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Home My WebLink About11526-z-- ~- __ FORM NO. 4 TOWN OF $OUTHOLD BUILDING-DEPARTMENT Office Of the B_uilding Inspector Town Hall 5outhold, N,Y, _ Certificate O{ Occupancy No...Z.].I. 5..8.5 ......... Date ............ ~a.z'. 9.h.,,, .3.0 .........19.8.3. THIS CERTIFIES that the building Addition Location of Property ...~.~.~..0 ~.e..e? Hole ])rive Flat-bituck ' - House No. Street Hamlet County Tax Map No. 1000 Section fl '15- . .Block fl ~ .Lot 1:/0 002 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .. ?.e. 9.e.m.b.e..~' .2.8. ..... , 19~.fl.. pursuant to which Building Permit No .... 'l. fl. .~ .2 .6. ~. ........... 9ecember 29 dated ............................ 19..., 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 ......... Attached .g.a?.a. ge...t.o..e..x.i.s.~i.~g, dwellin~ The certificate is issued to ...Fl.a~.~....&..~.qw..a~.d..~0.r.~.e.n. ................................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval' ... l~/~, ................................... N/A UNDERWRITERS CERTIFICATE NO .................................................. / . Building Inspector Rev. 1/81 TOWN OF TOWN ~HALL SOUTH'OLD, BUILDING FE~IT (THIS PERMIT MUST BE KEPT ON IHE COMPLETION OF THE WORK AUTHORIZED) UNTIL ULL Rev. 6/30/~80 · Bbildlng I~spector. Fee ............... Dote .......... ? .... , ...~....:.~/..~.iZ~ ~....~Yz~.~./...~.~.~Z.......;~.,.: ................ ~ ........................................ Coufity TaX Map No. lO00 'Sect,on ...././~ .......... Block .;".~.7 .........}Lot No ..... pursuant ~o application dated .~,~.~..e~. ,.. 19; and Opproved by the Permission' is hereby granted to: No. 1~1526 Z l~..~../ FORM NO. 6 TOWN OF SOUTHOLD Building DeparTment Town Hall $outhold, 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- tot with the following; for new buildings or new use: 1. Final survey of property with accurate location of ali buildings, property lines, streets, and unusual natural or tooograohic features. 2. Final approval of Heaith Dept. of water suop Y and sewereae d soosal--(S-9 form or e ual . 3. Approvat of electrical installation from Board of Fire Unde~rvvrit~rs, q ) 4o Commercial buildings, Industrial buildings, Multiple Residences and similar ,building~ and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the buiidina. 5. Subrni~ Planning Board approval of completed site plan requirements where aopl cable. ' For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing ail prooerty lines, streets, buildings and unusual natural or topographic features. ' 2. Sworn s[atement 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 inforrna. tion required to prepare a certificate. ' / C. Fees: 1. Certificate of occupancy $5.00 /land use ~'~,.~'/$5.00 2. Certificate of occupancy on pre-existing dwe ling 3. Copy of certificate of occupancy $1.00 New Budding . Old or Pre-existing Build rig(X) /Vacan+ ~*-,~ - Locet,on of~'op~rty ~.~.(.~_ .... --~--.-~-..../~ff...~ ~ ~~-~ Z' ~/. County Tax . )/~ ...... ~" ................................... ~ ,o. ~000 S~o,~on ............... ,~o~ .....f~ ...... ~o~.~:..~.~.... Suboivision ................................. Filed Map'No. - ..: ....... Lot N z-. :'"' ........... Permit No .... '. ua~e of, -rmi, .. ~Y/~ ,-~ ..... ~ ...... ;; ~, .. &. ~~. Heait~ Dept. Approval ........................ Labor Dept. Approval ...................... Unde~,vriters Approval ........................ Planning Board Approval .................. Request for Temporary Certificate ...................... Final Certificat~ ....... Fee ~ubmitted $ ............................. App icant . ' i~b/ .... ... ................................ ..~. ,o.,o.,~ . . 0o-~' J~oa3~ ., ,--, · ~. ,~ . . .'.-,. FIELD INSPECTION, COMMENTS / FOUNDATION ( 1 st) FOUNDATION ( 2nd ) ROUGH FRAME &' PLUMBING INSULATION PER N. