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Home My WebLink About10638-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Occupancy No..Z1 ] 0.0.Q i . .; Date . .~.ay..2..0. .. ., 198..~ THIS CERTIFIES that the building Location of Property ...1.6.~5. Jockel~ Creek Drive $out;ho~ld House No. Sffeet Hamlet County Tax Map No. 1000 Section .. ~.7.0. ...... Block 02 .Lot 019,004 Subdivision ....... X ....................... Filed Map Ho...X ...... Lot No. X conforms substantially to the AppEcation for Building ?ermit heretofore fded in this office dated .... Apr.:L1. ~ 5 ........ , ] 9 · ~ Ppu~suant to which Building ?enrdt No. 10638 ~. dated ...... R~.r. ll. ~.5 ............ 19.8..0, was issued, and conforms to all of the z~quitements of the appEcabie provisions of the law. The occupancy tot which this certificate is issued is ......... .... a~..acca~sorT..=1 t, or.a,g~..a.~e..d: ............................................. qe.r.b.e.r.t,' .S & Geraldine Arm The certificate is issued to ... . . (owner,/eme~ ~nawr) of the aforesaid building. n/r Suffolk County Department of Health Approval ...................................... n/r UNDERWRITERS CERTIFICATE NO .................................................. ........ ............. Re~. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10638 Z Permission is hereby granted to: ........ /~~.z...~...~......~ ....... ./..~x~...~7~.~.....~-~.~, ,, ..J2..~. ......... ~.z~.~.~....-.....z~..:..~..: ...... to ...... .~c~ ~. ~. .~ ~ r~` ~. . . ~ ~ . ~. c~ c ~. ~ .z. . . .a. ~ ?~ ~ . ~ ~ ~. . a. z.~ ~ . ~ . ~z.z~.~. .~e. . ~ ~ ~ ~ . ~ ...... ~, premises located at ..~...Z~..7 .~........~.~------~...~..~--~--~~"~ ~'~ ................................... ............................................................................................... ~'.~ .~.,4/~.......~........Z,Z........~..,. ...... pursuant to application dated ...~/~, .~ ....... ./'.~.-. ................. , 19~..~ and approved by the Building Inspector. Fee $.../~).~ ...... 'FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall $outhotd, 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- tot 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 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 bu{idings, ~ndustria~ 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 requ[remer~ts where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buiMings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topograph ic 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, ,pr 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. Copy of certificate of occupancy $1.00 Date , Ne. Bu.,d,n ...... · ' g ............. Old or Pre~existing BuildingC~) ....... =/Vacant Land ~ Owner or Owners of Property ~¢~¢t- ~, % ~)~ ~ ~J, County T~x Map No. lO00Seetion ,.,(~ ~ 0 ~, ~ ........... Blook ~ Lot.. ....... ......... ............ Health Dept Approval Labor Dept Approval Underwriters Approval Planning Board Approval - Request for Temporary Certificate,, ~.¢~, ............. Final Certificate Fee Subm tted S Construction on above described building an/¢ permi~(~ee,ts.~ , II app~cable~oodes and regu ations. App cant ., .... .,~ ...... .,,ff. .......................... . ..... Rev 10-10 78 Q.O. ? IRLD i ~SPE3i'ION CO],% .£"'2S __ .=_ ~%____ FOUNDATION FOUNDATION 2. ROUGH FRAME& PLUMBING (2nd) INSULATION PER N.Y. STATE ENERGY COpE FINAL ADDITIONAL COMMENTS_: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 D~sapproved a/c . .. ¥. .... -¢-~ ......... ~ ......... . ~ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No./()~.~-~..~. ....... 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 co, die, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspect, i~a~. I Ii~' ~ (Signature,9,f,a,p,p,,li, ca,nt p~r,n~a~ee, ifa corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, 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) Builder's License No .... ~.5 .......... Plumber's License No ........................ Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proponsed work will be done ....................... , ........................... .... ......... ........ .......................... House Nmnber Street Hamlet County Tax Map No. 1000 Section ...~.'70. .......... Block ...(J}.O~ ........... Lot .(~/. ~..-..O'.(.~.~. ...... Subdiwsion .................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occup, ancy of proposed oonstruction: a Existing use and occupancy ..... b. Intended use and occupancy .~'f~.,{-4'~:...~.x:./.z~-. ~.. ~C'TfT5~'~'-.,.~.O .~._.c7.' ~-.<7/.;.-7-~.<~ ~-..~z~...ff?..~... Nature of work (check which applicable): New Building .......... Addition .......... Alterafi~,..J.,, ,, ....... Repair .............. RemOval .............. Demolition ............ Other Work. ?!?:...~. ....... ~(~DO- ~,,, ,,O~ /~a"C~,,~ (Description) 4. Estimated Cost ............. . ......................... Fee . .. tvr.~..-.....' ....................... ~ (to be paid on filing this application) 5. I f dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ It' garage, number of cars ........................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 71 Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... 14eight' . .............. Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ....................... Height ...... ~ ....... ~ ........ Number of Stories ....... ~ .] ~. 4 ...... 8. Dimensions of entire new constrUction: Front ...1...a~../.~ .... Rear ............... Depth r-'~r.. I.~ ....... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ........... ~ .................. Narge of Former Owner ............................ 11. Zone or nsc district in which pr~mlses are s~tuated .... ¥.~./. ................ ~ [1)... 1.. l'~ .............. ~ 12. Does proposed construction violate any zoning law, ordinance or regulation: . .~.....'~(...~.....~....1~..~ .... 13. Will lot be regraded ...... ~.~.., ./L...l. ~. · a. ~..,a ...... Will excess ftiJxl be r~moved frglm premises: .~e_sak 14. Name of Owner of premises [...~...~.' .~..~ ~.l Address .1.~?.~..4~ ~ Phone No..9.~.~... r. .... .~.~..~.. Name of Architect .......... .: ................. Address ....... ~.~,...."'" '. ..... Phone No. Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly alii buildings, whether existing or proposed, and, indicate all set-back dimensions from property lin'es. Give street and block nmnber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW Y~RK/~/'....I l~ COUNTY OF .... -> ~4 ,~, .v~..' .D,. S.S ....... ~r[-~ .~5.~0.~g~...~....~..~.~. ~ ............... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the .......... ~ ~.~ ..................................................................... (Contractor, agent, corporate officer, etc.) of sakt owner or ownem, ~d is duly author~ed to perfo~ or have performed the said work and to m~e and file this application; that all statements contfiined ~ this application are true to the best of his ~owledge and belief; and that the work will be perfomed in the m~ner set forth in the application filed ~erewith. Swam to before me this ........ ~.[~ ........... da[ o~.: ~..x ........ 19.~ mota~ Public, .~~ .~~.~.~~~ty [~ NO1AR~U8~C, State oF Now York ........................... , No. 52-460)g97 (Signature of applicant) I Quabfied m S /folk Cour <¥',~ ,s,oa Exp.es March 30. ]9 ~