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Home My WebLink About11528-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hail Southotd, N.Y. Certificate Of Occupancy No.. ~.1.q8..5.5 ......... Date .... .~.a. qu..ar~ .~9 ................. 19 .~.2. THIS CERTIFIES that the. building ................................................ Location of Property . .t~64 5 ............ .~.qc..ky. ....... .... House No. Street Hamlet County Tax Map No. 1000 Section 09l ........ Block . .0.1 ............ Lot. 9.1.3. ............ Subdivision ....... X ................ , .......Filed Map No. ~ .... ;..Lot No. X. ............ conforms substantially to the Application for Building Permit l~eretofore filed 'in this office dated · l)~:.erabet'.. 1 9 ....... ,19.8l pursuant to which Building Permit No... ~ J5.~8. g ........... dated .... J).~c~l~Lb.~r?. 3.~ .......... .. 19 B. 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 ......... ·...a.n.. g.O.d.l, ~ .:t p.n...~9..e.x. 5..s.g.~.q g..d?.e..~ .1.J..n.g..t'p.r' . .~ ~.o.r.a.g.e.. ....................... The certificate is issued to ....... ~gPg.e. r:I~gdt~z:HLp .~..u;t..l:e. ...................... (owner, l~aze* of the aforesaid building. Suffolk County Department of Health Approval ...... 2~.Ztt ................................ UNDERWRITERS CERTIFICATE NO .............. iq/1t '~ ........... Rev. 1/81 Building Inspector TOW. O, s~T"~ BUILDING DEPAR'~E~NT, TOWN HALL SOUTHOLD, N~ Y. BUILDING PERMIT) (THIS PERMIT MUST BE KEPT ON 'I~HE PRE~ISES UNTIL EiULL COMPLETION OF THE WORK AUTHORIZED) ~ N~? 115 2 8 Z oot, ~..~.Z ?~...~.....,~.../...., 1 , 9. -~../ Permisslor is hereby granted to~ / . ~} ............ ............. .:~ .~ .~ .~ ~ , .......... ...... ~.. ~.~.~ 45~.~.~. ~..~..~ ~...~ ..... ..~cm~ ......... ~: .............. ~.,,~ .~,¢~ .................. ~, ~,~ ,o~, o~ ...~~.....~~...~h~.: ~ ~ ........................ CouS~ To~: Map No. 1000 Section ...~. ..;... lace ....... : .... t No .......... ~ pursOant ~o application dated ...~...., 19.~.~., and?pproved by the 8uil~ng Ifispector. Fee ~.../,. ,~.... ........... FORM NO. 6 TOWN OF SOUTHOLD [{uilding Department Town Hall Southold, N.Y, 31971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter 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, 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 us~, 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 Date 'z'~ ............ l .......... New Building ............. Old or Pre-existing Building ,..,~. ....... ~'Vacant Land Location of Property .~/.4. ~ ~.~ .... ~ .~. pC,~.:, c" , ' ' O orOw ers of Pioperty ..~'~ ....... ~, ........... County Tax Map No. 1000Section ,~,~,~ ....... B(ock ..~.{ ........ Lo,...~./.~.~ .. Subdivision ................................. Filed Map No ........... Lot No.. Permit No. l] ~. ~ Date of Permit ~ ;~//~plicant ,~ ~-~,~,' ....... Health Dept. Approva~ ........................ Labor Dept, Approval ........................ Unde~riters Approval ~ Planning Board Approval ............... ~equ~st for Tempo[~rg Certificate ...... ~. ............ Final Fee Submitted $., x~-, Construction on above described building and perm,i,t meets all applicable codes and regulations. App,,can . . . . . rC (1" ":' ' Rev. 10-10-78 FIELD INSPECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY QODE FINAL DATE COMMENTS ADDITI~AL COMMENTS:~ 765-18P9 o A/',~ '~O ~ nfi,i FOR THE 1. FOr. Ih,~'~''~h~ - TWn F{FQUIRED FOE '~'U?':I') CONCP.'E'FE 4. FIN~,I - r'mN'S-~",~LJCTION MUST ALI.. COi",'c'F~' IC~'ION SHAI-,~ ~EET THE REOT/',PC~'~NTS OF ThE N, Y. / STATE CONSTRUCTION & ENERGY / CODES. NOT RESPONSIBLE FOR/ DESIGN OR CONSTRUCTION ~ FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1802 Disapproved a/c ....... , ................. ~ .... ../ ' , ;. (Buildin~ Inspector) APPLICATION FOR BUILDING PERMIT Application No./. [.~...~...