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Home My WebLink About10645-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No.. Z..q.027.~ ........ Date ..... ~.q¥.e~., .~...2,6.~ ............ ,19. ~IS CERTIFIES t~t the b~d~g ................................................ ~fion of ~ope~y Co~ T~ Map No. 1000 Se~ion ..... Sub~on ............................... FRed Map No ......... Lot No .............. confo~s subst~ti~y to ~e AppOrtion for B~ding Pe~it heretofore fried ~ ~ o~ dated April Z of the app~cable pro~io~ of the law. ~e occupancy for wMch tMs ce~ifica~e 2 ~ued is ......... ~torage ~ilding For C~erci~ ~se~ Ma~t~ce. ~ ~m~oa~ ~ ~ ~o ...... ~. ~ . ~~ ............................... (own~,~ of ~e aforesaid b~d~g. Suffo~ County Dep~m~t ~EgWR~ERS CERTIFICATE ~O...~/~ ..................... ../ ................ Bufld~g ~pector FOR~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 106~5 Z Permission is hereby granted to: .... .... :~0..,.......~' /,~,. ~....~..~,:. ........... .....~/~zo~.~..:..~....._ ~ ~ .. ~ oT: :. . ~ ~ ~ r. ~ ~ . ~. . . . . . .~cr. o ~,,9 .~. . . . . ~x~ , ~ p ~. ,,,. ~. . . . . . ~. ~. ~. ....................... C~,,, ,,., ~. c ,,¢ c . . . . . ~f,~ .:._~. ~. . . ~.,,~.~,~.~. ~ =. . . . . ~ ............................. ot premises'oeo,ed ot ..Z~..~... .......... ~./Z.~...--.~.~.~..., ........ ..~.~ZZZZ.~..C.C..~.~.:~ 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. 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. 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 Budding ......... ~ ... Ol~d~d or Pre-existing Building ..... Vacant Land ............. Location of Property..~'. ~.~Y.~:~ .................. .~...//f: ..................... · .~.~.~'~.d:~.-~.'~.../~f' Houee No. ~ Street ~ Hamlet Owner or Owners of Property ............................................................ County Tax Map No. 1000 Section ............... Block ............ Lot ............... Subdivision ................................. Filed Map No ........... Lot No .............. [0 ~ Lf.~ . ~7'//~.~/.~.Applicant.. ~'..~. ..... ~- .Z~..-..' .~..~.J.~./?f?.~-..~--' Permit No ........... Date of Permit Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters ApprovaJ ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... F:: Submi:tned $' '::e'':'' i~dd:'~(~!n'' :''' :r~,'':'~ ?e/tsI C structl on ab d scr'b buid ga dp ')k.~u~tsall Applicant .... /~.~..~ .... Rev. 10-10-78 4 ~O~mAr ZO~ ( ~ se ) ~Ot~"DA~O~ 2o ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY cope ADDITIONAL COMMENTS: FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL LocaQon of Property ~ .~. ~.2 .~....~..~ .......... ~o~s~ ~o~ ..... / S~r~t , County Tax Map No. 1000 Section . ~( .~ ....... Block . .~ ~ ........ Lot .~.'.~. · ~. Subdivision ................. Filed Map No ................. Lot No .................. is ~turned herewith and disapproved on the follow~g grounds .~.. ~.~ ....... ........................ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-11~03 .... /y APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No../..~?. ¢. -~..~. ...... a. This application must be completely filled m 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 prelnises 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 apphcable laws, ordinances, building/fiode, housing_~code, and regulations, and to admit authorized inspectors on premises and m buildings for necessary inspe .... i~~.. s. ............ ..~....~ . .~..~..~....~... (Signature ~Sf applicant, o,~nam, e, if a c_o~poration) (Mailing address of applicantJ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... .............................................................................. Name of owner of premises..~. ~....~...~..d)~....~ .~..~.,~....~.. .............................. (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 ...................... Other Trade's License No .................... 1. Location of land on which proposed work will.be done ................................................. ............... ............... ........................ House Number Street Hamlet County Tax Map No. 1000 Section ..... .0..(-9...7. ...... Block ...... .~. .......... Lot ..... .~.~ ./(., .,~. ...... a. Existing use and occupancy . b. Intended use and occupancy Subdivision ................................ Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ............................................................ 3. Nature of work (check which applicable) New Building Addition Alteration , .. Repair .............. Removal .............. Demolition .............. Oth~l~ Work..~f.~.¥(~. ..~..~. 4. Estimated Cost .......................... Fee ... ' ............................... ~ (to be paid on filing this application) $. If dwelling, number of dwelling,units ............... Number of dwelling units on each floor ................ If garage number of cars _ . ~_ If business, commercial or mixed occupancy, specify nature and extent of each type of use ... I .... ~ Dimensions of existing structures, xf any: Front ............... Rear .............. 'l~;pth i i i i i i i. Height ............... Number of Stories ........................................................ -- Dimen'sions of same structure with alterations or additions: Front .. :.~7 ............ Rear .................. HeightDepth .................. t~ -. Nuntber"i'' Heightof Stories ............'~ ........ Numbeg~ Stories ........ ii 8. Dimensions of e~lr-e new constrUction: Front ........ /: .... ~ Rear . } ............. Depth . . ...... ..... .. ............. /. J'~b/7 ...................... Size of lot: Front .......... t ........... Rear ...................... Depth ...................... ~ate of Purchase .......... ! ................. ./~Name of Former Owner ............................. Zone Or use district in which pr~mises are situated.., r~ ................... Does proposed construction violate any zoning law, ordinance or regulation: ................................ Will lot be regraded ....... ._., .........~ .......... Will excess fill be removed from premises: Yes . No Name of Owner of premises .,¢/d~...../~z~t.P?..,?~..?~'.. Address . .~.~.~r.. ~ ? ........ Phone No. 7.&..~.~ (~.7. ~.: . . Name of Architect ' ... Address . Phone No. Name of Contractor .......................... Address ................... Phone No ................ 10. 11, 12. 13. 14. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and blocklnumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YI~RK- .......... ~--~~...~. ~.-~.~.~. ¢.~ . . . being duly sworn, deposes and says that he is the applicant (Name of iddividual sig~ ina 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 perfomed the said work ~d to m~e and file this application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the work will be performed in the m~n~r set forth ~ the application filed therewith. Sworu to before me this ........ ..... ..... ..... ...... , ~mm;~.