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Home My WebLink About10602-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No. 79937 Date Al~ril 29, ., 19 ..8? THIS CERTIFIES that the building ................................................ Location of Property ...~?.~.~...~.8. c..~.o.r~. ........... Maq;~;i~-uck, N..Y.... Avenue~ .............................. Houaa No. Street Hamlet County Tax Map No. 1000 Section ...... !.2.~. . .Block .... ? .......... Lot ...... ~.~. ......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated ApT:L3. ~9 198.0.. pursuant to which Buildin~ Permit No. 1.0.6.07 dated March 27, 19~.O. , 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 ......... One-family dwelling wl~ch fire place ~d The certif'wate is issued to . .LOR.J.$. ~.~Qk~8 ........................................... of the aforesaid building. Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector FO~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE 5OUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 10602 Z Permission is hereby granted to' / ......... Z.~..~...~.......~.:.z..~.~:.~ ......... .. z z.::..:... ~.,...¢..~. ~ ..... Z~. z-w.. ~..-z.. i~...¢..:.~ ...... . ..~.........~. ,, ........ ~o ...... ~.~.~.z~..~.~ ........ ~.~,.,~, ,.,~...,.~,.~....~ ~ ........... ....... ,.~ ........ ~.~.~.~zz~.~......~,~, ~,.~ ........... ~ .............................. ~.~ ~ ~m~, ~,~ ,~ .Z.Z.:.:.....~.~.~.-- ~...~.....'.:~'.'..~.~ ........ pursuant to application dated ,.~Ii/~9~'~..C~......~.'~.., ............... , 1~.., and approved by the Building Inspector. ~ee *./...~..::~ ..... Budding Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall $outhold, 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 or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable· B. For existing building,,; (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· 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 ........ /,'..L'. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ,,~ .......... ~,_~...~ ...... ;~ .....~. ?,~ ........ House No. ~ ~ ,,~ ~ Street ..... ~;r~e't Owner or Owners of Property . ,~....~,..~, ~. ~~.;. ' ................................ County Tax Map No 1000Secton /~-- Block '.~ ' ? ~ · /. .......................... LoT.. ~. ............ Subdivision ................................. Filed Map No .......... Lot Nj; .. '2, ......... PermitNo~.'.~.~.0..~.~ DateofPermit~..~.~?./.~..~Applicant .~.~.~ .~~i-~. ........ Health Dept· Approval ........................ Labor Dept· Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Cer,ti,ficate ..................... Final Certificate .....~.~.'.. .............. 0 L~ Fee Submitted $..-~.~ ........................ Construction on above described building and ~it meets all app~.~e_~des and regulations. Applicant ..... /...~...~... ~¢4'~...~..~.-:J. ...................... ,,.,o.,o.,, FOU~DATZOH FOUNDA?ION (and) 2. ROUGH FRAME & PLUF~ING INSULATION PER N.Y. STATE ENERGY C0~E FINAL ADDITIONAL COM~_ENTS: Memorandum from.... BUILDING INSPECTORS OFFICE TOWN OF SOUTHOLD TOW~ HALt, SOUT~OLt~, N. Y. 11971 765-18~)2 · V? ,,q lV FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL.: 765-1803 z.7., l ?ermit 0..4 / Disapproved a/c ...... .-'7.1'.... ~'. ........... ff.~ ......//' (Building Inspector) APPLICATION FOR BUILDING PERMIT ~...~., .~....~. ? Date .... Application No../.~..~.0~.. ........ 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, relatmnship to adjoining premises or public streets or areas, and giving a detaded 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 m 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 apphcable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessa~/i~spections. (Signature of applicant, or name, if a corporation) . ., o. .x. . /. . e .o. . 4 ....................... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) If applicant is a corporahon, s~gnature of duly authorized officer. (Name and title of corporate 9,fficer) . ~ Builder's License No.../..~ .......... t .~.. ~. Plumber's LicenseNo ...................... Electrician's License No. Other Trade's License No. '~ ' .~.' ~ ~ 1. Location of land on which proposed work will be done .................................................. County Tax Map No. 1000 Section ./..~.~. ........... Block...~. ............. Lot.../. ?. ............ Subdivision ................................ Fried Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...~..~.~...~:..~ .,I~. [.~..~].. ~g.M...~-. ~.tr./J~/..~ ................................ b. Intended use and occupancy ~/t(d.~.....~./.--./~..~r~J2./.~./.O.. '.A?..O~.....~'-'-/~t/,,'~ ¢.4k::... ~ ......... 3. Nature of work (check which applicable): New Building .......... Addition ....... Alter.~inn ......... Other Work 7T.~. ~ .~.~. Repair .............. RemovM~ .............. Demolition .............. ,~,~-.-.. . (Description) 4. Estimated Cost ............................. Fee ./.~L_~' i (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars ........................................................................ 6. If business, commercial or mixed p cupancy, 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 wit~ alterations or additions: Front ................. Rear .................. Depth ..................... !. Height ...................... Number of Stories ...................... 8. Dimensions of entire new constm, ctlon: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ' Rear ...................... Depth ............... 10. D-~,te of Purchase ............ ~ ................. Name o.f Former Ow~ter .............................. 1 1. Zone or use d~stnct in which premmes are s~tuated .... ;....w. r ........ ,~ ............................. 12. Does proposed constructmn wold:re any zomng law, ordinance or regulation: ...... /~.~. .................... 13. Will lot be regraded .......... ' .................. Will excess fill be removed from premises: Yes 14. N;tme of Owner of premises .................... Address ................... Phone No ................ Name of Architect ........... ! ................ Address ................... Phone No ................ Name of Contractor ......... I . Address . Phone No. 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 humber or description according to deed, a~nd show street names and indicate whether interior or corner lot. i STATE OF NEW YORK,. l ° S r~77,,'· ~.. ~~. · .' ..................... being duly sworn, d.eposes, and says that he is the applicant (Name of individual signing contract) above named. He is the ...................... . ................................ : ............................... ' (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dully authorized to perform or have performed 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 that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this Mo. sa'-4s2~7~ ~'f' '~ (Signature of applicant) Qtral~hed ~n Suffolk County Commission