 1 ........ Lot ..... .6 ........... Subdivision The Cedars .Filed Map No./4.2.1. ..... Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated · ...S.e.p..t :..3. 0. ........ , 19.8.0. pursuant to which Building Permit No ..... q.q 9. .0.3.Z. .......... dated .... .O.q l~ ,..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 ......... .... ~ ¢1.~..a,. ,a.e.c.k...t.o..e.x..i.s.t.i.n.g..d.w.e..Z.~.i.n, g, ...................................... The certificate is issued to .... .G.I~ a. G .E..B.,. L.0.H.5 .S ...................................... (owner, ~evf,~qi~i~r~)X X X of the aforesaid building. Suffolk County Department of Health Approval ... lq//; Iq/A UNDERWRITERS CERTIFICATE NO .................................................. Rev, l/al Building Inspector TOWN OF BUILDING TOW~ SOUTH*O~.r~, N~ Y. BUILDING :PERMIT' (THIS PERN~IT MUST BE KEPT ON THE PREM~IS~S UNTIL EULL COMPLETION OF THE WORK AUTHORIZED) ,.-~° 10903 ~Z Dote .... , ........... ~ ....... Permission is hereby granted to: : ......................................................... -...~;-.: ............ at premises Io~ated at ,,,~ .......................................... , ............. t"t"~ ................ ....................................... ~ .................................................. . ~,..,.~ ...................... ~ ........................................ ~,..~ ............ ~Lot N~ ....... ~. ............. . S~ p r ~.e, 19L~.:, *.~ approved by the pursuont to opplic~tion doteo .............................. ~ ................ Bu Idlng Inspector. ~ Building HnSPector Rey. 6/30/80 , · ~: , FORM NO. 6 TOWN OF SOUTHOLD Building Departm,e,n,~ Town Hall Soumo~d, ~. ~. I APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions ' ' A. Th~s aDphcat~cn must be filled in typewriter OR ink, and subn~itted in duplicate to the Building Inspec. tot '.v,:.~ the following; for new buildings or new use: 1. Final sur.,ey of property with accurate location of all buildings, property Fines, streets, and unusual n~:ur31 or togograohie features. 2. Final aa'cro,/al of Heaith Dept. of water supp y and seweraee dispose --(S-9 form or equal). ,3. Acproval o¢ electrical mstatlatlon from Board of Fire Underwriters. CorT',merclal bulJdmas, Industrmi buildings, Multiple Residences and sim ar build/nos and inst - 4, tions, a certificate o~f Code compliance from the Architect or Engineer responsible f~)r the buii~11nl;. 5. Suem~t ?fanning Board approval of completed site plan requlrements where applicable. B. For ex~stmg buildings (prfor to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate ~¢Jr~zey of peoperty showing all property lines, streets, buildings and unusual natural or topoereohic features. 2.Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Oa~e of ~.ny housing code or safety respect[on of buildings or premises, or other pertinent informa- tion required to prepare a certlflc¢,.e. /' C. Fees: 1. Certificate of occupancy $5.00 2. Cartmcate of occupancy on pre-existing dwelling or land use $5.00 3. Cop,,, of certificate of occupancy $1.00 Date .. New Budding ............. Old or Pre-existing Building(?~) ........ = /Vacant Land - , , ,, Hous~ irc. S~ra~ Ham/et Ccunty Tax Mae No. 1000 Section .. ,,/~'. ......... Block ,.../ ........... Lot...~--~. ........... Hea!~h Dear Appr,oval ............ L b D p'~ App Unda~.vrhers Approval ........................ Planning Board Approval .................. Request for Temporary Certificate ..................... Final Certificate ........ - ......... Construction on above described budding a~,ern~it'meets all apPL, icable~codes and regulations. ~IELD INSPECTION FOUNDATION (Ist) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY FINAL COMMENTS ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL.: 765-1802 Examined ......... . .~.~./L (19 .~''~ Disapproved a/c ............ ~ .................. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Btnldlng 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 ttus 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 Braiding 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, Orchnances 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 }nspections · ..... ..... (Signature of applicant, or name, ff a corporation) ·///./.. ,z_.-5o (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bmtde~ (as on the tax roll or latest deed) If applic;}nt is a corporation, signature of duly autlaodzed officer. (Name and title of corporate officer) Builder's License No .... /..o(~./. ............... Plmnber's License No ........ ./'?,./.'~. ........... Electrician's License No ....... ./CJ.A. ........... Other Trade's License No ...... 1. Location of land on which proposed work will be done .............. \ .......................... House Number Street Hamlet County Tax ~ap No. lO00 Section .................. Block ..... t.I ........... Lot .................. (Name) 2. State existing use and ~ccupancy ~f premises and intended use and ~ccupancy ~f pr~p~sed c~nstructi~n. a. Existing use and occupancy ...................................................... b. Intended use and occupancy ..... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair ..............Removal ............ Demolition .............. Other Work ..--..?...~.~r. ~.... :~.~.~ ~'.6). : /,~.~.? (Description) 4. Estimated Cost ......~ ........................ Fee ................................ (to be paid on filing this application) 5. If dwelllng, number of dwelling units ............... Number o f dwelling units on each floor ................ If garage, number of cars ..... , ................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each typ, e of use ............. ; ....... 7. Dimensions of existing structureS, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. ' ' ?gtor/es ............ / ....... Depth .................... i.. Height ........... ~ 't* ........ Numbe~gf "' 8. Dimensions of entire new construction: Front ..... 'J. ~. ...... Rear ...,t'.zx. ........ 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 ................................................... 12. Does proposed construction violgte any zoning law, ordinance or regulation: .............................. 13. Will lot be regraded ...... Yes ..................... Will excess fill be removed from premises: No 14. Name of Owner of premises /r~f~.~. ' .~.'~z~. Address.. ~ZJ:F~.~.. ........ Phone No .............. Name of Architect . .f ...... i ...... ; ....... Address ................... Phone No .... ).z ......... Name of Contractor .~/~ ~?. 1~ .~J.t.~b:... Address. ~-~//~.:?.~(~.hone No. Zf~.¢¢~.. PLOT DIAGRAM Locate clearly and distinctly M1,, buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block Lumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW y.9 zl .. , COUNTY OF...~.)'{J...0...{5~. :S.S ...............~D. ~...~~ ............ being duly sworn, deposes ~-,says that he is the applicant (Name ofindividuai mgnmg contract) above named. ~ ' ~ He is the ............ ~.~..~C~.~ .............................................. (Contractor, agent, corporate officer, etc.) of said owner or ownem, ~d is dul~ autho~ze4/to perform or have perfo~ed the said work ~d to m~e and file this application; that MI statements contMned ~ this/application are true to the best of his ~owledge ~d belief; and that the work w~l be perfomed in the m~ner set forth ~ the applica~on filed therewith. Sworn to before me this ...................... day o~ ............. , Not~ Public .... ' · ~¢~County ';' ' ' NOTARY PUBLIC,State ol New YorA ~ No. 52-8125850, Suffol~ Cou~ ~ ~ ~ TPrm CxmYe~ March 30, 19~ '