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Home My WebLink About10689-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building ................................................ Location of Property .... 3./45. Lu~hera~ l~oacl,~ ............... lia~;l~l.t~o~,. I~,Y, ..... Hou~ No. Street Hamlet County Tax Map No. 1000 Section .... ~ .... Block ..... ~ ......... Lot ..... 5 ......... .,,. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·..N~. y... ?7 ............. 19.8.0. pursuant to which Building Permit No... q..0~..8.9...Z ........... dated ...M~..~7, ................. 19 ~, was issued, and conforms to all of the requLrements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ....... Ac, oessol~r. Pol. e. Btam .................................................. The certificate is issued to ..... Rlabez'c~ .T~oulellOWSkii.. .... ... · :,. ..................... of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE NO ..... I~../.R .......................................... Building Inspector Re~ 4/79 FOF,~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING P. EP,.MIT (THIS PERMIT MUST BE I<EPT Oh/ THE PI~EMI£E$ UNTIL FULL COMPLETION OF THE wORI< AUTHORIZED) N? 10689 Z Permissmn is hereby granted to:.~.~...~ -.---- ..... ~.~.:.~.,-~... ....... Z-~_/~zz,. 2-. ~.c~..-.... ~.. ,..~'. ........... ... ~.~/z~.....~.~.~.o .... c ........ ~../~ . ................................................................................... premises Ioceted a~ ............. ='"'~' '/'~ ~ ' ' ond by Building I.speetor, Fee $.....~.. ................. spector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCtJPANCY 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· C. 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 Date .... '.~..~. ....... New Building ............. Old or Pre-existing Building ....... ~¢-'~.... Vacant Land ~.~.../~..~ .... Location of Property .... .). z../ .......::., ...... ................... , ................... :.,. House No. ~---- , Street I Ham/et Owner or Owners of Property . . . I.~. '~. .~.~.,,%(C~';C[' .... -ii . . .l~. }:~. c ~'~-J-~J%' ' '~ " i ........ County Tax Map No, 1000 Section .... /./. ,~ ...... Block ........... Lot..~'. ........ Subdivision ................................. Filed Map .~ No .......... Lot N~:_~o., l ........... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate .... , ................. Final Certificate ....................... Fee Submitted $.. ~o.O.d ....................... Construction on above described building ~_,rmit meets?l,! appliea ,le codes and regulations. Applicant .... .).:.¢. ¢. (. ¢:,. ¢~ Rev. 10-10-7S FIELD INSPE~TIO~ COMMENTS FOUNDATION ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined .~.'S.~ ........ ~./ ,l~ ~o Application No.../a. ~..~.. ...... Approved ~.. Disapproved a/c . . .~. . . .%-~. . . ............ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date 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 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 inspection throughout the work. e. No budding 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, butjld~g' code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary ifi~c~ons. ~ ~.~-- ........ ~ £.~.~.~....~..~. ~.-.-. ............. (Sig~ of applicant, or name, ifff~porati~n) - ..~!~.~ ~ .~ U..d,.~.~,.-~O,~ (Mailing address of applicant) State whett~er applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. · "'°8':~'~'"~' ........... ~"~ .... t ..... ~ .............. ~'"~ ................................ Name of owner of premises .. } .~...:.Q.~.~..*2q~ ........ ~..r: .~.~.c:.,q .~..,~.. ,g.?~.: ................................ (as oh 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. C~..U(~..~.~..~. ............. Plumber's License No. -.W....~.. 7 ............... Electrician's License No. Other Trade's License No ...................... House Number Street Hamlet County Tax Map No. 1000 Section .... ~'7 .......... Block ...... ~ .......... Lot ..... ~ ........... Subdivision .................