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Home My WebLink About10655-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No. Zl 0002 Date Jttue _30 19 80 THIS CERTIFIES that the building ................................................ 1620 Village Lane Ol'in®t, l~Y, Location of Property .......................................................... ..... House No. Street Hamlet County Tax Map No. 1000 Section 2~ .Block 2 ..... Lot 16 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated Apl'il 5 19 qO. pursuant to which Building Permit No. 1065~Z dated Nay 8 19 80 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 ......... Acoesso,'-y at~uotu~e - (Gal'age) ........ ................ . ...... .................... : ................... The certificate i~4,ssued to ..................... /o'~,'/a~~ ..................... of the aforesaid building. Suffolk County Depar~lent of Health Approval li/R UNDERWRITERS CERTIFICATE NO .................................................. R~ FOK~I NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIC, E SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 1O655 Z Permission is hereby granted to: Curtis A. Norklun .A../.C...~.~.r .~..E~ g~c,.l.r~ O~ ...]~ex.. 4 ~.~ ..... ..0...r.&..e~.t.,.....N..e..w.....Y...o..r...k......1..lg57 ............. ~ild a larger accesso~ (~.9~.~) ~.~g~ ............................. at premises located at pursuant to application dated April 5 ..... 19..8..0...,, and approved by the Building Inspector. Fee $.,, ,1...0, .,...0..0. ......... Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcation 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. FinaJ survey of property with accurate location of all buildings, property lines, streets, and unusual natura~ 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 simi[ar 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 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- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-ex[sting dwe{ling 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 ... ,/. ~ ?.0. ..... ./~. :' ./'./.~.~....~..~..~ .................... .~.. ,,~.~ .~. ~ ........ House No, Street Hamlet Owner or Owners of Property ....~... , ,~, ,~, :4:¢!'~.~ ......................................... County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................ Fded Map No ........... Lot No .............. Permit No. ~/.~.~..~,-.~. ~ Date of Permit ~*./.?/~.0..Applicant.., .~: ~?;, ,~,~P .... ~. ?.~...~...~?.~ ....... Health Dept, Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and permit meets all applicable codes and regulations, Applicant , .. ~,~¢'~.;.~.z-~''''~ ...................... A D D I TI r. Dtd' A L C E:)/,..~/v',, -..~.~- ..k-, T"...~ FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. Examined ......................... , 19........- Approved ....................................... , ermit No Disapproved a/c ......... .~..~.....~.~[~,.~,...,.~.~....zzzzz£.._.~~_~ .................................. Application No. /~&~'~"~ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ............... ~/.S..~. ........................ , ]9....~.. .... INSTRUCTIONS a. This application must be completely filled in by typewriter or! in ink and submttted in triplicate to the Building Inspector, with 3 set~ of plans, accurate plot plan to scale. Fee according to schedule. b Plot plan showing location of lot and of buddings on premises, relot~bnship to adjmning premises or public streets or areas, and giving a detaded description of layout ofproperty must be drawn on the diagram which is part of this application. 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 ~ssue a Budding 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 ~n 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 Budding 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 aIterations, or for removal or demolition, as herein described. The applicant agrees to comply with all apphcable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on promises, and in. buildings for necessary inspections. (S'gn ute of applicant, or name, if a c~orporation) (Address of applicant) State whether applicant ts owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises ............................................................................................................... If applicant ~s a corporate, signature of duly authorized officer. ,Name and t~tle of corporate office, r) Builders License No ............................ L/~.~.,L~ .~...i ........ Plumber's License No ................................................. Electrician's L~cense No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No: ........................................ Lot No .............. I .......... Street and Number .../...~....~.:.~.....~..(~!./.¢~.~,.....~.....~...n.:~ ........................................ / 0 c:)C~-- ~ ut~ 2:-- /(~ Munlcipoli~ ...... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ...~¢2~....~..~'... ........................................................................................................ b. Intended use and occupancy ..... property whether 3. Nature of work (check which a~pplicable): New Building ....~... ......... Addition .................. Alteration ............ Repair .................. Removal ..' ................ Demolition .................... Other Work ................................................... [' h0~/ (Description) 4. Estimated Cost .......................................................... rea . ,I (to be paid on filing this application) 5. If dwelling, number of dwellin~ units ............................ Number of dwelling units on each floor .......................... garage, number of cars .M..~...~.~'- ......................... ~. ........................................................................ If 6. If business, commercial or mixed occupancy, spe¢¢fy nature and extent o~ each type of use ....... ~ ................ 7. D,mens,on, of ex,sting structu,,,, ,f any. Front .....q.~5 ................. Rear ...... 9. ....................... Depth ....).~ ........... Height .....J.~.~ .............. Numbe'r of Stories ....~ ................................................................................................. Dimensions of same structure ~ith alterations or additions: Front ...... ~. ........................... Rear ...... z ................... Depth ........... ~ .................. H~ ght .............. ~ ........... Number of Stories ...Z. .......................... ....- ~ 8. D~mens ohs of entire new construction; Front ....... ~ ............................ , .... Rear ,...). ...................... D~th .~/... Height .,..~.~ ............ Number ~f Stories ..~.~. ................................................................................................ 9. Size of lot: Front ............ ~.~.r .................................... Rear ..... ~,~ .................... ~ ........ Depth ..,.~..~.~ ................... P te of .................................. of Fo,m,, .................... 1 1. Zone or use, district in which premises are situated ...... :~.t~ ................................................................... ~2. Does proposed construchon via,late any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded' .,.~ ...... ; ........... Will excess fill be removed fram premises: ( ) Yes (~No of Owne, of .............. Zddr,,, ............... ,ho, No. Name of Architect ............................................................... Address ................................ Phone, No ....................... N~e of Contractor ..~.8:~:¢.....~:...~,C~/~.~-- -- -- ........... Address ..b.¢/.~ .............. Phone No. PLOT DIAG~M Locate clearly and distinctly alllbuildings, whether existing or proposed, and indicate oil set-back dimensions from lines. Give street and blo4k number or descriphon according to deed, and show street names and indicate nferior or orner lot. /~ / STATE F NEW' COUNT OF ...~ ~'f.~l~. ............ fS.S ............. · ~. · · ~t;~. · ."~ · · · ·/:~..'. · · ·/~/"C'~/¢,'¢: ~ ................................... being (Name of individual s g¢ing contract) above named. , duly sworn, deposes and says that he ~s the apphcam He is the ¢.~ ..... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dujy authorized to perform or have performed the said work and to make and fda this application; that all statement~ contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn'to before me this ' i ........ day of ...-r.~¢~ .......... t ........................ , 19 ........ Notary Public,. ........................ ~..gZ1.C.~... ........... County .................~........~...:../.../.~ ............................... (Signature of applicant) STATE CCN STRUCT[OT'4 CODES N. OT RESPO,k4S~SLE FOR D~SIGN OR CONSTRUCT~Oh~ ERROR~