~7 ....... Date / ~ 19~/ INSTRUCTIONS a. This application ~nust 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 accordiug te schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stret or areas, and giving a detailed description of layout of property must be drawn on the dia~am which ispart of this apg cation. c. The work covered by this application may not be commenced before issuance of Building Pe~it. d. Upon apprc'.'al of this application, the Building Inspector will issue a Building Permit to the applicant. Such pern shall be kept on the premises available for inspection throughout the work. e. No building shall be occnpied or used in whole or in part for any purpose whatever until a Certificate of Occupan shall have been granted by the Building Inspector. ~PLICATiON IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to t Buihling Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable 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, ~d admit authorized inspectors on premises and in buildings for necessaz~~ ~~_,. (Signature of applicant, or name, if a corporation) · ............. of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build, N,'une of owner of premises ....................................... or atest (tee If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .... ~'~...~'..~. ............. Plumber s Lmens.~ No. Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ................ . . r.-.:. . ............. . . -. ......................... House Number / Street ....... Hamlet County Tax Map No. 1000 Section ...O..'~.../ ........... Block ...-O.d ............ 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 . ..~...~v...~......~. .................................. b. Intended use and occupancy .. .qT. .... ~ · . .: ., :'7, ...... ' .... t. Nature of work (check which a }plicable): New Building .......... Addition ..... Alteration .......... Repair .............. Removal ........... Demolition .............. Other Work ............... ~/ -~' (Description) Estimated Cost ... ~ Fee . ~. ~",2 . ¢. i (to be paid on filing this application) ; It' dwelling number of flwellingiunits '~' Number of dwelling units on each floor number of cars 4 I f garage, . ...................................................................... ;. If bus ness, commercial or mixed occupancy, specify l~ature, and extent of each typ. e of use .-.'~.-- . --. · · . . . .. .... L Dimens:ons of existing stnctures, ~fany Front ..... {..~. ..... Rear .... $. 5/ ......... Depth ' Z,.~." ' ' '" tlei:i' t ...... Number ot Stories ............... ,x ................................. '- . .. Dimensio ~s of same stn~cture w~th alterations or addmons: Front ............. Rear ............. Depth ~Z-C[ ' lleight /..~. .......... Nnmber of Stories I. Dimensions of entire._new, const[uction: Front ....... .~ ....... Rear ...... m ...... Depth . ."-' ............. Height Nnmber of Stories ). Date dfPurohase .../.?. 2, .(. .............. ;.. Name of Fo_freer ~wner .~, .~ ...... Zone or use district in which pr~mises are situated . /'~~ .&. ~ - ) Does proposed construct on v olate any zoning law, ordinance or regulation: . .~ .......................... Will lot be regraded ....... ,..~ ................ .... Will exce,ss fill b,e remqved from premises: ,Y.--~_ .,'~L..No L Name of O,,ner of pr~ml~s ~ .~ddre..s . .~-~- .............. ~": Phone No ................ Name of Arcl ~t~ct ......... , .... ,q ............ Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly al( buildings, whether existing or proposed, and,indicate all set-back dimensions from roperty lines. Give street and blocklnu ~.ber or description according to deed, and show street names and indicate whether tcrior or corner lot. / TATE OF NEW YORK, , OUNT. X OF . · ~ ......... ~,~ ....iS'S ~ ~,~-rl'~ being duly sworn, deposes and says that he is the applicant . (Name of indMdual sigriing contract) )OVe nalned. e is the .... ~.:...'~. ....................................... .............................. (Contractor, agent, corporate officer, etc.) f said owner or owners, and is du!y authorized to perform or have performed the said work and to make and file this ~plicaiion; that all statements contiained in this application are true to the best of his knowledge and belief; and that the '.ark will be performed in the manner set forth in the application filed ~herewith. worn to before me this i850, Suffolk C0unbt , ' ........ i ;Term Ex 'es March 30, 19..~..~0'*''"'~ (Signature of applicant)