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy o/4~emises and intended use and 6ccupancy of proposed construction: a. Existing use and occupancy . . . ~X q D.3! .~: ~ ........................................................ b. Intended use and occupancy 9. 10. 11. 12. 13. 14. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... Estimated Cost. Fee .................................... (to be paid on filing this application) If dwelling, number of dwelling hnits ............... Number of dwelling units on each floor ............... If garage, number of cars . ;~...C?.c-,&. ............................................................... If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... r)imensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Nun]bet of Stories ........................................................ Dimansions of same structure with alterations or addition~: Front ................. Rear .................. Depth .................... i.. Height ........ ~,/,.~ .......... Nu~f~of Stories ..... Dimensions of entire new construction: Front .... ~.~'(-.~t'.. ...... Rear .. ~5.~ :(J' ......... Depth .............. Height ~ ......... Number of Stones .. .~.~ .......................................... Date of Purchase ........... , ................ ,~,'Name of F~r~n~r O,w~er . ~...; ..................... Zone or use district in which pr~mises are situated. ~.~¢.~.;.c~. y.~. [~._!....~.'~: . .~ ...................... ;. ..... Does proposed const]~uction violate any zoning law, ordi~'~ula[ion: . .~I[~. ................... Will lot be regraded f]~ ..... ~ ..... ~ ............. ~;~fll e~v"~ ~xc~g~ fill'~'t~lnoved f[~eno~p, remises: ~ ~ c,Yes,.~ No Name of Architect ......... J .......... .~. ..... Address ..... ~'.~.~. I:-~:~ .....Phone No ................ Name of Contractor ... (~'vx .~7, ............... Address ................... Phone No ................ ~. "property lines. Give street and block interior or corner lot. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from ,er or description according to deed, and show street names and indicate whether ........ .~:'. ~-_~.~'..~ ff.~..~.. (. ~ ..................... being duly swom;~s and says that he is the applic~t (Na~e of individual si~ing contract) abow~ named, k J He is the ..... .~] ................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is ddly authorized to perfom or have perfomed ~e said work ~d to m~e ~d file ~is applicatiofi; that all statements cont~ned ~ this application are true to the best of his ~owledge and belief; and that work will be perfomed m the m~ner set forth ~n the apphcat~on filed therewith. Sworn to before me this i ~RY ~BLIC, State of N~ i~ 52.8125850, SMf~ ~ (~ig~ature,of applic~t), or NOTE: forCerly UNAUTHORIZEO ALTERATION OR ADDITION TO THFS SURVEY 15 A ViOLATiON OF SECTION 7209 OF THE NEW YORK STATE ~DUCATION LAW COpiEs OF THIS SURVEy MAp N~TBEARING THE LANO SURVEYOR'S INKED ~EAL OR TITLE NO. 75-S-77.41( now or formerly Mary Meskouri$ REVISIONS OCT. 16, 1980 YOUNG & YOUNG 400 0STRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W, YOUNG PROFESSIONAL ENGINEER A N O LAN D SURVEYOR SURVEYFOR: DOUGLAS HUNTER ~ FLORENCE A. HUNTER AT MATTtTUCK JGUARANTEED TO: HOME TITLE DIVISION OF 0¢ ~0~ NO T£ ' forrcerlY TITLE NO. 75-S-7241( peter.' ' ~o ~ :'Ei,:, formerlY MarY Meskouris ~ IVECH REVISIONS YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W, YOUNG HOWARD W. YOUNC SURVEY FOR: DOUGLAS HUNTER 8~ FLORENCE A. HUNTER AT GUARANTEED TO MATTITUCK HOME TITLE DIVISION OF C.ICARD TIT~; ]N¢;IIR~,N('~c ~n ~OTI~FY 8U~EDfNG DEP'/~IL~MkNI 76§-1802 9 AM T0 4 ~' ~L~OWING INSPE~I~N~ FOR POURED CON~E~: ROUGH - FRAMrNG g INSUlT[ON FINAL - CON~RUCTrO~ B~ COMPL~E FOR C. O1 FOR pOURED CONCRETE BE COMPLETE FOR C. O, ALL CONSTR[JCTION SHALL THE REOUIREMEN¢S OF TI4E STATE CONSTRUCTION & CODES NOT RESPONS~B~ DESIGN OR CONSTRU~ION . j