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Home My WebLink About10915-zFORM NO. ~- TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hail Southold, N.Y. Certificate Of Occupancy No.Z.q.{ 5..3.5 ........... Date .......... lv~22g~..7 .............. 19 .~.3. THIS CERTIFIES that the building .. ~ckl±t;[o~ .................................... Location of Property H3~s~9~O..~he..C~es~ East ~arion,~.Y. . ' ....... ~Yo;i ....................... h~¢i County Tax Map No. 1000 Section ...~ ....... Block .... ~ .......... Lot ..... ~7 .......... Subdivision.. ~¢~..~ .~ ....... F~led Map No. ~.~...Lot No... ¢5 ......... conforms substantially to the Application for Building Pe~it heretofore filed in t~s office dated ...~¢~P.~?. ~ ...... ,19~R pursuant to w~ch Building Pe~it No ...... ~9~ ......... dated .... ~)~. 2 ............ ~959., was issued, and conforms to an of the requirements of the apphcable prowsions of the law. The occupancy for which t~s ce~ificate is issued is ......... .... ~?~r¢.~59~ .?~. ~..~9~ .~9~.~$9¢..~. ~5~.. ~%¢3.~ ........... The certificate is ~ssued to .55A5~9¢..~. P.~i~R{ .................................... (owner, lessee or tenant] of the aforesaid building. Suffolk County Department of Health Approval .. ~/~ .................................... ~/~ UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 BUILDIN~ PERMITI (THIS PERMIT MUST BE KEPT ON ~H,E PREMIS $'UNTIL LL COMPLETION OF THE WORK AUTHORIZED) N? 10915 ~Z , ,ote~ ,. . ,, ,~/~ ........................ , ~. Permission s hereby gra~ted to -~ t ' ~- ~,:~z ......... ~..~.n....;¢,~,/...~..~.,~....~ ............. ~.-., .... ~,~L~ ~ ...... ~&. ~ ~-., ~.,., .~ ~ ~ ~. ~ ....................... .........'~<L~ ~_~ .~:.,~- ~~' '"'""'"'" -- , ' '" "' ' ~ ~'~', Z.~/~.,.z~nT~ ................................. ,,. [ ............ ?[....: · · Coun~ T~x Mop ~o. I~00 ,Section .~.~...L.4. BI~ .,.: ................ ~}km Mo ......................... ~ - ~ :~¢~ ~ i ~ ~ ~ approv~ by the Building Inspector. Fee $ ........................ R~v. 6130/80 TOWN OF SOUTE[OLD OFFICE OF BUILDING INSPECTOR ' P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 - Applicant This is to advlse you that the job under Building on ~ q-~BL~_o~ ~or O~ c~k ~)~L~c~ is c6mpte~ed~an~ V a final inspection has~ has no%z~ 'been done. In order to complete this file, it is necessary that a Certzficate of Occupancy be issued. Please fill out the enclosed form(s), return same to the above offzce wzth a check for $5.00 payable to the Town of Southold. Please indicate to whom the Certificate of Occupancy is to be mailed, and arrange with this offmce for an inspection date. Thank you for your promp't attention. Very truly yours, Victor Lessard Admznistrator VL:ec Enclosures FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N,Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and subr~itted 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 natura~ or topographic features. 2. F~nal 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 buildfngs, 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 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 certffmate. " 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 Date ..... New Building ............. Old or Pre-existing Building(:~)., ....... =/Vacant Land ............ House IVo. Street Ham/et Owner or Owners of Property . ! ~.,.~ :,.~ ~L . .l~'.~. ._., .... ~..~. ~.,.,.,, ~ ...................... County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdiws~on ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. Underwriters Approval ........................ Planning Board Approval .................. ~ ,., Request for Temporary Certificate ..................... Final Certificate ........ - ......... - Fee Submitted $..A .'. ~.'~/ ...................... Construction on above described building and permit~meets all app~cable~codes and regulations. Applicant . .~..?..~.~...~.~..., Rev. 10-10-78 FIELp INS~ECTION FOUNDATION FOUNDATION 2. ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY CODE FINAL COMMENTS ADDITIONAL COMMENTS: now FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ...... ,19. ~. . Approved((~-.~... ~ ........ 19~..~. Permit No./(~.).~. ./. ~ ~ / Disapproved a/c ......... :i . . . .~ ................... ,~, / APPLICATION FOR BUILDING PERMIT Date ........ t'. 5..~.( . Application No. ? ~ ?' Zh~ 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 promises 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 apphcable 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 ins.p,~ctions. (Signature of applida}~i; ;Game, i; ~ c~r~oratI~n') .... (Mailing address of applicant) State whether applicant ~s owner, lessee, agent, architect, enginee eneral contrac electrician, plumber or builder· 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) Plumber's LicenseNo ......................... Electrician's L~cense No ....................... Other Trade's License No ..................... 1. Location of land on which proposed work will be done....~.~.~..~.% ~.4'~M: .O~-~.:. :~?..~ .............. ........ .:...:.:. .......... . .:. .:. :: . i i i i i i i i . . . .:?. :. . House Number Street Hamlet County Tax Map No.~100,.0 Section ........ .~....~. .... Block ......... ~ ..... Lot..~t. .... '~/? ~ Filed Map No ............... Lot . r,-.-~, ......... Subdivision .... :'.~::~ /~..~-r:. (~_.o. ,, 7/,.~.-. / ........ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: _ · ' ,/ :. .istiug use and occupancy .. ........................................ b. Intended use and occupancy ...... .,~....~-~-~. ?.~._.'.... ~...,~...C.(..~..~..~ ...................... 3. Nature of work (check which applicable): New Building ..... / .....Addition..~.. ..... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... ' ~ (D ipti ) / escr on 4. Estimated Cost ...................................... Fee ................................. (to be paid on filing this application) 5. If dwelling, number of dwelling Units ............... Number o f dwelling units on each floor ................ If garage, number of cars ..... i ................................................................... 6. If business, commerciai or mixecl occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structure~, if any: Front ............... Rear .............. Depth ............... lq eight ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... '.. Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front .... ~-.-~.: ~.. :~.. Rear ... ~ -.~ ~ ~.'.' .... 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 violate any zoning law, ordinance or regulation: ............................ 13. Will lot be regraded ......... i ................... Will excess fill be removed from premises: Yes 14. Name of Owner of premises .. ? ................. Address ................... Phone No ................ Name of Architect . 'c~' 7': ~'/2_' '! ............ Address ...~ ................ Phone No ................ Name of Contractor . ~ O;~.~'..~2~-.t~ ...... Address . ..~..~.~.~../.~ ...... Phone No. c/.2 2~7/.~ .~ ..... PLOT DIAGRAM Locate clearly and distinctly all J 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 cbrner lot. STATE OF NEW.~¥ORK, COUNTY OF. ~ .~..~.~. ...... S.S ......... ~o ~ c.e'P..R.,..5'~{ ro ~s/~.~-. · .~ ........... being duly sworn, deposes and says that he is the applicant (Name of individual sigq~ng contract) above named. He is the (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is du~y autho~zed to perform or have perfumed the said work and to m~e ~d file this application; that ~1 statements contained ~ this application are true to the best of his knowledge and belief; ~d that the work will be perfumed in the m~nSr set forth in the application filed therewith. Swum to before me this Notary Public, ........... ~ ....... (Signature of applicant)