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Home My WebLink About11493-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building ................................................ Bu~ngalow Lane ~ ' Location of Property . 2.890 .......... .P. IIi. x..v.a.t.e...R.d.,.,...~.mg.t.. 99.{1..P. 9.r.k..A..v?.,. ?.1 .a.t.t.i.t..uc k House No. Street Ham/et County Tax Map No. 1000 Section . .~3 .... B(ock ...0..~ .......... Lot 0.?..(5.00.3 Subdivision...~ ........................... Filed Map No. 7, .Lot No. X[ a conforms snbstantially to the Application for Building Permit heretofore filed in this office dated ·. ~.q~. ~. Ln.b.o.~.. ~.6 ...... , 19.8. ~. pursuant to which Building Permit No. 1 14 93 g · dated ....D.~.q 9 .m.b.~.r;...~ ............. 198.1. ., 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 ......... ~ ~l.e.ck. addition to an existing dwelling. The certificate is issued to .... .~.n.~. h..o.n.y...lq:..~.. ??.n.d..a..K....I.t73.5:?~ .................... (owner,4e~see. of the aforesaid building. Suffolk County Department of Health Approval n/r n/r UNDERWRITERS CERTIFICATE NO .................................................. *Appeal 02299 granted, Parker J. approval of access on 6/23/77. Wickham: This parcel D with Planning Board approval A 106-53. Building Inspector Rev. 1/81 TOWN OF TOWN HALL SOUgH'OlD, (THIS PERMIT MUST BE KEPT ON THE PRE~IS~S UNTIL I N°. J~1493 Z Date Permissior is hereby granted to: ~o ..... ~.~~....~.. ise~ im d at prem ate at IhSpector. JLL ~, ~nd ~pproved by the FORM NO. 6 TOWN OF SOUTHOLD Buildin~l Department Town Hail Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and subr~itted in duplicate to the Building Inspec- tor with the following; for new buiIdings 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 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-existipg Building(~)~_ :_= fVacant Land : ............ Owner or Owners of P~:;~rt;°' ,~~ ~ ..~; .......................... H~ County,o. 000 S. ,io, ....... .... ...... Uot ................ Subdivision ................................. Filed Map ......... Lot No. ,, ~.~% ~. , . Permit No..A/~2~. Date of Permit . .Applicant ~ ........ ~ ....... Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. Unde~riters Approval ..................... ~ . .Planning Board Approval .................. ' ~ ' Request for Tempora~Certificate ..................... Final Certificate ..... Fee Submitted $ ..... ~ ...................... Construction on above described building and pern'Ait~ meets, aH app~i,cable~codes and regulations. Applicant .... ,' ',~'~'~' >.~-,d..?-'~..;,~2 ....... FIELD INSPECTIO~ · FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C,ODE FINAL COMMENTS ADDITIONAL COMMENTS: FOIL~ NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. Approved~.~-~ ....... ..~.. .............. , 1 .~..../... Permit No.../../~.....~...~.~..~ ....... D~sapproved o/c ...................................................................................... 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 ofproperty must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced befqre issuanc~ ,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 o 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, odditions 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 ir~ buildings for necessary inspections. cant, or nome, if a corporation) ..... ........ ........ ......... ('Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................ ................................................................................................................................................... '-/r'? Name of owner of premises ......... ~..J'.L~.,.....¢~....~. ...... /~./~._~.~./7..~'........[2~J. ....... ~,:~.~. ........................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which oro,posed,wock will be done.. MapNo.: ....... ~ ...................... ~ ..... Lot No...~.,. ................... Street end Number ...... PC.~(~.L....~..~.~...~..D.~...~.~6~.~.~..~..~.~`.~.~...~..~ ........... ~.~..,..~4~.¢,,.k. .... Municipality State existing use and occupancy of premises and intended use and occupancy of .proposed construction: o. Exisiting use and occupancy ................ ~.C~....~,..C...~........C-.4L.~.~i,.,.t..~. .................................................................. b. Intended use and occupancy .............. ,,~./~. ........~..,~.....~-~.~.,0.~.~ .................................................................. 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ................. Repair .................. Removal ................. ~ Demolition. .................... Other Work ....... ~..~.C,.J.~ ......................... . .... (Description) 5. If dwelling, number of dwelling units ......... .~. ................ Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. 6. f business, comrnerck_d ar mixed occupancy specify nature and extent of each type of use ......... ~.....; .......... 7. Dimensions of existing slructures, iF any: Frorlt-..~.¢~'..f.~/.~.'. ......... Rear ....... ~..(2..[ ................ Depth ........ .~.. ........ Dimensions of same structure with alterations, or adclitions:. Front ...... ,,'~.,~...i...l~, ............... Rear ........ ~...~...,i .......... 8. Dimensions of entire new construction: Front R, Depth ................... , ................ ear .................................................... Height .................... Numbe~ of Stories ..................................................................................................................... ,0. DeLe of Pu,chase .......... ; ......... .............. lome of Former Owner 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation: .............. /~.~. .................................. 13. Will lot be regraded .....~..~..] .............. Will excess fill be removed from premise, s: (,),)'es (X~ No ;" PLOT DIAGRAM J~J ~lf~'¢"~¢ ~: Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-b~ck dimensions from property lines. Give street and bl¢ck number or description according to deed, and show street names and indicate whether interior or corner Io~. STATE OF NEW YO['~I.(,, ~./~ h_ I c ¢ COUNTY' O F .......... .,~¢~ .'~.~.~.1~..... ¢ ¢ '¢ ...................... ~/~.....~,../%/I[SS.,.,~¢ .................. being duly sworn, deposes and says that he is the applicanl ,(Nome of individual~signing contract) above named. ~ ~ eJ He is the ...................... ~.~.~.,.,..~,.,.~. ........................................................................................................................ (Contractor, agent, corporate officer, etc.) of said oener or owners, and is drily authorized to perform or have periormed 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 fo~h in the bpplication filed therewith. Sworn to Before me this ~ _ o, Momrv Pub lc, . ................ ~ ~oun~ ........ ~.~ ....... ~./ ...... ~....¢..../....., ........... ~- - / ~IZAB~H ANN NEVILLE ~ pUBLIC, Stat~f New York ~0. ~[-8~8~0, SUfJ01k O0u~ Term Expires March 30, 19.~