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Home My WebLink About10909-zFORM NO. 4. TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ...... g.l.Z~q ~6..,.. Date ...... U.ay..2.~. .................... 198..~. THIS CERTIFIES that the budding ...... .d.c. q .k..&..g .a .z.e.b. 9..a.d.d. ~..~ .5_ 9.n. ............... Location of Property ... 5.5.5 ............. &l.v.a..h.s..L.a..n.e ............... C..u.~.c.h.o. $.u.e ..... House No. Street Hamlet County Tax Map No. 1000 Section ....I .0.9. ..... Block .......... .1 .... Lot ........ 2. ,9 ....... Subdivision ............... ~ ............... Filed Map No .... .~ .... Lot No.. × conforms substantially to the Application for Building Permit heretofore filed in this office dated .... Se p.~.e, mber..29..., 19 .~0pursuant to which Building Permit No ...... ~. 0..9.0.9. Z. ......... dated ....... 0c.¢.qt~ eJe..7. .......... 19.8. 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 ......... .... Deck .&. g,~.~.e b o..~.d,~,;i..t,.~q,L~..t,.q..e .x.:L.~.t...~.~.,~ .a.. 9 9.e.s.~. 9~.y'' .b..u:L..]..d.. ~ .nC.. ............ The certificate is issued to ........... g.q ~ b ~..~. ~I~.~...H.I.G.B.E..E .......................... of the aforesaid building. Suffolk County Department of Health Approval ................ ~./.g ...................... UNDERWRITERS CERTIFICATE NO ........................ .N./.g ...................... Rev. 1/81 Building Inspector BUILDING' PERM!Ti P'RE~ISI~S ~ULL (THIS PERMIT MUST BE KEPT oN THE UNTIL COMPLETION OF THE WORK AUTHOR, ZED) · ~ at premises located / Section t County Tax Mop No. 1(~00 ...................... ~. Block ..... ,, ................ NO '"~ ~ ~ ~ ~! and approved by the pursuant to appiicotion~doted ..~;/,Z. ........ ! ~ 19 Building Inspector. Fee $...L~? ............. Building 6/30/80 V FORM NO, 6 TOWN OF SOUTHOLD Building Deparrmen,~ Town Hall $outhoid, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions A. This apphcation must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor wi[h the following; for new buildings or new use: 1. Final survey of property with accurate location of ali buildings, property lines, streets, and unusual natural or topograahic 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 Enqineer responsible for the building, 5. Submit Planning Board approval of completed site plan requiremer~ts where applicable. B. For existing buildings (prior to Aprd 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1, Accurate ~urvey of peoperty showing all property lines, streets, buildings and unusual natural or topograph lc 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. / 1. Certificate of occupancy 2. Certificate of occupancy on pre-existing dwelling or lend use 3. Copy of certificate of occupancy $1 .O0 $5.00 Date .. New Budding ............. Old or Pre-existing Building{X) ........ = ZVacant Land . .. Srree~ H Owner or Owners of Property ~O~... % ~.~ .,_~.}.~ ~.~ ........................... ~.. County Tax Map No.,1000 Section .... [~.~ ...... Block ,, .~ ......... Lot. ~ ......... Sub~iws~on ................................. Fi~ed Mac No ........... Lot No Perm,t No. /~. . Date of Permit ./~-..7.'.~.~pphc~n,~ '" ' .~, .~J.l~.~ ..................... Health Dept. Approval ........................ Labor Dept. Approval ...................... ,,. Unde~riters Approval ........................ Planning Board Approval ....... / Request for Temporary Certificate ..................... Final Certificate ~ - Fee Subm,tted $ ~ Construcuon on above descr,bed building an~per~it meets~li a~cabl~odes and regu ations ............................. Rev. 10-10-78 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR · P.O BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-I 802 Dear ~< c This is to adv'~se ~=~ ~he 3o~ unaer Building Permit No. [9~% issued to_ ~,%.~~ a rlnal lnspeccion naS-~ ~,as ~o%~been doh~. In order to complete thzs fi!e~ it is necessapy ~h ~ - Y issued. F!ease fill out ~' = check fop $5.00 payable to the Town of Southold. Fledge lneicate to whom the Cepti£!cate of Occupancy is to be mailed, and arrange w~th this o£flce for an !nspec[ion date. Thank you for your prompt attention. Very truly yours, Victor Lessard Adminis ~r~ ~or VL:ec Enclosures ~ORM I~O. