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Home My WebLink About10935-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No ...... .g '102.~.~. .... Date ...... l~ovembo~. · 20 ............. THIS CERTIFIES that the building ............................................... Location of Property ...... 269.5.0le. House No. Street Ham/et County Tax Map No. 1000 Section ..... J.22 ....Block .... ,~, ......... Lot ....... 1 ,/4 ........ Subdzvision .............................. Filed Map No ......... Lot No ....... I ....... conforms substantially to' th~ Application for Building Permit heretofore filed in this office dated .... Ocf;c~Ber. gJ. ..... ,19.80pursuant to which Building Permit No ........ J139 gSZ ....... dated ..... 0 .c'g(~Bel'. 2.g ........... 19 .~, 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 ......... ............. A.6el£t>:[ma. t:o .One..Fam.~[.yI~e3-.~.~.~g ............................... The certificate is issued to .......... -I~e1~.l.e .al~l~o.~o~r,~ .~tr~~ .................... of the aforesaid buitding, Suffolk County Department of Health Approval ........... I~/R ........................... UNDERWRITERS CERTIFICATE NO ................... 1~/.I~ ........................... / ' Building Inspector Rev 4/79 ~or~ l~o. ~ TOWH !O~ ! BUILDING ToWN HALL SOUTHOLD, N. Y. BUILDING~ P,E~iTI (THIS PERMIT MUST BI: KEPT ON ~H,E PR~IS~S UNTIL ~ULL COMP'ET'tiN OF T.E WORK ^U*HOR,ZED) : N9 10935 Z ~to ~ ~o~., aa , ~...~ Permission is hereby gradted to: r. O. 20X 9~0 ~....~.~,...~.,~.,.,J.3.~.h, ~ ................ : ............ ................................. Ot ~lse~ IOCOt~a aT ..., ................. , ..... ,. ....... ~ · · ~- ~'~ ................................................ .~.~*~, ~[, 3 ~ ~:. ~ . . : ' . ................. ...................................... ~ ........................... , ~ :~ ~o. ~ 00 soctio~ ...J.g~ .......... .,. ~o~. ...... 5. .......... ~ ~t ~o ............... put to ~pplic*Hon}dotod ......... .~.~..~.~......:..~.~,.;.~....., 19..,~, ~n4 ~pprovod bv ~5.oo Fee $ ....... . ................ ' , ~ Budd,ng~ Inspector L FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- I802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A, This application must be filled in typewriter OR ink, and submitted m ~ 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 unu~Jal natural 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. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property 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 certificate. Fees: 1, Certificate of oc~cupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5.Updated C.O. $15.00 NewConstruction $15.00 10/24/86 Date ...... Old or Pre-existing Building Vacant Land Location of Property ~95 O.l.e.j.u,l.e..L.aqe, ~a..~.t.i.t..u..c.kN ¥. House No. Street Ham/et Owner or Owners of Property .. . 122 B lock 5 Lot 1 County Tax Map No. 1000 Section .............................................. Subdivision ................................. 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 $...$.1. ,Qp...C. 9py' ,qr,..C.O..z. ! .0.2.77 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 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 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. C. Fees: 1. Certificate of occupancy $5.00 2, Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copv of certificate of occupancy $1.00 , ............. New Building CtL~h~.~ ....... Old or Pre-existing Building ............ Vacant Land ............. oeetion o* Property .... ..... ........ ........ House No. Street Hamlet Owner or Ownersof Property .}~')~L.'~r. ~,/5.. ~-:/~-.~, ¢~1~ ... ,'~.~t~.~.. .................... County Tax Map No. 1000 Section ./. ~.~ ......... Block ...~..-~. ......... Lot .... ,/.~Z .......... Subdivision ............................... Filed Map No ........... Lot No .............. Permit No./~. ,~.~¢.. Date of Permit ~'.0/~/~.Applicant ~¢~%Y.~k'.l.. ~.~..~.~.~,-. .......... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ..~.. ................... Fee Submitted $..~.~.O.?~') ...................... Construction on above described building and permit meets all applicable codes and regulations. Applicant..---~~ ..~., ~~.. .................. , I: Ai~) DIT~Ot, JAL CD /,--A~'u'~--~/,d"~--,~- FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 //},/,,.. Examined ....... .c~.~.:,. .... , 19. ~. Disapproveda/c. -""-<.i ...................... ...... ..... (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No. [ 0 -~ 3 5- 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 necessary inspections. ............. (Signature of applican , o n , corporation) .. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (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 ...................... O~her ~rade s License No ........ v-. r.,-: ~.L,~. . .~,'~t ~ t ~ ' ~ Location of land on which proposed work will be done .................................................. ................... ~at?~ .................. ~¢ ................... House Number Street Hamlet [ ~/~ County Tax Map No. 1000 Section . .~..~...I.~.-.....'q '~'- Block. ~.~Q." ...... 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 .. F.~'.~/q~.~.c.'?,.~ ..................................................... b. Intended use and occupancy. ~.~'.~'1 a ~.~ ¢ .~ ....... . .~......~..~).. ~t,t~,. ~.~..~ ~dt,.~3.. 3. Nature of work (check which applicable): New Building .......... Additionq~tl~%9.C.~.? ratioz~ Repot .............. Remogal .............. Demolition .............. u~ner worn ~ ~, .......... ,,.. t~escripuoflT 4. Estimated Cosf{~. 7~Z~ ............................. Fe~5~.~ .............................. ~ ¢o be p~d on filing ~is application) 5. If dwelling, number of dwelling Chits ............... Number of dwelling units on each floor ................ If garage, number of cars ..... [ ................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. D~ensions of existing structureS, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Sto~es ........................................................ Dimensions of same structure wi~h alterations or additions: Front ................. Rear .................. Depth .................... ... Height ...................... Number of Stories ...................... 8. D~ensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stohes ........................................................ 9. Size of.lot: Front ...........~ ........... Rear ...................... Depth ...................... 10. Date of Purchase ........... ~ .................. Name of Fomer 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 ............................ Will excess fill be removed from premises: Yes No 14. Nme of Owner of premises ... ................. Address ................... Phone No ................ Nme of Architect .......... ~ ................. Address ................... Phone No ................ Nme of Contractor ......... j ...... ~ ~ ...... ~ Address ................... Phone No ................ Locate clearly and dffiinctlg dl~uild~gs, whethe~xisting or proposed, and~ indicate all set-back d~emions from property lines. Give street and block number or desc~on ~cording to deed, and show street names and indicate whether inte~or or corner lot ..... STATE OF NEW.~YQIRK,. ~.~ COUNTY OF. DtJ~..L_~ ...... ~'~. ........ ~&~ ~.~. ~ ~ ................ being duly sworn, deposes and says that he is the applicant (Name ~individual sig~ing contract) above named. (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have perfomed the said work and to m~e and ~e this application~ that all statements con{dined ~ this application are true to the best of his ~owledge and belief; and that the work will be perfomed in the m~n~r set forth in the application filed therewith. Sworn to before me this ...... ~.~ ~ ........... day o~..~.~ ...... ,19 Nota~ Public .... ~ ...... County NOTARY PUILIC, $1~e ~ ~ ~ ................. N,. 470~ (Signature of applicant)