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Home My WebLink About10736-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ....... g.~. 57.zt'.5 .... Date ........... A..u~.u.~.~.. ).2. ........... 19~..~. THIS CERTIFIES that the building . .~.d..d.5-~5.9.~.. .................................... Location of Property .3~..~5 ............ Strohson Rd. Cutcho~ue h~se No. ' ......... County Tax Map No. 1000 Section ...... q .0~...Block ......... ?.0....Lot ...... q.~. ......... Subdivision .............. .~ ................ Filed Map No .... .x....Lot No ..... x. ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ...~.~.e, .q7 .......... ,19~.Q. pursuant to which Building Permit No .... ~.Q?~.G.g. .......... dated ......... ~.¢B~. tiff. ........... 19~.Q., 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 ......... Garage addition to existing dwelling. The certificate is issued to ....... ]J-ER~3ER~..~AI~)~. ~..~.~ .~.~.~.Q~..A..E..22~..O.R~.. ............ (owner,~ of the aforesaid building. Suffolk County Department of Health Approval N576722 UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 FOF,~M NO. 2 TOW~ OF $OOTHOLD 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) N? 10736 Z Permission is hereby granted to: ..... ~~..r....~...,.......ZZ,~ .......... ...... Z¢'~. ~,.~. c./c....-....~:..~ ~o.. ~.z~. r~.cz:..:... ....~.~.~./.r.,~ .......... at premises located at ~..~.~..~`~....z~/..~./~.~/~.....Z~.~.~..~f~......~......7CL~/`~.~.4.U....~ pursuant to application dated ......... ~'...~7. ..................... , 19...~...., and approved by the Building Inspector. B FORM NO, 6 TOWN OF SOUTHOLD [~u i~d~n9 Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions Th,: ;2,')haatlen must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- 1. Fmc] sur,'e'/ of p o~,~r,/ w~tn accurate location of ail bui!dings, property lines, streets, and unu~a] 2. Foal ,,:~2rcvat of Heaitn Der):. of water ,, ' su~ulz aha se.zero.ce d~sposJ--(S-9 form or aqua ). 3. ~,c::c,,.~l of electrical msia!lotion from Booed'of Fire Underwriters. 4. Commercial buildings, Industrial buildm_es, Mu!t~ple Residences and similar buildings and instaHa- Uens. a c~rtd~cate of Code compliance from the Arch[tact or Engmeer respons;bla for the building. 5. ~u~:m~ Pl~nmng Board approve[ of completed site plan requirements ,,,/here applicable. For ex~s,hng bu,!does (prior to Aprd l~a/), Non-conformma uses, or buitdincs and "pre-existing" lane u:es. ~ A; ....... sun/e,/ of peoperty showing al/ prooerty lines, ~reets, buildings and unusual natural or 2. Sworn s~a~:ment of owner or pravlous owner as to use, occupant,/and condition of buildings· .3. g~(e o;' .~m/ housmg code or safer,/ ,, spca,ion of bulldinos or premises, or other pertinent mforma- Fees: I. Ca~:,cats of OCCupancy $5.00 2. C~r:~,c3ta of occup3ncy on pre-ex~sting dweihng or land usa 3. Cc=,,. of ce-;Iflcate of occuDanc'/ S].C0 Date .... - - ~ ............... ~. ..... ~./~411~.~~ ...... !~3,/o-Z6 .. ~ ............... ~ ............... Ccun~'/Tax :,.1~o No. 1000 Section ................................ ..... . ..... .............. Hs.Yth D~, Aperova ..... .................... Labor Dept. Approval ...................... ,.. U ~/r .... Ap~rozaf ........................ Planmng Board Approval ................... . Request for Temporary Cer[~fm*m .... ....................... BOARD OF FIRE UNDERWRITERS ~;i°°°77i" · , ~THE,, NEW YORK ,~URE^U o~ %t. EC'r.,¢,TY ' ~ '~ 85 JOHN STREET, NEW Y~K, NEW YORK 10038 ~ N 576722 only the eleetrlcal eq,dpme~t ~s ~seribed be~w and i~troduced by ~e oppticant named on the a&o~e application n~nher in the pre.si,ses of OUTLETS SWITCHES .0 FIXTURES OF NEUTRAL P.O. I~o× 143 L~t~ituck~ N,Y. ]i952 Tic, 242-.,i~ THIS IS YOUR BILL FOR SERVICE RENDERED AND IS NOT A CERTIFICATE OF COMPLIANCE THIS BILL PAYABLE AT THE NEW YORK OFFICE, 85 JOHN STREET, NEW YORK, N Y 10038 FIELD IN~PEC~0N COMMENTS FOUNDATION FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N.Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .... ...... .'...~. .............. ............... . ........ Disapproved a/c ...................................................................... .2. .................... Application No./.~....~..i~.~... ............. APPLICATION FOR BUILDING PERMIT Date ............ Z2......, INSTRUCTIONS 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 t° schedule. b. Plot pla? showing location of lot and of buildings on premises, relationship to adjoining premises or public streets o~ areas, and giwng a detailed description of layout ofproperty must be drawn on the diagram which is port of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this applica)rion, 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 ar 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 Lows, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descr bed 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. (Signature of apphcant,~;~ name, if a corporation) .... