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Home My WebLink About11374-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southoid, N.Y. Certificate Of Occupancy No.. ~J..1.3q.4 ....... Date ..... ~.e.c.e.m.b. 9?' .1.3. .............. ,198.~. THIS CERTIFIES that the building ................................................ Location of Property . :]-Q.0..~$~..&e.t~¢.e..D.~. ,..E.a.s..t;. ~.a.~. $.o.n.,...N.~ ........................ House No. Street Hem/et County Tax Map No. 1000 Section . 0 3.8 ........ Block .. 0 ~ ........... Lot .. 0. 9.2 ............ Subdivision... g.a.p. 5,9¢..Ha.~9? .............. Filed Map No.20.~.8 ..... Lot No..3.3.. .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated S ¢ p.~.er~b.e.p.. $ ......... , 198.1.. pursuant to which Building Permit No...1.1.3. 7. 4. .g ............. dated . ~.e.p.t, era.b.e.~.. ;1-5 ............. 198. ., 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 ......... ... .... :..],~-~D..s.~,9.p.a. ge...sB.e.d. ............................................. The certificate is issued to .. F;c.e. 4q r j_.c.l¢..E....~a, g.e.n, ............. (owner, ................ ) of the aforesaid building. Suffolk County Department of Health Approval .N ./g ...................................... UNDERWRITERS CERTIFICATE NO...IXl .//~ ............................................ Rev, 1/81 ......... ~- Building Inspecto} ........ FO~M NO. 2 'TOWN iOF $~)UTH~Lp TOWN HALL SOUTH*OLD, N~ Y. BUILDING PERMIT Re¥.6/~O~ 80 ~ (THIS PERMIT MUST Bf~ KEPT ON THE Pt~.EMISSS UNTIL dULL, COMPLETION OF THE WORK AUTHORIZED) N°. 11374 Z Do,e -~,~Z~-~ /3-- , ..~...d Permissio~ is hereby granted to: ~ ...~.~.......~Z~..~ ............ ~ premises located et .Z~ .......... {~2~., ..... ,, ! ...... ~ .......... ...............:' ..................................... : ......... ~ '"' ~'3~ ........................................ .~~..~.~.~.....~ ............... ~ .......... ,... ~ · ..... , ..-~- ....................... Coun~ T~ ~op ~o, 1000 Soctio~ . ~. .;..~. Block ,: ,..,....;..~ ~[Ot ~o ............ pursuant tO ~pplicaflon d~tod ..... ~ 1 .~ ~nd ~pprov~ by the Buil~lnO I~poctor, , FORM NO. 6 TOWN OF SOUTHOLD Buiiding Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions A. This application must be filled in typewriter OR ink, and subr~itted in duplicate to the Buitding Inspec- tor wi~h 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 topograohic features. 2. Final approval of Health I)ept. of water supply and sewerage dlsposa -(S-9 form or equal). '- 3. Approval of electrical installation from Board of Fire Underwriters. 4. 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 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 a~d "pre-existing" [and uses: 1. Accurate survey of peoperty showing all property )ines, 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 requ[red 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 . New Building .... .~.....¢'~.. Id or Pre-existing Building(X) ........ . = /Vacant Land -', ........... Location of Property ....... House No. $~ree~ /Ham/et Owner or Owners of Property .... County Tax Map No 1000 Section Block ' Subdivision ............................... / .Filed Map'No. ·.: ....... Lot No. . .' ........... Nealth Dept. Approval ......................... Labor Dep;. Approval ...................... ,.. Unde~riters Approval ......... . .Planning Board Approval .................. Request for Temporary Certificate ..................... Final Cerdficat~ ........ ~ ......... Fee Submitted $ . . .. .... . Construction on above described building and per'ir meets ail aP~c~l~odes and regulations. -:: .:"::::: ......................... TOWN OF SOUT~OLD OFFICE OF BUILDING INSPECTOR ' P.O. BOX 728 O%~N HALL SOUTHOLD, N.Y. 1 I97I TEL. 765-1802 _ - Applicant ~ hxs xs ~o a~vlse you shat the job under Building rermit No. ~%q~. issued to a ~na~ inspection aas~-~ nas no~ been done. In o~de~ to complete this £iie, it is necessary that a Certificate of O~,~ - ~u~=ncy be issued. F!ease fill out enclosed formls), return sa~e to the above office with a check for $5.00 payable to the Town of Southold. Please indicate to whom the Certificate of Occupancy is to be mailed, and arrange with this office for an inspeclion date. Thank you for your prompt attention. Very truly yours Victor Lessard Adminis tr~tor VL:ec Enclosures FIZLa INS?