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Home My WebLink About11367-zFORM NO. 4 TOWN OF 5OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. 'Certificate ',Of Occupancy No..7,108.1.4 ......... :,:Date ...... D¢~.ambeJ~..13 .............. 'THIS CERTIFIESthat the, building ................................................ i'~,Location Or'Property . 18.5..lt'rckovy. A~ze .,..(.&. 32.(l.Bivc. h. A3/~... )., .... Sou.thold ...... House No, ,/Street Ham/et 'County TaxTMap :No. 1000 Section . . 07.7. ..... .'Block . .. 0.1 .......... Lot , Subdivision .... .~.qOOO..~o,¥. ~,s.~;a~;.eg ...... Filed Map No.. 1 J 7.6~..Lot No. 23.1.-.235.. ~ Inc · conforms substantially to the Application for Building Permit hei:etofore filed in this office dated ...... ~.e.g t)0ra.b.e.~..1.0. , 19 .~ J pursuant to which Building Permit No...1 .1.3.6."~..g ............ dated ..... S. Op,t,,e,m, ,b,e?, ,1.0 ......... 19,8.'1, was issued, and conforms to all ofttm requirements of the applicable provisions of the law. The occupaz~cy for which this certificate is issued is ......... ·..~. ~.e.c.t~. ~ ¢.tt~,l; ~.p.n..'~9..e.~ %~c.~.~;. pr.t.~a !;:e..o.r.,~r.f. qz.n'.z.Zy..c}.~.e.Z.~%n.g., ........... The certificate is issued to . . . [,.a.~.r'..e.n.c.e.. ~g.ci..q,r~a.o.], .a. ?.ll.::l: .ng.:l..p.a..t;9 ................... of the aforesaid building. Suffolk County Department of Health Approval ....... i'l/. tt ................................ UNDERWRITERS CERTIFICATE NO ............... I~./..R ................................ Rev. 1/81 Building Inspector BUILDING Di~pARTMENY TOWN HALL · $OUTHOLD, N~ Y; - · No. 1~1367 BUILDING PERMIT · (THIS PERMIT Must BE KEPT ON THE PREA~ISEs COMPLETION OF THE WORK AUTHORIZED) Z Date Permis~sio~ is hereby granted to: ... ~...~,.~..z~... ~:.~,,~.~...~.,.Z~ ~/// Q , ,.. .. ............................ ...... , ......... , ................................................................................ ~~...~.~~:,......~.,. .~..z~....,, .............. Bu Idin~ In,per,or. Fee .......~ ................ Re¥.~ 6/3o~$o 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 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 w{th accurate location of a~l 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 use, occupancy and condition of bul]dings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required 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 . . (~C~o ~r New Building ............. Old or Pre-existing Building(X) ..... ~/Vacant Land Location of Property , .o[., .... ........................................... House No. Street Ham/et County Tax Map No. 1000 Section .... ,O. 7.7 ...... Block .... .O./. ........ LOTS'...?..~. ~/."7. Subdivision ........... f..~ ( .~.~. ............... Filed Map No ........... Lot No, . .(~...~, ,~' ..... · · . ......... Appli ........... 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 appi4ca)ble~codes and regulations. '- FIE,~.,D ~S~ZCT~ON FOUNDATION (1st) COMMENTS FOUNDATION (gnd) ROUGH FRAME & FLUMBING INSULATION PER N. STATE ENERGY GODE FINAL ADDITIONAL COMMENTS title NO. S - ~2/~.~Zj, '~ the Lon~ I~land Association ~ ~nd ~t.~y~ Unauthorized alteratlon or addltlon to this survey is a vlolaf[on of Section 7209 of the New York State Education Law. Copies of fh[s Survey Map not bearing fha land surveyor's inked seal or embossed seal shall not be considered to be a vaiid }rue copy, C~uaranfees indicated hereon shall run only fo fha person roi' whom the survey is prepared, and on his behalf to the Title Company, ~overnmenfal Agency and Lending Institution listed' hereon, and to fha Assignees of the Lending [nsHfutlon, ~uaranfees are not transferable to additional insfifu}ions or subsequent owners. CO. CLK. NO. //~ FILE DATE LOTS Z~/ ~0 23~ £/~CZ. ~LOCK l mPm Goose. Ba.y DRWN BY: ROBERT A SMITH ?. L. S. LAND SURVEYOR · LAND PLANNER ~47 BAYPORT AVENUE BAYPORt NEVV YORK LOCATION: ,jCO,~,/~i/) 0/~./ f'a~,'/'~ ~'/' 50~4 ~/~, ~ ~/~O1~ 11705 E~n /~ ~ ~ w ~ IIC. NO. 049239 PHONE NO, 472-O190 SURVEYED: 0~ 3~ /~78 ~ ~'~/~ GUARANTEED TO: L~~ ~ C~/~ ~/~/~ ;_~: t" =30' B~ ./ ~c~ . , CHECKED FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ..... ,197. ' Approvod ..... .... , ..-"7 Disapproved ale ....... ~ ........ _.,, ...... ,~.../.. ...... '. (Building Inspector) /\PPLIC>,TION FOR BUILDING PERMIT Application No./'/A ~ Z INSTRUCTIONS a. Tins application must be completely filled iu"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 <bowing location of lot and of buildings on premises, relationship to adjoining premises or public stre~ or areas, and ~qving a detaded description of layout of property must be drawn on the diagram which is part of this apg 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 pern shall be kept on the premises avaihthle for inspection throughout the work. e. No buildi:;g shall be occupied or nsed in whole or in part for any purpose whatever until a Certificate of Occupan shall bare been granted by Ibc Building Inspector. APPLICATION IS IIEREBY MADE to the Building Department for the issuance ora Building Pe~it pnrsuant to t Building 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 h~spec/ors on premises and in buildings for necessa~ inspections. ~ . .~O ..... ~.=. . " (Mailing ~dress of a~l~anQ , ~.. State whether applicant is ownm, lessee, agent, architect, engineer, general contracIor, electrician, plumber or builfl. .......................... (as on the tax roll o¢latest deed) ' ' If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ........ O~.r~.(,-i~.. ......... , ./ P n b~r s L~cens.. No ....... Elcctrtcmn s L ce,se No ' . .../ ............... Other Trade's License No ...................... 1. Location of land on which proposed work will be done. .. .~'.~/~.OC ............. .... ,,..8..s$... t.4. .... .................. ................... House Number Street Hamlet County Tax Map No. 1000 Section ... 0.7.~. ......... Block ...'..C.?.t ........... LotS...~.~./.~..,,~O.~.. ] Subdivision..~..-O.c,;'~;,E~..z~"ffS~'ff...~.~.~..-f:hr. 4'~-'~). ?... Filed Map No. (il (Same) .... (:~ :.7 ~ ...... Lot .............. 2. State existing use and oecul, ancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ~..A/gT', '.. ~.~---,.qe .,~/.(,.7...,dT'.'~. e'~..q,~,../(.~..~..~ .......... · Intended use and occupancy ..... ~,'~C7~ /Sff.~./~F~.'~/;.~, ..................... ......