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Home My WebLink About11384-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificnte Of Occupency Date October 27 ~.1. THIS CERTIFIES that the building ................................................ 350 Pvt. Road ~9 Marion Lane, East Marion, New York Location of Property .......................................... House No. ~ Street ................ 031 08 030 County Tax Map No. 1000 Section ............ Block ............... Lot ................. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ~eptember 14 81 11384 g ..................... , 19... pursuant to which Building Permit No ...................... dated...... ...... September... ..... 22........ 19..8.1, 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 ......... Acceseovy Storage Building The certificate is issued to George W. Smith {owrm~m~xx of the aforesaid building. Suffolk County Department of Health Approval N / R UNDERWRITERS CERTIFICATE NO. N/R Building Inspector Rev. 1/81 Map No. 1000 S ~ ................ . ,: .,.? .......... ..../ _et co~ T? e~,o~'i~?:.~ ' /i ~o~, .;~ ~?~ ~,' .o. ~ ........ ...~..~ ......... , ..., and ~ppr~ by the ng I~spector. Fee $~ ............... ......... ~ev :6/3o48o:~:_ ~ ~. ~ ~:~ ~, (THIS pERMIT MUST BE KEPT ON THiE'PREMISI~S UNTiLIULL COMPLETION OF THE VORK AUTHORIZED) ' No. :~3s4 z Dote .~, Permissio~ is hereby granted to: ~ /~ ' '~ · / ~' ...~2~ Z.~.~ ............ :.~ ~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 ~ubmitted 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 featu res. 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 Date . (~.C.. 7~': ~..~,., ........... Old or Preexisting Building ............ V~cant Land ............. New Building Location of Property .~..~.~. House No. Street Hamlet Owner or Owners of Property ,..~/.~...4...~..~..~...~.~p.~'.~ .~....~..%..~..~./..~. '.~. .................... County Tax Map No. 1000 Section ....~...~./ ...... Block...~..~. ......... Lot...~...~.~. ........ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./~ ......... Date of Permit .......... Applicant . .' ................................ Health Dept. Approval ........................ Labor Dept, Approval .................... , 'l' · Underwriters Approval ........................ Planning Board Approval .............. -i~. ~.~,{0'~ ~ equest for Temporary Certificate ..................... Final Certificate ......... .1~.. .......~... Fee Submitted $ Construction on above described building and perm')~meets all appli§abte c~es a, nd regulations. Applicant Rev. 10-10-78 FIELD INS FOUNDATION FOUNDATION, ROUGH FRAME INSULATION STATE C,ODE o FINAL rION ~ "DATE COMMENTS (1st) MBING ER N. Y. ERGY ADDITIONAL COMMENTS: TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 / TEL.: 765-180:2 Examiner'S- ........... (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No.,/./. -.~.~.. ...... 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 to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stre~ or areas, and giving a detailed description of layout of property must be drawn on the diagram 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 approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such pent 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 a Certificate of Occupan 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 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, and admit authorized inspectors on premises and in buildings for necessary insp~tions. D ( 'g pp ' ,o e, ' p ' ) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build, Neane of owner of premises ........................................................................ (as on the tax roll or latest 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 ......................... Electrician's License No ....................... Otlfer Trade's License No ...................... 1. Location of land on which proposed work will be done /¥[ ~ L..~..., I"(,~z.4.~..~,_ . House Number Street Hamlet County Tax Map No. [000 Secffon ..Od/ .......... Block ..~Z ............ Lot..~*0 ......... Subdivision ..................................... Filed Map No ............... Lot .............. (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy . ~t-.~( . ~..~. ~ .'...a~....~ ......... !. L Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) Estimated Cost .............................. Fee ................... -. ....... (to be paid on filing this application) ;. If dwelling, number of dwelling units -- Number of dwelling units on each floor ................ If garage number of cars i. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..... '~. ............... z. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ' Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear ........... ' ....... Depth ...................... Height ...................... Number of Stories ...................... .... f t f 5. D~mensmns_o$ entire new construction: Front .. ~. ........... Rear .. ~. ........... Depth . ~. ............ Height . .~/. .......... Number of Stories ....... ./ ................................................. ). Size oflot: Front .../..~ ................ Rear ...... l~., ............. Depth .l~"O. ................. ). Date 6f Purchase .. ~.~'. C ¢~$.~...~ .. I .~.'/.! ....... Name of Former Owner . q~..~. ??...~.~.. ~,~p.~.a.,ep ......... 1. Zone or use district in which premises are situated 2. Does proposed construction violate any zoning law, ordinance or regulation: ..... N..o ......................... L Will lot be regraded .... ~/..~ ............. ; ........ Will excess fill be removed from premises: ~ ~ No Name of Architect .... ~ .................... ~.d~tr~ss~...~o.Y,.../.z..~. ....... Phone No ................ Name of Owner of premzses . ../~ ................ Address .~ t~ ................ Phone No.~. 7.7=..~. ~.7. ~' .... Name of Contractor ....~.. .................... A44r-~,s ~.~ .~.~.T., .t/..~.R./.o.~ ..... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from roperty lines. Give street and block number or description according to deed, and show street names and indicate whether terior or corner lot. rATE OF ~EW Y,~R~,,/./.~' r~ o ......... ::,i:,:~,:~~::.; .......... being )ove named· duly sworn, deposes and says that he is the applicant e is the .......................................................................................... (Contractor, agent, corporate officer, etc.) t' said owner or owners,~and is duly authorized to perform or have performed the said work and to make and file this ~plication; that all statements contained in this applicatiomare true to the best of his knowledge and belief; and that the · ork will be performed in the manner set forth in the application filed therewith. worn to before me. thi~ '~~'~¢~" ........ · .~...~.-~..~.......day of ..... ,9,~?, otary Public,~_d,Z~. ~..: .~..~~ounty %0,*. *. /7 . L) Notary Public, State of New Yo~k ,o. Cou. / ........ .............................. Commission Expires March 30, 1900 ' / (Signature of applicant)