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Home My WebLink About10676-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificale Of Occupancy No. Z9968 Date . .J.u.~. 3.. 19.8.0 THIS CERTIFIES that the building ................................................ Location of Property 2500 Maple Lane (Unit G - h[~s'e 'IV'o; ..................... 'S'ttJeet ' ' Hamlet County Tax Map No. 1000 Section .. ~.~...~. ..... Block .... .Off. ........Lot .... .0.'[SG ........ Subdivision .~..~.e.s.q .e.n.'~..~ .egg.lq .C. 9.n.d. qlg..il'l.J, ql~iled Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated May ~ 3 19 . .8.Opursuant to which Building Permit No. 106762 . dated ..... M. ~t.y..'1,.5. ................ 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 ......... ....... ~?..n.p.e?.k.. b.d.4 .&%&o.n., .t9...~..~.s.e3. n. g...~..e.~.Z3.n.g .......................... The certificate is issued to ........... .M.y'..z~. a..J.:..K.~.~.g ................................ (owner, of the aforesaid building. Suffolk County Department of Health Approval ............. .~../..R ......................... UNDERWRITERS CERTIFICATE NO. Building Inspector Rev 4/79 FOI~,~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PEP. MIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10676 Z Permission is hereby granted to: ...... ,~-/,~x-.~,~,~.../..;,~,~..~ ..- ...~..~ ....... ~...~,~ .............................................. ..~./~,~__~.x~7~,~...~....~.,.~, ....... /./..~.,z~ . ~o...~.~.cz: ...... ~'~.......' ~....~.~e~....~....~.~7 ~.~.x~.~.....~,~. ............ ~t~ ....... ~~..~...~ .......................... at premises ,ocate~a~O~.....~/~ ..~.; ....... ~rl..~..~' '"['~ .......... ~... ~ ..................................................................... ~r../~ . ~ 4.~¢~¢~,, ...... ~¢~.~¢,~.,~/.~ ............. 0~., ..... ~¢~ ....................... Building Inspector, FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instruotions 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 P~anning Board approval of completed site p~an requirements where applicable, B. 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. 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 3 L~,~/.¢~, '~ ' i~,' ~,0 New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location eT rroper~y .............................................................. House No. Street Hamlet . y..& ................................ County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. J. 0~'.~] (~.. Date of Permit .......... Applicant . ~ ~ ,~. ,~ .~. ~'.../?./~..~ .~'~..~. ......... Health Dept. Approval ...................... Labor Dept. Approval ........................ Underwriters Approval ...................... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ... ~...~?. ............... Fee Submitted $ .... .~: .0, ........... Construction on above described building and,~/~, it ~:ets all applic~bl~o~es~and regulations. App ,icant ?,..~ .C~..L¢~. ~,- .... .~..'~....~7~TI .................... FIELD, i]~SP~ECT!ON FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N.Y. STATE ENERGY COpE 4. FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved .... 19&.Permit ... Disapproved a/c ..... ~ ..... ~ ....................... ..~ ~ ~ ~ (Bu~mg Inspector) ~ ~/~/~ fi' 7~ APPLICATION FOR BUILDING PERMIT ~ ff;~-2~ ~Ze~ INSTRUCTIONS a. This application must be completely filled in by typewriter or inink 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 code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. apphcant, or name, if a corporation) (Mailing hddregs oI appficant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name o~ owr~di' of premises . .I. b~...~ .-dg~. ................................................... U ~ (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...~2. ?. ~ ................ Plumber's License No ......................... Electrician's License No. &/O.A4.~. .............. Other Trade's License No ...................... Location of land on which proposed work will be done ............................................... 1.3 ..................................... .......... House Number Hamlet ~-~}'T'/Zd'.,~ JCl ¢4 ,0 .y County Tax Map No. 1000 Section .................. Block .................. Lot ................... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~. ~ ....................................... b. Intended use and occupancy ..... ~,..,,-O f~.. X~ .................................... 3. Nature of work (check which applicable): New Building , .......... Addition .. Alteration .......... Repair .............. Rem6val .............. Demolition .............. Other Work ............... 4. 1: st~rnated Cost .... 1090 . · .~ .... (to be paid on filing this application) 5. If dwe!ling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage number of cars ' 6. If business, commercial or mixe~l occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height.. .............. Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth'. ................... '.. Height ...................... Number of Stories ...................... ' · pth 8. Dimensions of entire new constructmn: Front ............... Rear ............... De ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ~ Rear Depth 10. Date of Purchase ............................. Name of Former Owner ............................. 11. Zone or use district in which premises are situated ..................................................... 12. I)oes proposed construction violate any zoning law, ordinance or regulation: ................................ Will lot be regraded ........ i ........ ; .......... Will excess fill be removed from premises: Yes No 13. Name of Owner of premises~/~.~-~ Address 0~;0..&):gg..~r~. ~?~? · Phone No ~J ~-* .c/.g q.'.~.~7 14. Name of Architect ......... ~2 ....... ~ ......... ........ Address ................................. . . / Phone No Name of Contractor k,/-.0qM~ .~ ........ Address q.o~..~.),... Phone No.W 7.7.:.o!.7. ~ ..... PLOT DIAGRAM Locate 'clearly and distinctly al{ buildings, whether existing or proposed, and. indicate ail 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 6orner lot. STATE OF NEW YORK, '" S COUNTY OF ' ' t~k2~'Zflff~'~~ .... .... ~~l.si2 ... being duly sworn, deposes and says that he is the applicant abow~ named. He is the.. ! .......... ~ ~ ............. ~~n~gent, corporate officer, etc.) of said owner or owners, ~d is d~ly autho~zed to perform or have perfo~ed the said work ~d to m~e ~d file this application; that all statements contained work will be perfomed in the mannbr set forth in the application filed therewith. Sworn to before me this .. , ....... .;~/./.day 0f .............. Nota~ Public, . ......... z ..... . .....~ .~ .~ou~ty ~'~ : '~ ~ ELIZAg~ ANN NEVILLE ~' 4 Z" $~, ~'8125850,Juffo18 C*unty