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Home My WebLink About10606-zFOR~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z.1.1.1.'[5 .......... Date ..... ~q.e. 19.t;.emb. q .e..9. ............. ,103.2.. THIS CERTIFIES that the building ................................................ Locatmn of Property ,..28~. ................ 0u~.an. o.t:je, eeg ............... ~rg.e.n.g 9¥.[... r~ouse tvo. Street Hamlet County Tax Map No. 1000 Section . .Q~. Q ....... Block . p.3. ........... Lot ...0. 0..8 ........... Subdivision .... X ......................... Filed Map No..X. ...... Lot No...X ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ·.. P.e.ce~i~b~·. ~ 9 ..... ,19 9.0. pursuant to which Building Permit No... 1. 9.6.0.t~. ¢ ........... dated ... 1)~.c.qr~l~op..3 ~ ............ 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 ......... · .a. ~.c;7oe~, .en¢.l,q~ed..I~ .~;L.o..g cl,d.:(g. 2~ o~. ........................................ The certificate is issued to ......... A~l:one. J.,..i'l~.~J~g¢ll k.a.~ ......................... {owner, of the aforesaid building. Suffolk County Department of Health Approval ....... ln,/.l ............................... UNDERWRITERS CERTIFICATE NO ............... ~xZa ............................... Rev. 1/81 Building Inspector TOWN OF SOUTHOLD BUIkDIHG DEPARTMENT 'TOWN CLERK'S OFIqC. E SouTHOLD, H~ Y. BUIM)ING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. ~0606 Z Permission is hereby granted to: pursuant to application ~~'.~..~..~.. ............ , 1~..., and approved by the Building Inspector. Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N,Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions A. Th~s apphcation must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor w~th 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 features. 2. Final approval of Health Dept. of water supply and sewerage disposal--iS-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 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- t~on required to prepare a certificate. Feesl 1. Certificate of occupancy $5.00 2. Cemflcate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 New Building ............ Old or Pre-existing Building(:¢) ......... =/Vacant Land .......... Location of ?roperty ~c~,-<;Ic/'~ "' ~ Hou~ No. Street ~' ~H t Owner or Owners of Property ~ ~o ~ CountyTax Map No. 1000 Section ............... Block ............... Lot ................ Subdw~sion ................................. Filed MaD No ........... Lot No .............. Permit No./~ ? .0.¢...Z.. Date of Permit/.~z/..~.f/4~'. ~...Applicant...)~.~Z .~ .~. o..~.~..~.4.~ ~ ¢.~/¢ Health Dept. Approval ........................ Labor Dept. Approval ......................... U nde~riters Approval ........................ Planning Board Approva~ .................. ~ . ., Request for Temporary Certificate ..................... Final Certificate ....... : ......... * Fee ~ubmitted $... 5~. ~ ................... Construction,on above described building and perp~t~mee~s ali app~'cable~codes and requlations. FIEI~ INSPECTION COMMENTS FOUNDATION FOUNDATION 2. ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY COpE FINAL ADDITIONAL COMMENTS: /V FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approve~.. ? ....... ,19 .~.. Pe,~it No. Disapproved a/c "~ ...... (~ "~u ~';;~'i;~3;it'o;~ ' ...... APPLICATION FOR BUILDING PERMIT Application No../.. ~.'.~..~. ~ ....... Date .J?.~?.e.".m..~..~ .~.. 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 tdschedule. b. Plot plan showing location of lot and of buildings on premises, reltitionship 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 South. old, 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. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~ArT o ~t¢~' ~J'. (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 ..... .~..~..~.e'..~ ............. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No. "- . ..... 1. Location of land on which proposed work will be done .................................................. .~...~.( ................. .0.... ~?...~ .............. .c.-:~..-q~ ~ .o.~..~ .................. House Number Street Hamlet County Tax Map No. 1000 Section Subdix;ision ..................................... Filed Map No ............... Lot ............... (Name) 2. 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 ............. ~ ;:~)~L'~ '~ ~3'" k;k;~2~;¢)~ ............. 3. Nature of work (check which aplplicabte): New Building .......... Addition .. tx Alteration Repair .............. RemOval .............. Demolition .............. Other Work ............... ' , .jeff ,.~ ~,, ~ (Description) 4. Estimated Cost ............ Fee ...~ ................................... (to be paid on filing this application) 5. If dwelling, number of dwelling ~nits...............~A~'~' Number of dwelling units on each floor ................ If garage number of cars 6. If business, commercial or mixed occupancy specffz, nat,ure and extent of each type of use .............. · .... · · · 7. Dimensions of existing structures, if any: Front ............. Rear .< .-:.. ......... Depth.. ~ ~: .... Height ............. Number of Stones ...................................................... Dimensions of same structure w)th alterations or additions: Front ................. Rear .................. Depth Height Number of Stories q.~'..~. ........ 8. Dimensions of ?_tire new construction: Front .... .~.~ ........ Rear ...~..ar. ......... Depth .../.J. .......... He~d' [6,.~r .~,9~4..r.. ~.t. Number of Stories ....... P.*ff. ............................................ 9. Size of lot: Front ........... ' ........... Rear ...................... Depth ...................... 10 Date of Purchase I Name of Former Owner 11. Zone or use d~stnct ~n winch promises are s~tuated ...... /~ ....~. tJ.~. .................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ..... ZI.~ ................... Will excess fi~ be removed from premises: Yes No 14. Name of Owner of premises .~ig. ,r'q .a(~...~.a. 4t.a(0.~.~./~ress . .~.e.~.. $~',. ..... Phone No..~.~..~. ~. ~/~.. · · Name of Architect ........................... Address ................... Phone No ................ Name of Contractor ...... .~.~..'q .~. ............. Address ................... Phone No ................ ~ ; PLOT DIAGRAM Locate clearly and distinctly al! buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and blocklnumber or description according to deed, and show street names and indicate whether interior or corner lot. Stp¢ tt t ' STATE OF NEW YORK, COU~Y OF.. ' (Name--6f individual sig~ing contract) above named. duly sworn, deposes and says that he is the applicant He is the ..................... I ................................. . .... , .................... , ........... . (Contractor, agent, corporate officer, etc.) of said owner or owners, and is drily 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 Notary Public, ~.~ .... NOI^RY PUBLIC, State et NeO York . . .h~.~ ......... ~, ........................... [ : No. 52-4524771 (Signature of applicant) , QUsllfJed In Suffolk C0tmty i Commission Expires March 30,