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Home My WebLink About10657-zFORM NO. 4 TOWN OF SOUTHOLD BUll-DING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ..... ~ 106.0.1. ...... Date ........ ,/u 1¥.. 23 ................ ,19 8. l THIS CERTIFIES that the building ................................................ Locati of Pro eft 205 F:[~herraant~ Beach Road~ . Cut:choguet New ¥o~'k on p y ............................................................. House No. Street Ham/et County Tax Map No. 1000 Section . . .1.1 ] ...... Block .... IL .......... Lot .... 59 ........... Subdivision .P.e.c.o.n. ~.c..B.a.S. ?.~o. p....I.n..c: ..... Filed Map No..7.8.6. .... Lot No. 4. ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... Apl~.l..25 ...... , 19. B.0pursuant to which B[dlding Permit No.. A065J..$ ........... dated H~7.9 ...................... 1980., 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.~.~. t..o.n..~.9, p.n.~.. F.~.n.~. ~. y..q,.e..~.~.t.n., ............................. The certificate is issued to ...~.amols..~,..O.t. tie;I.~..J, .&..t4.~ ~ .............................. of the aforesaid building, Suffolk County Department of Health Approval .... ~/.~1 ................................... UNDERWRITERS CERTIFICATE NO... I~/.R ........................................... Rev. 1/81 Building Inspector lX)WI4 CLiRK'S O4~FICE SGUTHOLD, N. Y. BUILMN~ II~LM IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION Of: THE WORK AUTHORIZED) l~lo. 10657 Z Permi~on is hereby granted to: ..... ................... ,'/.......~..,:....Z.,:~.-. ........... .'f...e...,... ,o ..... ~K ....... ~ ...... a ......... ...,~........Z(...~..~ ....... ~..z..8:.r....;.....: ................... ............ : ...... ~-.'"'.'"';""Ri~i~Zii~~i;~;["~.i ...................... iii'i'iiii ........ ,,,,,,,,,,,,,~o,~,,, ....... ,. ............... ,~ ..... ~ ...R;.i~i.i..~.i~ZZi ........... .............................................................. d}~Zc.~....::.: ............................. ...~: ...................... ~ .......... ~......, .......................... ~ ...................... ,.. ..................... ,. .............. ..... ,.,~, ..... ..a.....s..... ~.., ,,,,,,,.,,,~ pursuant to ap~lication dated ......................... ~. , and by the Building Building Ir~pector 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 disposat-(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 P~anning Board approva~ of completed site p~an requirements where applicable. For ex~sting 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 certifmate. 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 House No. Hamlet ............... :.z....z..... .................... Subdivision .w.~.a ~ ~ .~., .~..~,/~..~_County Tax Ma ~o. 1000 Section /i...//' ?~ .~..~ dF~ed~apBIOck ....... 7d~l ....... Lot · · · · · · .~, ¢.--i · ·~';° ~ , . No. ~ . .Lot No, Permit No ........... Bate of Permit ~r/~/,~.Applicant .... , .~..~:..~.~.~."~., .~. ................ Health Dept, Approval ........................ Labor Dept. Approval ........................ Underwriters Approval . . 'N '~ .............. Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building an,~..~ippl~ulati°ns' Applicant.. Rev, 10-10-78 APPROVED A$ ~OTEDI FEE: /~ BY: ~ NOT1F¥ BUILDING DE?,~,RTMENT AT 765-1802 9 AM TO 4 DM FOR THE FOLLOWING INSPECTIOF~S: ]. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FP~MING & PLUMBING 3. [NSULAT!ON 4. FINAL - CONSTRUCTION MUST BE COMPLETE ~Oq C O. ALL CONSTRUCT!ON ?-"~LL MEET THE REQU~REMEK!TS OF THE N Y. STATE CONSTRUCTION & ENERGY CODES NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS, . /,q, Examined ................ ,19 ... FORM NO, 1 TOWN OF SOUTHOLD BUtLDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 ....... .. (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No. t/~/?~ ~'-y INSTRUCTIONS a. Th~s application must be completely filled ~n 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 drown 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 inspechon 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 Ordmance 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 demohtion, as hereto 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. ..... ~....