~CT~? COMME~ZS . FOUNDATION FOUNDATION 2. ROUGH FRAME & PLUMBING (1st) (2nd) INSULATION FERN. STATE ENERGY qODE FINAL ADD~ITIONAL COMMENTS: FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1502 Approved .. ~ ...... Permi~ No .... D~sapproved a/c ....... '. ......................... ' ( / / ............. .................. , . ;. (Buihdng inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This 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 tc schedule. b. Plot plan s}mxving location of lot and of buildings on premises, relationship to adjoining premises or public sire* or areas, and airing a detailcd description of layout of property must be drawn on the diagram which is part of this cation. c. The work covered by this application may not be commenced before issuance of Building Pemdt. d. Upon appm'.'al of this application, the Building Inspector will issue a Buildiug Permit to the applicant. Such pern shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in v/hole or in pan for any purpose whatever until a Certificate of Occupan slmll bare been granted by the Btdlding Inspector. ~PLICATiON IS IIEREBY MADE to the Building Department for the issuance ora BuildingPe~it pursuant to t Btfilding Zone Ordinance of the Town of Sonthold, Suffolk CounW, 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, azd admit authorized inspectors on premises and in buildings for necessai7 inspections. . ......... ~ ~ (Signature of a~pl~c~n%,, 9r ~meAf a corporation} ................ ~ ~ ~(Mailing ad.ess of applicant)_/ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build, .... ............................................... Nmne of owner of premises ........................................................................ (as on the tax roll orlatest deed) If applicant is a corporation, signature of duly authorized officer. (Nalne and title of corporate officer) Builder's, License No .... ~, ....~.~.. Plumber s License No ..... ~ ~ 'N ............. Electrician's License No.' ........ ~ ........ Other Tra&e's License No ........... ..~ ... I. LocatiOn of land on whic~h proposed wokwill be'done House Number / 7 d~-' Street ./~'?*'<: Hamlet County Tax Map No. 1000 Section .................. Block . ..~. ~ ........... Lot....d~.....,.,.~. ....... (Nalne) 2. State existing use and occupancy of premises and intended use and occunancy of proposed construct on ~,.Nature of wort; (check wlnd apphcablt:) New Building ....... Addition Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... ~,_~ */~ ~ (Description) ~ ~ .~0. , Fee - Estimated Cost ....... ~..< ................................................. (to be paid on filing this application) L If dwdling, number of dwelling units ............... Number of dwelling units on each floor ................ Ifgara2e .u . ~ ur of cars i. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... Dimensions of existing sm~ctur:s, if any: Front ..... ~.~ ....... Rear .... ~.Q ....... Depth . .. ~.~ ....... IIeiaht .../.~ ........ NumberofStories. ../J .............................................. Dimensionsefsamestmcturewithalterationsoradditions:Front ..~.~ .... 7. Rear .................. Depth ...................... Ilei~t ...................... Number of Stories ...................... D/mensiens of entire new construction: Front ..... A~.' .... Rear ....... 4~(... Depth ... l.~ ......... ' . ........... . ~tn)~ber of Stories ....... /. ? ..... , ......................................... 1. Sizeof ot Front ,Z PM. ....... Rear .... ..~.~ ....... ' ....... Depth ...~.q.P .............. ). Date of Purchase ............................. Name of Former Owner {. Zone or use district in wificb premises are situated .......... :" ................. : Does proposed construction violate any zoning law, ordinance or re=ula, on. ... ' N, r ,,'.. , ' ..... :-..- ~'~ O~ ~',~/ ~ o ~ ~p, re~veA f~m premises: '. t ................... Add,~.,s J ......... ~,~. Phooe No.. KT.. .~. .... Nam~ o, Arct ..... t ........................ :.. Address ................... Pt~one No ................ Name of Contractor .......................... Address ................... Phone No ................. · , . . . , PLOT DIAGRAM ~1~5 I.ocaty. clearl':, ay~ d~stmcfly all buildings, whether existing or proposed, and. indicate set-back dimensions from mpcrty hnes. Gwe s,rzet and black number or descdp'tion according to deed, and show stre[t n:m~o~ and indicate whether Ierior or corner lot. ~ / ~ rATE OF NEkl4YORK. -- OF ' s.s/ . ........................ (Name of iL.lividual si~ning contract) )or-' named, is the (Contractor, agent, corporate officer, etc.) said owner or owners, and is duly authorized to perform or have performed the said work anti to make and file this 2plicalion; tl~at all statemca~s contained in fids application ai'e true to the best of his knowledge and belief; and that tho ork will be performed in :he manner set forth h~ tho application filed t?erewhh. ~vorn to before 1ne this ....... ......... _.. _ , .., ........... No. 52.4524771 Qualified in Suffolk Coun~