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Home My WebLink About10622-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Occupancy 826 Date August 2 ................................ ,1985. THIS CERTIFIES that the building ... gna?age, zddition ........................... Location of Property ~$$~.. 0 ............. ~Blue. .ar t ni i.v.o ........ Ore e. ap rA.,a,hio County Tax Map No. 1000 Section ...0.~.7.. ...... Block .... 0'1 ..... Lot 033 Subdivision..S.o.u.~.h.o. ~.d..S..h.o.~.e.s. ............Filed Map No....~.8.~.~..Lot No ...... .'12 cOnforms substantially to the Application for Building Permit heretofore ~ed in this office dated April 7 ,198..0. pursuant to which Building Permit No. I0622Z dated ...... .A~p.~.5:. ~..7. ............. 19~.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 ......... The certificate is issued to ...................................................... of the aforesaid building. Suffolk County Department of Health Approval ................ .N/.I~. ...................... UNDERWRITERS CERTIFICATE NO ........................ .N/.t~. ...................... Building Inspector Rw. 1/81 FORM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~06~ z Do,e X~X~-.. ....... .7.. ........................ , ~.' Permission is hereby granted to: 1 ......... ~.:~.~ ...~.~,~ .... ...... ./..x~..;.o.......~.....~...~.~.....z~... ....... ~z~...-~,~...~...~ ....... xu....../......~ . ~o.,,~......z~ ....... :.T......dS~~....~...r~ ......................... ,~ ...... ~..~.,-..~Z/.,r. ....... ..,,s ............................................ . .................. , ............ , ....................................... et premises ,ocoted et ...~.~..~.....~....~... ...... ...~.....~.,.(~....?....--..~...~...~..~..~.~. '/~.:. .................... ~ ......~ ~.....~ ..................... ~ ......................... ...~ ........ ~....,: ............. ~~:~....-.~. ~z.~...~)..~......~..~ ......... .7. .......... ..z....o-..~. ........................ ~ pursuon, to opplicotion dated .~......~...~.,~.~... ....... ~ .................... , 1 : end opproved by the Building Inspector. ~,,.x...~.-....-.... ...... ~ ..,/./,, : Building 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, Finat survey of property with accurate location of all buitdings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrmai 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 ail 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- t~on required to prepare a certificate. 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 / / Date ....... -?. (.~. ~..//~. ( ........ New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property .... l [ .,~,~:o. ....~..L.~..~...../~..~. ~.~. J .~., . . .~..~., ........... ~.?. House No, Street Hafnlet Owner or Owners of Property ....~.~..~I..~.~..~.~ ...... ./~/..~.?~'.~..~. ,~,. ............................ County Tax Map No. 1000 Section .... ~.~-~-.~, ..... Block ... (~./ ......... Lot .... O~.,~ ....... Subd,vision . .~. :? -~../7~?.~..~.~.-~. ....... F,led Map No...~.~....~., .Lot No .............. ,erm,t No. /..~, '~...~..~.. Date of Permit~.L ~ ~.0..Applicant./x~.?~A...~ . .~.~.~.(./.~.~(.~. ·.~, ........ Health Dept. Approval ...... /~. · .~. ............. Labor Dept. Approval ... ~/~..~. · .............. Underwriters Approval ...... ,~. ,~. ............. Planning Board Approval . .~..~.:'. ............. Request for Temporary Certificate ..................... Final Certificate Fee Submitted $, . .~....-~i ~ .................. Construction on above described building and per~it meets all applicable codes and re_gulations. Apphcant .. . Rev. / FOUNDATION (Ist) FOUNDATION 2. ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY 4. FINAL ADDITIONAL COMMENTS,: if. FORM NO. 1 TOWN OF ~OUTHOLD BUILDING DEPARTMENT ~ TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 .... .... Disapproved a/cdA' ..... ~ ~ ...................... .. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely fdled 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 building~ on premises, relationship to adjoining premi~e~ 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 appl/cafion may not be commenced before/~uance of Building Permit. d. Upon apprOVal of this application, the Building Inspector w/ii i~ue 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 Dep~tment for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Suuthold, Suffolk County, New York, and other applicable Law~, 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 pr~mises and in bufldinge for ~ecessary inspections. .... (.S.tgn_ a_tu_re_ _ of~t., or _name, ff a corporation) 1150 Bi~ blarl'~n Dr. Southold NY (M~illng address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Owner Name of owner of premises .... ~,IU~P,~Y. ~EX'~ ..................................................... (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 .... n.o..n.e.....~..~..~. ....... / Plumber's License No...none .... ./. .......... / Electrician's License No. ~lor~... 't" .......... / Other Trade's License No ........ /'" .......... 1. Location of land on which proposed work will be done .................................................. ......... 1150..Blu,~ /~larLi. n. Dr ........................... S.o. 9.t.h. ql..d ........................... House Number Street Hamlet ~ County Tax Map No. 1000 Section '.....~.~. ...... Block .... '...~. / ......... Lot...(~.. ~..~.. .......... Subdivision../~OUl:b,Ql, d. Shq~l; ................ Filed Map No. 3.8.5.3. .......... Lot. ~.2. ........... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of ptoposed construction: a. Existing use and occupancy....~..~..~..~f~..~..~.~..~. ~.J. ~ ................................. b. Intended use and occUpan ..... 1. Car. G~r:~je... ,,~J7 .~z. ~i'J~O..~ ............................. 3. Nature ofwo~ke(ch~k which applicable): New Building .......... Addition x ........ Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4. Estimated Cost ......... $.],7.0.0... ...................... Fee., ./'. ~)7.-~. ............................. (to be paid on fiUng this application) $. If dwelling, number of dwelling units ....... B/.4 .... 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. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... He/ght ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... He/ght ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ..... 12 ........ Rear ... ~- ~ .......... Depth . 2.2. ........... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ... 19.?.1 ..................... Name of Former Owner ... II,~. Rewe ................ 11. Zone oruse district' ' m' which premises are situated .... .~.~s..i.d.e.q.t.i.a.~. ................................... 12. Does prnposed constrnction ~oJa.t.e any zoning law, ordinance or regniation: .... ~O ....................... ~ 13. Will lot be regraded ...... d/'.4'...; .............. Will excess fill be removed from premises: Yes (N0) 14. Name of Owner of premises .. M .We~.:~man ....... Address J,150. ,B/il,lO..I~/~.r..,. Phone No. 7.6.5. .~..8.8.9....77~.. Name of Architect .... ~one .................. Address ................... Phone No ................ Name of Contractor ... 3~qO~ .................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all building, 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 st~et names and indicate whether interior or corner lot. see attached STATE OF N,~YORK, COUNTY OF...~ ..... S.S ........ ~]~ .~. .... (.~.k.'-/~T'/~./)../~. ..... ......... behag duly sworn, (Name oTindividual signing contract) above named. deposes and says that he is the applicant He is the ......................................................................................... (Conlractor, 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 ali mteraents contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the mariner set forth in the application ~ed therewith. Sworn to before me this ......... /......~ ........ day of ..... ~ ........ ,19 .d..~ otary ...... NOTARY PUSLIC, State of New So. ~'~o~m .~ ~ (Signsture of applicant) @ual~i~ ~n Sug~ol~ 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL CONSTRUCTION MUST BE COMPLETE FOR C. O. ~ CONSTRUCTION SHALL MEET I~t.tE REQUIREMENTS OF THE N, Y, ~FATE CO~qSTRUCTION & ENERGY C~DES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS.