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Home My WebLink About10914-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy Z10255 Date November 5, 19 80 THIS CERTIFIES that the building ................................................ 2045 Lnke Avenue, Southold, New York Location of Property//~ds~ h/o: ....................... ~r'e~' ....................... ~/~r~/e~ County Tax Map No. 1000 Section 59 . .Block .5 .Lot 4 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Applicahon for Building Permit heretofore filed in this office dated ...... O..c.t.o?).(?['..~ ..-, 19.8..0. pursuant to wtuch Building Permit No....~.0.~.l.&... ~ ........... dated ... 5.°?.? .m.b.e(~...5 ? ............ 19..8.{,)was issued, and conforms to alt of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Pddition of Deck to Existing Dwelling The certificate is issued to .... - (owner, I~~ of the aforesaid building. Suffolk County Department of Health Approval ..... ~I/.R. ................................. UNDERWRITERS CERTIFICATE NO.. ~./.5 ............................................ ....... .~¢.~,~.. ,~~.,,- ........ Building Inspector Rev 4/79 To*N}HALL i ~ SOUTHO~D~ N~ Y~ BUILDING~. P, Em~ ~ (THIS PER~IT MUST BE KE~T ON THE~, ,.~.~..I S UNTIL I~ULL COMPLETION OF THE WORK AUTHORIZED)? Permission is hereby grar~ted to: tO InspeCtor' FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. 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 topographic featu res. 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 "pre-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. C. 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 New Building ............. Old or Pre-existing Building Locat,on of ~ropertv ...~..~..~.~..../.~ ~.~ .... House No. Owner or Owners of Property .. ,0. ~.,5'¢~. ..... ..... .% .... Vacant Land ............. ...... ..... Street Hamlet County Tax Map No. 1000 Section ~ Block Lot.. Subdivision ................................. Filed Map No. ~'~' .Lot No. ~. No ~.O~.~ Date of Permit /0 .~.~.,~.~Applcant ~M~"//~~ /.~.¢,~-/.'/~ .. Permit .......... ~ ........................ ~ ...... Health Dept. Approval .... ~.~./2,~. ............. Labor Dept. Approval ,.../~?, .;~, ............. Underwriters Approval ...... ~?.'~..~. ........... Planning Board Approval ... Zf/.~. ............ Request for Temporary Certificate .... .~.'~. .............. Final Certificate ///'~ Fee Submitted $....~: .0.0. ..................... Construction on above described building and permit meet~ all aF,1~cable codes and regulations. re,cant ......... ............. FIELD INSPE~TI0~ FOUNDATION (2nd) 2. C OiV~ENTS ., <~ ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: · -' FORM NO. 1 '~' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL.: 765-1802 E amined....~ ...~ 19 Approvedd2 ..-...¢ ..... ,19TX Permit No./X 7/' Disapproved a/c ...... ' [~ ............. .~ ........... (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No../.~ ./.°./..(2~.~ ....... 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 tssuea 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. (Signature of applicant, or mi'me, if a corporation) ......... ~ ..¢.~.~.. ~,,..4?,,./A,./Z. .~. ? (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...u2. 4,... V~.~. dy ...... t~.,,, ld~. ............. _:.. ............................................ 7'o~ .//. .,Z,',,,~,.~.,.-...~.~.~'. .............. Name of owner of premises ..... ~ ............................... (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.../~.~04 ................ Plumber's License No ...... /P~.'~:~.~. .............. Electricmn's License No .... ~.e,~t ¢ .............. Other Trade's License No.. ,/P~,4~r .............. Location of land on which proposed work will be done...~.o. ,..,~ ,c/~...~.q 4('e...'.D.r'.,...,~· .d)?.d.'. . . . . . . . . . .~t/ ,w~/~/~.~ .~'4~)*.. . · ~..o.v.~:...,/,~... ~.e.e. ................... .,?~.~././,.~./..,4 ..... .x.,. ~.. ....... ~.... y.,. ............ House Number Street Hamlet County Tax Map No. 1000 Section .... ?.~-~ .......... Block ..... ~..~ ......... Lot ..... /.~ ............ Subdivision .................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .../...~.'zv ... ge.d.c.' ............................................ b. Intended use and occupancy . ~.¢.c~...O. ~...ff~.~do...~..~.. ~.,V/:r. ff~.'./,~...~?.tTi.~]~,. ...................... 3, N,qture of work (check which applicable) New Building .......... Addition .......... Alteration ........ R~,pmr .............. Removal .............. Demolition ...... Other Work ............... ~-~ ~ ' (Description) · ~ ;~ i 4. Estimated Cost .......... Fee (to be paid on filing this application) 5. If dwelling, number of dwelling ~nits .. ~ ....... Number of dwelling units on each floor.. ~ ......... If g~age, number of cars ...~ ................................................................ 6. If business, commercial or mixedloccup~cy, specify nature and extent of each ty~e of use ...~q~ ..... . . . - 'j' .. 7. D~menslons of ex~sting structures, if any: Front... ~.~ ......... Rear . . ~ ~ ......... Depth .. /~ ~ Number of Sto~es ~ . Height .. ................................................................. D~ensions of same structure wilh alterations or additions: Front ... ~.( ......... Rear . . .~( .......... Depth .... ~.~ ............ ~ . HeiSt ...~.~ .............. Number of Stories ...... ~ ............... 8. D~mensions of entire new construction: Front . .~( .... Rear .............. Depth . . ~ ~ ........ Height ..... ~9~ .... Number of Stories ........................................................ 9. Size of lot: Front .... Y~...; .......... Rear ...... ~.~ t Depth ...~. ~ 10. Date of Purchase ...~,~...~ .............. Name of Fomer Owner ............................. 1 1. Zone or use district in which premises are situated .... Z. ~'~ ....................................... 12. Does proposed construction violate any zoning law, ordinance or re~lation: ... ~ .......................... 13. Will lot be regraded ..... ~. [ .................. Will excess fill be remgved from premises: Yes No 14. Name of Owner of premises .~ ~. ~.. ~ ~ .... Address ~ ~.. ~ ~ ~{ .~ff~ Phone No. ~(~.~... Name of Architect . . . ~.,..~<(t.~. ............ Address . . ~r~.. ~q ...... Phone No. ~w. ~ . N~e of Con~ractor Address ~ Phone No ' PLOT DIAGRAM Locate clearly and distinctly all ibuildings, 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 ,.vOmit, COUntrY OF.. O~.-M. 0]./: ..... ...... .............. (Name of individual sig~ning contract) above named· ...... being duly sworn, deposes and says that he is the applicant He is the ......................................................................... ' ................ (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 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. ...................... day of ........ , Notazy Public, ~or UtVD~ r. ~ow~s~ ARY PUSL .*res