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 ~ ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a c . ;: ~ APPLICATION FOR BUIkDtNG PERMIT INsTRucTIONS a. Tbis application must be completely filled in 'by typewriter or in ink and submitted in triplicate to the Buildi Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of brfildings on premises, r~lationship to adjoining premises or public stre~ or areas, and giving a detailed description of layout of property must be drawn on the dia~am which is part of this apF cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon apprcval of this application, thc Building Inspector will issne a Building Permit to the applicant. Such peal shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or nsed in whole or in part for any purpose Whatever until a Certificate of Occupan shall have been granted by the Bnilding Inspector. APPLICATION 1S IIEREB¥ MADE to the Building Department for the issuance of a Building Permit pursuant to t Building Zone Ordinance of the Town of Southold, Suffolk Connty, New York, and other applicablg Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for ~ ' ' m,cessary l~p¢ctlons. / ~_~f ~ (Signature of applicant, or name, if a corporation) (Mailing address of appiicant) State whether applicant is oxw~er, lessee, agent, architect, engineer, general contractor, electrician, plumber or bnild, (as on the tax roi! orlatest 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 ......................... Ekctucian s L cense No ....................... ' Other Trad'e's License No ...................... ' 1. LocatiOn of land on which prol~sed work will bedone ...................................... ' House Number Street Hamlet County Tax Map No. 1000 Section .................. Block ..... Lot ............ Subdivision ..................................... Filed M~ .... Lot ¢..- ...... ~. (Name) 2. State existing usc and occupancy of premises and intended usc and occupancy of proposed constructio~ ' b. Intended use and occupancy.. '''ff'~'~..~,/~.. .......... 1. Nature of work (check which applicable): New Building .......... Addition . ,'.~ .... Alteration .. ........ Repair Removal Demolition Other Work / ~..~. (,/..~. q_.~o. ,~/"-/~",.~ (Description) ' Estimated Cost ............................ vee . .t .......... (to be paid on filing this application) L If dwelling, number of dwellin~ units ................ Number of dwelling units on each floor ................ .... ................................ i. If business, commercial or mixed occupancy, specify h~ttt~etand extent of each typ~e of use ........... } ...... '. Dimensions of existing structures, if any: Front ..... /.Oe'7. ...... Rear .../. ~.' ........ Depth .c~. ,~/: ....... Number of Stmies Height ' Dimensions ofsame stmcture with alterations or additlons: Front................. Rear... ....,........, Depth ................... ?.. Height ............ , ......... Number of Stones .................... ~. Dimensions of enlire new consirt ction: Front ..... /. ~ t. ..... Rear ..../. ~..t ....... Deuth ,oq¢.~/. t. :r,, ~,. /,,5 Nt nberofStories O ..."k't~-~'.. . ........... t. Sizeoflot Fro~t .... ,]0,[.~ ....... Rear ] O~ ' De~! ;~.,~ ,~' ). Date of Purchase ..... /. q 7.: ................ :.. Name or Former O,wer ......... I. Zone or use district in which p~emises are situated... 2...' ............. ' ......~ .-.~. i". ................. 2. Does proposed construction rig, late any zmling laxv ordinance or re,,ulation' /1-,>/--,'/'"- 1. \\'ill lot be regraded ...... ~. 1, .... _,, ............ ... Will exce~s fill ho removed from premises: Yes No N fA '.' I ......... :" ~, ....... amc o rclut,,ct .......... Address ................... Phone No.. .............. Iq fC Add Ph N amc O ontractor ........................... ress ......... ....... one o. . . ............. PLOT DIAGRAM ' Locate clearly and distinctly ~d,l buildings, xvhether existing or proposed, and, indicate all set-back dimensions from roperty lines. Give street and blocl, nun:ber or descdp'tion according to deed, and show street names and indicate whether .terior or corner lot. % ~ ..... being duly sworn, deposes and says that lie is the applicant ontract) )OV~ named; , e is the ..................... ~..,,.,~,,r-,,,~.... .................................................. i (Contractor. agent, corporate officer, etc.) f said owner or owners, and is drily authorized to perform or have performed the said work and to make and file this )plication; that all statements contlained in this application are true to the best of his knowledge and belief; and that the 'ork will be performed in the manner set fortlt hi tile application filed therewith. worn to before me this i . ........ ........ . .' ' ~'~'are~ ~iTerm Expires ~ar¢ ,~... , ,, (Signature of applicant)