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Home My WebLink About10594-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. ~.1.0.4..6.3 .......... Date ....... AprJ~t. ~0 ................. 19.87 THIS CERTIFIES that the btfilding ................................................ Location of Property/~/~s~ ~5' County Tax Map No. 1000 Section ... I 03 ...... Block ...04 .......... Lot .... 0 ~ ......... Subdivision...LJ.t~.]~e. I~e.ck. P~,.oper.t;.~.e~..Filed Map No..6048...Lot No .... 1.0 ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ·.. ?1.a.~.c. ~..2~. ........ ,19.8.0. pursuant to which Building Permit No....I p.5.9.~..Z ........... dated ...l~lt~.~qh. 2.h. ............... 19..8.0, 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 ......... ........ .~.c~.,! ~ .~ ~.o.n...~p..~.?.o ~.~.~.n. ~ ................................................ The certificate is issued to ..... D~¥~.d .I~op ..... ~ .Jo~.eph~.n.e .. ...... (owner, of the aforesaid building. Suffolk County Department of Health Approval ......... t~l!~ .............................. UNDI~RWRITI~RS CI~RTIFICATE NO ....... ~/.I~ ....................................... Rev. 1/81 Building Inspector FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE I(EPT Obi THE P~,E/vllSES UNTIL FULL COMPLETION OF THE WORK AUTr~ORIZED) N? 10594 Z Permission is hereby granted to ...... ~..~. z~....~....~......~..~C: .. ~L~.... ~.~ ~..... ~..~ ....... ...... C'~.~.-c.~.~.~..~.~ ........ at ......................................................................... premises located at ~.~....~.~.~:...Z~Z.~...y...__~Z~.//...~.. .~ ........ ~. .Z~ ......... ~.....~ ....... ~ ....... ~ .......... Building Inspector. Fee *..l~:..~... Building Inspector 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 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 o~ Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan 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 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. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancv 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 ~..,r~.~ .~[/: .~. ........... ~,,~.~'~I~.~.~..~,.. ~..~.*.... House No. S~reet Hamlet Owner or Owners of Property ~p~., . ~..~~~ ................... County Tax Map No. 1000 Section .... IO.~ ...... Block ...~ ....... Lot .... /.~... Subdivision L L~4~-. ~(-[~ .~gFe~(~.. Filed Map No,~... Lot No .... ~'~ ...... Permit No. ~ Date of Permit pplicant . Health Dept, Approval ........................ Labor Dept, Approval ........................ f F I tf t Request for Temporary Certi icate .................. ~na Cer i ica e ....................... Fee Submitted $ .... ~/.~. ~ ................... Construction on above deseribed building an~c~l~itA?~ee~.ll a~p~ab.~le~.e?nd regulations. Applicant../..~..~.~...~.....¢~.%,'~, ,~,,Z .~:~, .'¢~,, ............ Rev. 10-10-78 FIELD 1. COMMENTS FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME& PLUMBING (and) INSULATION PER N.Y. STATE ENERGY CODE FINAL FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TILL.: 765-1803 D~sapproved a/c ...... ;~ ............... ~//,.//0[ APPLICATION FOR BUILDING PERM IT Date .~./°..~?. ........... , 19 ~. 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 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 applicatzon may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Braiding 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 m whole or in part for any p~rpose 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 i~nspectmns. ;...: ..... (Signature of apptff:ant, or name, ~f a corp ration) (Mailing address of applicant) ' ~/~', ' State whether applicant is owner, lessee, agent, architect, engineer, geheral contractor, electrician, plumber or builder. Name of owner of premises LA. Tn-?.o5.... ..... (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 .... .~ .~. ............ Plumber's ~icense No ..... .: ...... : ........ Electrician s Lzcense No... :. ............... Other Trade's License No. /-. ............... 1. Location of land on which p~oposed work will be done. House Numbel Street Hamlet County Tax Map,No. 1000 Section, .l .~..~. ........... Block ....O../ .......... Lot .... ~....O..~...~... Subdivision .~O.5¢~..¢~.~ .................. Filed Map No. ~ ~ ...... Lot. ZO .......... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy...~ ~..~ ( ~ )....~ ~/4/~<..~ ................... b. Intended use and occupancy ~~.. .~/~ ...... '.~i~.~.~ .... 3. Nature of work (check which applicable): New Building .......... Addition ........ Alteration .......... Repair .............. Remoyal .............. Demolition .............. Other Work ............. ,~, ,-- ~ (Description) Fee ' / b .... 4. Estimated Cost. ~ .~.~. J.~..~.. ........................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling u,'nits ............... Number of dwelling units on each floor ................ If garage number of cars ' 6.If business, commercial or mixed loccupancy, specify nature and extent of each type of use ..................... 7.Dimensions of existing structures[, if any: Front ............... Rear .............. Depth ............... ' h He~g t ............... Number of Stories ..... ..~.. ............................... .. ................. Dimensions of same structure with alterations or additions: Front ................. Rear ~ ................ Depth ./.~..:~a~... ............ .. Height [. ~ .~.'~'..~.' ............ Number of Stories ...................... 8. Dimensions of entire new constrqction: Front ............... Rear / .............. Depth ............... Height ........... ~...~. m__J~r of St~$~ .............. , ....... ~ ........ 9. S~zeoflot. Front...~....!..~.q~.,['.. Rear .... .{~?....J..~..~.:... ~)epth'i 10. Date of'Purchase ........... i ................. Name oftF/~,~a~}~' Owner ............................. 11. Zone or use district in w.hich pre ~mises are situated ............ ~.]. .............................. 12. Does proposed construct, on violate any zoning law ordinance or regulation: ......................... (.k.. 13. Will lot :be regraded .... ~'~'~' 4 ................... Will exce~ fill be removed from premises: Yes 14. Name of Owner of premises ~),4 F~,/g..~,. ~/~/y~t~.~'Address .'~ -/,~/~.~o.6'q.. ~'7~f~ Phone No. )7...~.(d.. . Name of Architect . . ~57 .cr-d. 4,f. ~e~ ............... Address ................... Phone No ................ Name of Contractor .. ~ t>~.~.,eYZ .............. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all ,buildings, whether existing or proposed, and. indicate all set-back dimensions from property lin~s. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW ~'ORK' "Y-' ~.S COUNtrY OF. ~ .... ..... O.. i .................... being duly sworn, deposes and says that he is the applicant (Name of ind~¥idual signing contract) above named. He is the ..: .............. ~. .... , ................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; ~that all statements contdined in this application am true to the best of his knowledge and belief; and that the work will be performed in the manne~ set forth in the application filed therewith. Sworn to before me this q~(9.,~..: .,..~..~,..,~../ .... :day. ofj..~ .......... , 19 Oc~... V blio ..... I~OTtII~y .. £ ALS/f/ .................... P~o,~c, sto~o o~ ;~ r.~' / ~ (Signature of applicant) }65-1802 9 AM TO 4 PM ~:OLLOWING INSPECTIONS: 1. FOUNDATION . TWO FOR POURED ~. ROUGH - FRAMIN~ & D. INSULATION 4~ FINAL . CONSZRUCTION MUS~ DE COMPLETE FOR C O. ALL CONSTRUCTION SHALL MEE~ ~HE REQUIREMENTS OF 7HE N ~TAZE CONSTRUCTION & CODES. NOT RESPONSIDLE D~IGN OR CONSTRUCTION