~.....~.Y~. '../~ ..... ;a'ti~ .... (St~gnature of applicant, or name, if a corpo ' ) (Mailing address of applicant) State whether apjclica~nt is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......... er .. . . ............................ N e*owne ofp emises ......... ....................... (as on the tax roll or lates~/fleed) If applicant is a corporation, s~gnature 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 .... j~. ;~..~..~ ~ ...... ~. O~..? ..................... ..................... ' ., ...... L ............ House Number Street Hamlet County Tax Map No. 1000 Section ....... /.././. .... Block [ Lot Subdivision.. ~.~.~. p~ ~///.~.¢ .(.N.~.me~)..~.~.¢~ :~, ./3...~_. Filed ;~p' ;~i'' i i ',~.. '.~. i i i... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... ~,_~..~4.~...L..L:..[...~..~. ............................................ t/ b. Intended use and occupancy .................................................................... .I 3. Nature of work (cheek which apPlicable): New Building .......... Addition .... ~ .... Alteration ...' ..... '. Repair .............. Removal .............. Demolition ........... Other Work ............... ? ~. ,~ /~., .,~.~_. (Description) 4. Estimated Cost ....... ,~.~. ~> Fee ...... (to be paid on filing this application) 5. If dwelling, number of dwelling 9nits ............... Number of dwelling units on each floor ................ If garage, number of cars ..... 1 ................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of ex~sting structure~, ff any: Front .... .~../. ...... Rear ...~./. ........ Depth . ~.")../. ........ Height ...~,~Z'.' ....... Number of Stories .../.././.'2r. .................................... , ........... Dimensions of sapac structure with alterations or additio~ns: Front ... ~../f .......... Rear .. ,~/~ ............ Depth ...... g/~. .......... ... l-Ie~ght ......~.~.. ............. Numb.er of Stones ...... /. ~'...~ ........... 8. Dimensions of entire new construction: Front f~/. !, .. Rear .. ~.. (. ~. ....... Depth . .~....~ ........ Height ... ~,~- Number of Stones ...... /.../.-~. ............................................ 9. Size ol~lot: Front .. 7~,. ~.~'..! ........... Rear ...... ~..3'.: .~. '. .........Depth .~,~.7,~... ~..~./.~...~..... 10. Date of Purchase ~4-~'28 /~ ' 7 3 Name of Former Owner -,,JCk/z~ irl~t~'r..~..cj ..... 11. Zone or use district m' v which premises are situated... ~.~. (4..~'"/~ P../.~.'..-~.. ~..~e..n. .......................... 12. Does proposed construction vio, lgte any zoning law, ordinance or regulation: ...... ,~.~. .... . .................. 13. Will lot be regraded ....... ~.~.~..~..~ ............ Will excess fill,beremove0, from premises: ~Y,es 14. Name of Owner of premises ~7~/;~.e 5..F..f)..~.~..L.(_.. Address ./~. f~.~_V.~.pq.r,.~r~.,~.d Phone No ,,~,?..~r .~.~.~/; Nam~-~of--ATchitect ............................. Address ................... Phone No .............. ~... Name of Contractor .%].~./~ .tq..--~/..'¢~/~:4'~ .~. Address ~-~'Tf. (~ff~.¢~.... Phone No. rff..~..~: .~..~.~.~... PLOT DIAGRAM Locate clearly and distinctly all! buildings, 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 street names and indicate whether interior or corner lot. STATE OF NEW YORK, i S.S COUNTY OF.. ~.O¢,~ EFT. O.L }q~.. .......... · .xY.~,~. ~t/· · ~/~/, · · ~.~ ............... berg duly sworn, deposes and says that he is the applicant (Name of individual si~ing contract) above named. He is the ......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly anthodzed to perform or have perfomed the said work and to m~e and file this application' that all statements conthined ~ this apphcat~on are true to the best of his ~owledge and belief; and that the work will be perfomed m the m~nqr set forth m the apphcat~on filed therewith. Sworn to before me this : No, 52'452477~ (Signature of apphcant) MAP OF I_._,