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Home My WebLink About11401-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ..... 1. J:.Qg. ~ ........ Date .................. Ju.ly. 20 ........ 19 82. THIS CERTIFIES that the building ................................................ Location of Property . 2675. Cox. bleek i Road ~ · I~la il; 7_ tu.ck k~r'a3i .... ~ ~ .............. House No. ' ' ' County Tax Map No. 1000 Section .... $ :L3 ..... Block ... 07 .......... Lot .. 009 ............ Subdivision ............................... Filed Map No ......... Lot No...; .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... Sept, .23 ..... 19 B.1. pursuant to which Building Permit No.. 114,01 ............... dated .. Sep tembe r. 2c~ .............. 19/3.1., 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 ......... ....... c.h. ~.m.~.~X .................................................................. The certificate is issued to . . .I~lary .¢.. Liadsay ......................................... (owner,/essee or tenant) of the aforesaid building. Suffolk County Department of Health Approval., ~I./.A. .................................... UNDERWRITERS CERTIFICATE NO...U/P, ............................................ Building Inspector Rev, 1/81 TOWN!O *, TOWNi:H~LL sou~.o~e; ~,r. (THIS PERMIT 'MUST BE KEPT ON TH~ PRE~, IS~S UNTIL ~ULL COMPLETION OF THE WORK A~JTHORiZED) i ~ i: No. 114O1 Z tO at premises located at ...... ...,. · · ....;~ ..........................~ ~.; , .,...~....;.... '~....~ ...................... .~ ........................... County Tqx Map No. 1000 Sechon ,...~ ...... ~. Blc~:~ ~..,.~. ~' : 19 l ~, and }approved by the pursuant ~o apphcatmn dated .... ;...~. .~;...~..-..?..;:.-.., · BU Iding Ihspector. ee ~,...., ......... FORNI NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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. Finat 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. 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 buildings. 3. Date of any housing code or safety Mspectiqn of buildings or premises, or other pertinent informa- tion required to prepare a certificate. / Co 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 ....... ~.~ ~ ........ ~ 'Vacant Ne~ i'/h¢l~t Old or Pre-existing Building(X) Land Locat,ooo, Property .%?S- O.d.'. House No. Street Hem/et Owner or Owners of Property ...... Z~I~ ~r-~.... C~-~ ~. ~.[' .~.,.~ County Ta× Map No, ~000 Se*tion ....~!~ ........ B~oe~ .... ~. :?. ...... Lot .... .~P..~ ....... Subdivision ....... .~2. ........................ Filed Map No. ~. ........ Lot No.. ~. .......... Permit No..~.l.d~.('-~.J... Date of Permit ,~./7~/r~/..Applicant ... ~t¢,...~., ...... Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. Underwriters Approval ........................ Planning Board Approval .................. ~ .. ~ Request for Temporary Certificate ..................... Final Certificate ................. * Fee~b~tted S .... ..~..,..d~ .... .~. ......... Construction on above described building and permit' meets all appl~cabte~co~es and regulations. Applicant .; .... ,~.-.._,~.~,, ...... ,.~: ..................... ~. ~ ~o3~0 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL $OUTHOLD, N.Y. 11971 17 June 1982 TEL. 765-1802 Mary C. ~indsey Applicant Mattituck1 NY 11952 Dear Mrs. Lindsey : This is to advise you that the job under Building Permit No. 11401 issued to Mary Lindsey on _~_9o~~ for rhimne,~ is completed and a fihai~ih~pection-has/~ has not~ been done. In order to complete this file, it is necessary that a Certificate of Occupancy be issued. Please fill out the enclosed form(s), return same 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 and arrange with this office for an inspection date. Thank you for your prompt attention. Very truly yours, Victor Lessard Administrator VL:ec Enclosures mailed, FOUNDATION (1st) 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 Examined .. ~...., 19 .~2/. Approve . .".~'.' ..... , I , Permit No .......... .,. (BuJldJng Inspector) ~ APPLICATION FOR BUILDING PERMIT Application No//.../. ~/~.~P.~. INSTRUCTIONS a. This application nmst 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. Plet plan shoMng location of lot and of buiklings on premises, relationslfip 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 apl: catio:~. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon apprcval 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 occupied or used in whole or in part for any purpose whatever nntil a Certificate of Occnpan shall have been granted by the Building Inspector. APPLICATION 1S I IEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to t Building Zone Ordinance of the Town of Soutbold, 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 ou premises and iu buildings for necessary inspections. (.Agnature c~ applican}, or name, if't/corporati~ , : l ........... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engiueer, general contractor, electrician, plumber or build, If applicant is a corporatiou, signature of duly authorized officer· (Name and title of corporate officer) Builder's License No..'7.0.Z ~}12ff. ............. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Locatibn ~o~/f._,d on which proposed work will be done ................................................ · ZC ...... ............... .............. House Number Street Hamlet County Tax Map No. 1O00 Section .... /.0?.9 ......... 'Block ...... .~ ........... Lot .... .~' ............ Subdivision ..................................... Filed Map No ............... Lot .............. (Name) State existing use and occupancy of premises and intended usc and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy ............. m ......................... I. Nature of work (check which applicable): New Buildiug .......... Addition .......... Alteration .~ ......... Repair .............. Removal .............. Demolition .............. Other Work .~Jl £ ~.,qq~.~... (Descriptiofl) (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 ~ature and extent of each type of use .................. t. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............ N b of Sro ' HeiSt ............... um er nes ..................................................... Dimensions of same structure wiih alterations or additions: Front ................. Rear ............... Depth ...................... Height ...................... Number of Stories ................... I Dimensions of entire new construction: Front Rear Depth . . Height ............... Number of Stories ..................................................... L Sizeoflot:Front...:~ .................. Rear ............... · ........ Dep~ ~~.).... ..... ). Date 6f Purchase ..................... :.. Name of Former Owner I. Zone ot use district in which premises are situated ............................ ~ Does proposed construction violate any zoning law ordinance or regnla:ion: ' 1. ¥,'ill lot be regraded .......................... ... Will excess fill be removed from premises: Yes No I. Name of Owner of premises ................... Address ................. Phone No ................ Name of ~,rchitect ........................... Address ................... Phone No ..... . ........ · Name of Contractor . · ...... · . Address ........... '. Phone No. · ;'~'c .... :PLOT DIAGRAuM i ::z y Locate clearly and distinctly fll bnildin~, whether existing or proposed, and,indicate al! set-back dimensions from roperty lines. Give street an rl block number or description according to deed, and show street names and indicate whether .terior oz corner lot. - -- TATE OF NEW YORK, OUNTY OF ................. S.S o ind 'o'dt;ilti .......... e is the being duly sworn, deposes and says that he is the applicant (Contractor, agent, corporate officer, etc.) '-' f said owner or owners, and is duly authorized to perform or have perfonued the said work and to make and file this )plication; that all statements contained in this application an: true to the best of his knowledge and belief; and that the · ork will be performed in the manner set forth iu the application filed d:erewith. worn to before me this ......... day of. ., 19 ota~ Public . County