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Home My WebLink About10608-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy ~uly 11 ., 1980 .... .... Oat .................................. THIS CERTIFIES that the building ................................................ ~. .... ,,~.__...,. 111.50 Bayview Avenue Southold, II.Y. Lo.du. u~ ~suto~s ~y ............................................................... HOUSe NO. 0 ~- S~t 051 Hamlet County Tax Map No. 1000 Section ............ Block ............... Lot ................. Subdivision. ~lmlme:e ][ave~ .Filed Map No. 1133.LotNo' 11bt - 117 conforms substantially to the Application for Building Permit heretofore filed in this office dated ~lax.oh 31 19 ~.0. pursuant to which Building Permit No. 10608Z dated ..... .N.?.~..~...37 ............. 19...80 ,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 ......... Aooe,,8or7 8fox'age · ~gene A. Cohen The certificate is issued to ..................... /o'~;n~,'~ ..................... of the aforesaid building. a/a Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO .................................................. Rev FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT 'TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10608 Z Permission is hereby gronted to: .... .... ..z...C.,,C'~....~.~.~r.~ ..~2~. ~/-~,~ -- .~.-__ ~,~. ...... ~.~.~/~ .......... /~..../ .... ....... ~......~ad ............................................................................................. z~ .... ~,~,~ ,~,~ ~, .~.~.o .......... ~-,=~...~....ez~'~.~..~. Building Inspector. Fee $....~. ~..,,;'.',:7. ..... 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 Wpewriter 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 features. 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 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 requ ired 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 ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property.. ! ~.~' .~. ............ !~.f~r, .,/. ,q//..~-~ .~.). ,./~...~,C ....... 5.~. House No. Street Ham/et Owner or Owners of Property ...~:~.'..~.57,',~:,.. ,/('./1. t.. ,~.~'./.".(~:', .~. .......................... County Tax Map No. 1000 Section ~ ~:%.~ ~ .... Block .... .~. S.'~. ...... Lot ..... .~..~.7 ...... Subdivision. ~'~b'h.! ./'.f (=:'Z,,.../.~, .~.(.~:~?. .......... Filed Map No.../.J?, .~....Lot No..1./.~..~./.f?.. Permit No../'.O~.~. ,?: .~.=- Date of Permit '.~/..~/.~.( .~.O, Appiicant....~.. ~./..~%~:.m~..~.~. .~..'. ,(-.~ Health Dept, Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate .... Fee Submitted $..~.,..~. ...................... Construction~ on above described building and permit. ~--~meets all applicable coded ~ations. Applicant Z I w,:zFe~ ~,vif.,4,'n ~.00 ~.f.. FOmm~A~I0~ (~s~) FOUNDATION 2. ROUGH FRAME& PLUMBING (2nd) INSULATION PER N.Y. STATE ENERGY co~E 4. FINAL ADDITIONAL COMMENTS~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 76§-1803 ^pprove&&*.. ....... , l .i. e=it No ............ / Disapproveda/c ...... : ...... ........ ....... // (Building Inspector) APPLICATION FOR BUILDING PERIVIIT Application No. [.~;~...~.~...~. ....... 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 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 an 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, building code, housing code, and regulations, and to buildings for necessary inspections. admit authorized inspectors on premises and in /'L~: _ ...., .-~...~.~..-r~,~4:. c:4~...~:,'-~.~... (Signat0)~ 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 or owner of premises.. ~-~. ?.':~..:. :~--?/~.?(~....~/. · ........................................ (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 License No .......... ~ .-~. ~.~. .......... Electrician's License No ............ '~-x, ......... Other Trade's License No. ~--r-- 1. Location of land on which proposed work will be done .................................................. /~<;~ ~d, / ~-v~/~- /~" _C'o,,~-~,=_ ........ ......................... ..... .......................... .... House Number Street Hamlet County Tax Map No. 1000 Section .... ~ ..... Block ..... .~...~.T ...... Lot .... .(~...-~:--./ ......... Subdivision ,~- U/-~/vT¢'T.~ /-/./f.V/.[~7~../. ............ Filed Map No..././. ~.~..~.~. ...... Lot ././.~. ~f./..~../(~f~'.Z~ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy I)I/D e.'~ t ~'J' O- b. Intended use and occupancy ................................................ 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal ;' .......... , Demolition .............. Other Work ............... i (Description) .~ , . 4. Estimated Cost ...... ~ ................... Fe ............................ 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 occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if ~ny: Front ............... Rear Depth Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height .......... : ........... Numb~r~of~tories. Depth ....~ ........... 8. Dimensions of eatij'e new construction: Front .... ./.~..~ ....... Rear .... /..~.; ~. ......' ......... ! ......... Height ...... ~.~. ...... Number Of Stories , ! ................ /o'~t ~ .......... ;/~;"'r" 9. Size oflot: Front .............. , ........ Rear ...........~ ......... Depth .iii~i~.'.'~.i.)'iiiiiiiiii p ' 10. Date of urchase .............. , ............... Name o,~l~aer Owner ............................. 12.11. Zone or use district in which.,..~premis?s are situated .......... ~ '~' ........... /'///5 ......................... Does proposed construction j. cwccte any zoning law, ordinance or regulation: . . . .~, .'f. ...................... ~ 13. Will lot be regmded ..... .r~.,~,,~ ~,~. ,,~. -,,*., ..../.. Will exgess Jill,be removed ~oTn~premises: _ Yes /(~j~' 14. Name of Owner of premises 47.~¢..~'.¢../'/. '. (-.~../~.~.:~.. Address/. ~,-¢?. './~.A¢'~. ¢~..~'.?~..,4~ Phone No...2' f..F?..~/~.¢. ¢'~.. Name of Architect i Address Phone No Name of Contractor ............ i .............. Address ................... Phone No ................ Locate clearly and distinctly all property lines. Give street and block interior or corner lot. PLOT DIAGRAM whether existing or proposed, and, indicate all set-back dimensions from [escription according to deed, and show street names and indicate whether I 71/' STATE OF NEWYORK, ,~ COUNTY OF .~^.. ...... .~.t4(_~..~...A-~../clt.,....(-<. 0 )~-,/0¢ ................ being duly sworn, deposes and says that he is the applicant (Name of individual signinb 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 re ru to h e h k o I e nd e'er' application; that all statements contained in this application a t e t e b st of is n w erg a b h , and that the work will be performed an the manner ~et forth in the application filed therewith. Sworn to before m~his .' . -- . . ..... ,,~ .... ., ............ clay ot .,/,/¢ t44. ............... 19 .".. Notai'y'Public, . ................. i .......~: County LINDA F. KOWALSK[ J ,o~r,n¥ eunuc, stm of r4:,w ¥¢rg? ........ (Signature of applilin't3 I i~o, 52.4524.771 , Qualified in Suo k County Comrmssmn ExpJres March 30~