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL,: 765-1803 Examine .. Z ...... ,19 Application ....... D~a~p~o*ed a/o ...... ~.. ~ ...................... (B~ildin~ Inspector) APPLICATIO~ FO~ BUILDING PERMIT Date ... ~.~. ~.~ INSTRUCTIONS 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 drawn on the diagram which is part of this 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 necess~_>~/~.~ections.. ~ C//--~ · ................ (Sig~u~ of applicantf-6r name, if a corporation) .5.55. A~v.~h: s..Lan~.,..Cu~chogue.,. 2~f. 13.935. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. OwBer ............................. Name of owner of premises ....J..o~s..E.. gr~d .~ry, .E.. ~J~kgbee ....................................... (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. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done..W/S..Alvah.'.s. Lane ~. C~tohogt~o ~ . Ne.~~. -York ..... .... 5.55. ~2~t~ .............. 32Lva,h.~ s..Lane ................. Cu:~oho gue ...................... House Number Street Hamlet County Tax Map No. 1000 Section . fIO9OD. .......... Block .. DflO0 ........... Lot..02900.0. .......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... l~ivg.g.~ .t~e~/,0, ol~Oe ............................................. b. Intended use and occupancy t,e~isur~e-:use,,~w/possib~!~%,,~, O~tm~i~F~u,t. aide £urni.t.uxe during tRe' 3. Nature of work (check which applicable): New Building ........ Addition .......... Alteration .......... Repair .............. RemCval .............. Dem~olition ....... . ...... Other Work ............... ~t (Description) ' F ] dr/ . 4. Lstzmated Cost ..................................... ee .... ~.t ............................ $500, ~O '$1000, (to be paid on filing this application) 5. If dwelling, number of dweilinglunits. ............... Number of dwelling units on each floor ................ If garage, number of cars ' 6. If business, commercial or mixe:d occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stones ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. ' Height Number of Stories Depth .................................................................. 8. Dimensmns of entire new constructmn: Front . . .,~. ........... Rear . .~o ............ Depth ./~...~ ........ Height . .l .L/. .......... Nu,mber of Stones . .. J[ ................... ; .................... i ............ 9. Size o~lot: Front ...~.~, .(~.7. ............ Rear..~.~.~ .~-..-~ ............ Depth 2.q.~.-.g..~. ........... 10. Date of Purchase .......... ! ................... Name of Former Owner ..... . ........... .. ........... 11!. Zone br use distriCtconstructionin which p~emises are situated .... ordinanceS" ..... ' ......... ~" ................................. ~/ 12. Does proposed violate any zoning law, or regulation: . 0 ........................... 13. Will lot be regraded . .~ O... ................ Will excess fill be removed from premises: Yes ~) 14. Name.of Owner of premises .................... Address ................... Phone No ................ Name of Architect ......... ' .................. Address ................... Phone No ................ Name of Contractor ........ i .................. 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 .SUff. olk........, S.S ....... 1~. g.~y..~.....H.ig~, o..o ..... i ..................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) abow~ named. He is the ............. o~er...~ .................................................................... , (Con,actor, agent, eorpomt~ officer, etc.) is d~ly authorized to perform or have perfomed the said work and to m~e and ~e this Of said ~d owner or owners, application; that ail statements cont~ned M this application are true to the best of his knowledge and belief; and that the work will be perfo~ed in the mm~n~er set ~th in the application filed therewith. Sworn to b~ore me this Notaw Public,. ~.4[ .~ . ~ounty , ~lgl~ IN ~K ~,, NO. 5240~. . ~ff ~ L~gnarure ox appnc~t)