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· Name of owner of premises .....?.....~....~...~./.~...~..~....~..~..,~..~..~...~.....~..~......~......~....~..~'~.......~.~~. ................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. ,,,'~,,,,~,.~/~.FA/. ....... ,/,, .~,..,/. ................ Plumber's License No...~.~..:..~../.~ ...... Electrician's License No. ~.:~..~...~..C~../.~r~...'/~ ........ Other Trade's License No. ~...~..~.~.~..~'..~'./.~ ............ / ~ ~ ~' / ~ 1. Location of land on which proposed work will be done. Map No.: ...... .................................Lot No....~./....~.. .......... Street and Number~.~.~.~....~e.~/..~..././~.~.~..~....~...~.~.....'.~..~..~P~.~.~: ............................. ..~...~..~..~..~..~.~?.....' Muni~JpalJty 2. State existing use and occupancy of premises and intended use and 'occupancy of proposed construction: a. Exisiting use and occupancy ............ .~...~, .......................................................................... .~ b. Intended use and occupancy ....... .~...~ ....{~..~.~ ....................................................... · ' ~ .......................... 3. Natule of work (check wblch applicable). New Budding ................ Addition .... ~ ..... Alteration ............... Repair Removal Demolihar ..................... Other Work ................................................ ~' . . ,4D~ ,~.],~_~_, (Description) 4 Estimated Cost ..... r,/4..¢.:~. .......................................... Fee /.~. Z;'f ............... (to be pa~d on filing this apphcation) 5. If dwelling, number of dwelling units ........................... Number af dwelling units on each floor ........................... garage, number of cars ...... ,~..,.~-.~...~.,t4,.e.,~:..,.Z~.~.4Z.~.~, ~. I~ business~ commercial or mixed occupancy, specify nature and extent o~ each type of use ........................... 7 Dimensions of existing s~ructures, ff any: Front ............................ ~eor Hmght ........................ Number of Stories ...... ~ ...................................................................................................... D~mensions of same structure with alterations or additions: Front .................................... Rear ........................... Depth ............................... Height ........................... Number 9~ Stories :"t': .......................... 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ....................... Height .................... Number of Stories .................................................................................................................... 9. S~ze of lot: Front ........................................................ Rear .......................................... Depth ............................... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ....l.~.....~....m~,~...l.,.~.~.. ............................................................ ]2 Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No Owner of premises F?~.~.~,.~,?.x~.~,.c~.~.4~¢:/;.,,;Z..~,~ress ..~¢¢.~r..(~r~.... Phone No..Z~.~.:,~Z~.( 14. Nome Name of Architect ..... ~,,,,,..~,,w ........................................... Address ......... z~r..~ ....... Phone No ....................... Nome of Contractor 4..~x, nr .S.~.,.~Z,...J..~.~z .,¢~ ................ Address .,~.~.~:4.~ ..... Phone No. ,~.~,e.~...~f.~.~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property hnes. G~ve street and block number or description according to deed, and show street names and indicate whether interior or corner lot STATE OF NEW YORK, ,/ IS S COUNTY OF ...¢~.X/.,~FT..~...~/~. .......... f ' ................................. ~ ........................................ being duly sworn, deposes and soys that he is the apphcom (Name of individual signing contrac¢ above named. He is the ........ ' .......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have perEormed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and thor the work wiil be performed in the manner set foRh in the application filed therewith. Swam to before me this ............ ..... ................................ ........ ..................................... -- LINOA [' -- at Ne~ ~omLbignorur~t applicant) ~O~ARY ~UBL~C, St~t~l ~ ' ' ~o. 52-45z*~' s h~a[ch 30, ~