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Home My WebLink About11491-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Zl 1521 Date February 25 83 THIS CERTIFIES that the building Accessary Location of Property .. 220.~.0. Mafi.n. Ro.ad ........................ 0rient.,..N. Y ...... House No. Street Ham/et County Tax Map No. 1000 Section . .q 7 ........ Block ....G .......... Lot .... 9~2 ......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .l~.o.y.e.m.b.e..~..27.... , 19 8~} pursuant to which Building Permit No. ~I ~1/¢95 Z dated ?e..c.e.m.b..e .r..3. ............... 19.8q.., 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 ......... an acoessary ga:~age The certificate is issued to Alfred W. & Elizebeth II. Rose ..................... [o~t,'e'r, '/~.~e'~r't~/~a'n'tJ ...................... of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE NO. Rev. 1/81 Building Inspector TOWN OF s~UTHO~D ~ SOUTHOLD, N~ Y. BUILDING P, ER~iTi (THIS pERMiT MUST BE KEPT ON THE PREMIS~S UNTIL ~ULL · COMPLETION OF THE WORK AUTHORIZED) 'O N. f1491 Z Per~issiori is hereby granted to: / t y ~: ~ , - , . ............. to ..... .~.~.~.~......~......~.~.~.~..~...~.~~..~ ........ ...... , ......... ~ ........... ~.~. .......... ~~. ....~,~...~.~ ............. co~ ,& ~p ~o. ~00o s~,o~ ,...~z.7.~...;. moe~ ~:~.~;~ ........ ~cot So.;¢~..~... purs~ont io oppllc*tion d~t~d ~~~.........~..., 19 ., ond ~pprovod by tho ,Bud~ing I~spector. Fee :$../...~.~ ............... I~SPectdr FORM NO. 6 TOWN OF SOUTHOLD J3uJlding Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and sub~ tted n 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 buildlngs, 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 dr 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 ~howing 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. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 ,.. . New Building .......... Old or Pre-existing Building(X) ......... =/Vacant Land Location of Property ~-4~. ¢~.~O..~..O.. ...... ,/~ ~: ~'~. ~., ~,.o~.: ...... ~2~,;~ ¢~./._~.~, . . . Hou~ No, Ztreet Ha~/~t Owner or Owners of Property .......... County Tax Map No. 1000 Section ~. Block Lot. Subd v s on ~'¢~ ............................... Filed Map No ........... Lot No .............. Permit No. Z/~/. Date of Permit . ~l~/~( .Applicant .~--4~...~~ ...... Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. Unde~riters Approval ........................ Planning Board Approval .................. Request for Temporary Certificate ..................... Final Certificat~ .~ .......... Fee Subm tted $ ~.~. . .% ......... Construction on above described, building and permirmeets all appli, cable~cod_cs and regulations. Applicant ~ ~~ - FIELD ~NSF~CTION · FOUNDATION (lst) FOUNDATION ~ (2nd) ROUGH FRAME & PLUMBING COMMENTS INSULATION PER N. Y. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: DATE: ~ B.P. 765-1802 9 AM TO 4, PM FOR THE FOLLOUz?,'z ~? m:'[CTIONS: 1. FC'"D?=~': ',q".~ ~ TWO REQUIRED p ..... ~, ~-,z~ CONCRETE 2. ?5 ....... ~ - ~ASAD.~G & PLUMBING 4. F~''''~ ~"~:7"'tUCTION MUST REQUff~EME~TS O~ THE N.Y. ~T~ CONSTRUCTION & ENERGY -- ~SIGN OR CONSTRUCTION c~ 7--///~ -zx6' ccz~ FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y, 11971 TEL.: 765-1803 E×amined, . ..... Approved ...... , Disapproved a/c .. APPLIGATIO~ Application No././.~. ~..ff. ........ 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 in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building ~nspector. 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 inspections. (Signature of applicant, o£namo~if a corporat'on) (Mailin~ address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............... ..................................................................... Name of owner of premises .... ~./.~.~. ~ ~...~/~.,..~.O~ ~ ............................................ (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 ....... ~,~ ~L~. ............ Plumber's License No ......................... Electrician's License No. ~...Z~./,~r~.y. Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. z'z o ¢o .................. ......... House Number Street Hamlet County Tax Map No. 1000 Section ..... ~ .7. .......... Block ....... ~ ......... Lot .... O~ .~ ......... Subdivision ..................................... 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 ........ .~..C~q: '~z', ~ C. ~...)~~~, ~ ...................... b. Intended use and occupancy ....... ~.e .~. c~. ~..~~. .................................... 3. Nature iofwork (check which applicable t~,t,ai~ ~.. Addition .......... Alteration .......... Repmr .............. Removal .............. Demolition .............. Other Work ............... (Description) 4. Estimated Cost.. . C ........................ Fee . (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 structurei, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... ~.. Height ...................... Number of Stories ...................... 8. Dimensions of entirsnew construction: Front ..... .~ .~. f .... Rear ............... Depth . .:~./. ........ Height ..... /'.5" ....... Number of Stories ............................................ . ............ 9. Size of lot: Front .... /..Z 2../: ........... Rear.../..~.or. ~ ............ Depth ....,,t'o~9.: ............ 10. Date of Purchase ........... ~ ................. Name of Former Owner ............................. 11. Zone o~ use district in which pre~nises are situated ..................................................... 12. Does proposed eonstruction viol~te any zoning law, ordinance or regulation: ../.'1./o. .......................... 13. Will lotibe regr ded ......... t~.~ ............... Will excess fill be remo~,ed,~om premises: Yes ~4. Name Of Owner of premises .~./~'~.~.,.q~..O/,. ~0~'~... Address .. t::~-,'~v~ ~P~ ./.~. ~.. Phone No ................ Name of Architect ........................... Address ................... Phone No. Name of Contractor . .C-',~-/~'... ~'t~,,a. Address .~.tz.e,o.~.ce.} .~.~.~., Phone No. PLOT DIAGRAM Locate clearly and distinctly all ibuildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. . r' ....~,~_~. '~tr~./_ __ .<Z~xf~..~-~1~[~ ..... being duly sworn, deposes and says that he is the applicant l(Name of individual signing contrt~ct) above named. He is the..; ................... '.~ .~<. ................................................... ~~actor,~7'~ent,/., .~-~--..-~ ~.,~ corporate officer, etc.) of said owner or owners, and is dul~ authorize~fl~t'~ v~£o"rm 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 Nota_m Public, ~ ~ ....... ~ .~ .. County }10. $2-8125850, Suffolk Term