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Home My WebLink About11402-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy July 24 No. Zq 3672 Date 198.5,. THIS CERTIFIES that the building ...... .c,h.i..m,:u, .ex.... ................................ Location of Property ... ,~.6.9.0. .............. .B.e.r. g,e.n. ,A.y.e,. ................ ~,a.t.t. $.t.u.c.k.. House No. Street Ham/et County Tax Map No. 1000 Section .... ~.fl.~ .... Block ......... ~. ..... Lot .......2.:fl. ....... Subdivision ............... :g ............... Filed Map No..~. ...... ]~ot No. conforms substantially to the Application for Building Pernfit heretofore filed in this office dated September 22 ,19~.!. pursuant to which Building Permit No. fl ~0.2Z dated........................SeP'~omber 20 .... 19 .~.fl. , 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 masonry chimney. The certificate is issued to .............. ~JZ~_I~i, .&..0..A.~..~.R..I.~...I?.~.~.D.~.~..Y ............. (owner,~c~t) of the aforesaid building. N/~ Suffolk County Department of Health Approval .......................................... ~/~ UNDERWRITERS CERTIFICATE NO .................................................. ~ing Inspector Rev. 1/81 FO~I~I ~qO. 2 TOW'N~ OF ~O~TI~'O~D: BUILDING ,DEP.~.RT~N~ TOWN HALL SOUTH'OLD, N~ Y.? BUILDING PE~!I (THIS PERMIT MUST BE KEPT ON THE PREK41SES UNTIL ~ULL COMPLETION OF THE WORK AUTHORIZED) ; hereby granted. Jo:, x/~,'~;~0 ~ .... ........ ~o .... (~ ~.~,.... ~....~~ ..:..~~ ~ ...... ; .......................... ..................................................................................... ; ....... ;.?....~ ....... ~ ......... } ............. ~ .................. ;~-. Coun~ TaX ~*p No I000 Soct~on ....... ~ ...... Block ,.~ ........ Lot No. :~O'~"'~O/ pUrs~ont {o applicotion dated ~,. ,, ,. , ., · i ............. ~.. , ....?....* .... I ond opprovod by the Building I~spector. ~ - ~u~lcllng ~ nspector R~v. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions BLDG. DEPT. TOWN OF SOUTH?LD__ A. This application must be filled in typewriter OR ink, and submitted ia ~ 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 responsibb 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. Accu.rate survey of p~operty showing all propertv 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 inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00Q~., 2. Certificate of occupancy on pre-existing dwelling $ [ 5.00 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 Oate ./?.//. ........ New Building .~.~. ¢.4t.¢...e.~ · · Old or Pre-existing Building ............ Vacant Land ............. LocationofProperty -- q ~ C( o , , , .L~_,. ,~t~. ~. , Owner or Owners of Property . · · · ,~. i !./.~ .~..P~. · · .~. · ~-¢~, .-~- · .~ ¢'¢'. ,~. · · k I: .~,~,k-~,(~.~ ........... County Tax Map No. 1000 Section ... li 5 ........ Block ..... .~. ........ Lot .... ?..L 1 ....... Subdivision .......... .~, ..................... Filed Map No... ,./~. ..... Lot No ..... ~.. ...... Permit No././.~.0~..~. Date of Permit ~ ,~_..C~., .Applicant. Underwriters Approval , .Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ,, ~ ................ Fee Submitted $..~.,,¢.o,, .J..~, [ ,~. ~ ........... Construction on above described building and permit meets all applicable codes and regulations. ~, ,0~ ~'~-~- \~'~, Applicant. 6/A-/~-~-4¢~, ~/.. ~..~¢¢..~..~¢¢~-~..~/--¢~ ............. Rev. 10-10-78 TOWN OF 5OUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 BLDG, OEPl, ~-~ SOUTHOLD _ To Whom This May Concern, We are unable to complete your Certificate of Occupancy because ,of the following reasons. /--_~ An application for Certificate of Occupancy is not on file. /5/ The check is outdated~ /5/ No final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. Building Dept. FIE~,D ~SPECTION FOUNDATION (ls FOUNDATION (2nd ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE FINAL "DATE COMMENTS ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TQWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1B02 Examined d' ..... , 19 Approved ..... I Permit No ........ Disapproved a/c . .. '. .... '..' ..................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Application N o.././.~'~. .... INSTRUCTIONS a. This application mttst he 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, r¢Iationship 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 ap[ 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 issne a Building Permit to the applicant. Such porn 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 nntil a Certificate of Occupan shall have been granted by the Building Inspector. APPLICATION 1S ItEREBY MADE to the Building Department for the issuance ora Building Permit pursuant to t Building Zone Ordinance of the Town of Soutbold, Suffolk County, New York, and other applicable Laws, Ordinances Rog:clarions, 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, honsing code, and regulations, and admit authorized inspectors on premises aud in buildings for necessary inspections. (Signature ~)f applican}, or haT, e, if a corporation) : .... ........... (Mailing address of applicant) State whether applicant is mvner, lessee, agent, architect, engineer, general contractor, elech4cian, plumber or build, Nmne of owner of premises .... ~ .................................... (as on the tax rolV'or latest deed If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Bui,der'a L,cense :7..O.,g. Z..5.' ....... ... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Locati~sn of land on which proposed work will be done ............. ..... . ........... .............. ................ County Tax Map No. 1000 Section ..... ~.4~ .~a ........ Block .... O, .~ ~. ~,' ....... Lot..O.(~ ~-.o p. }. ...... 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 /~.o./1/.t.~. b Intended use and occupancy ' 1. Nature of work (chcck wbicl, applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work. ., ~a{o .. (Description9 EstimatedCost~.~. O "' ~7/~5'"~'~ ' (to be paid on filing this application) ;. If dwelling, number of dwelling units ............... Nmnber of dwelling units on each floor ................ If garage, numt:er 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 ............... Ileight ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear ................ ;. Depth ...................... ltei~tt ...................... Number of Stories ...................... i. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ L Size of lot: Front ...................... Rear ............... · ....... Depth ....... .' .............. ). Date df Purchase .......................... :.. Name of Former Owner ............................. 1. Zone or use district in which premises are situated.., i ............................... :'. ................. !. Does proposed construction violate any zoning law, ordinance or regula:ion: ........ ~ ....................... ~. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 1. Name of Owner of premises ............... · ..... Address ................... Phone No ................ Name of Architect ........................ :.. Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all ou'Idings, whether existing or proposed, and.indicate all set-back dimensions from ropcrty lines. Give street and block number or descfip'tion according to deed, and show street names and indicate whether 'FATE OF NEW YORK, (iWame of i~'ii'idual sigl~.,gg contract) (Contractor, agent, corporate officcr~ etc.) f said owner or owners, and is duly authorized to perform or have performed the said work and to m~e and file this >plication; that all statements contaiued in this application are troe to the best of his knowledge and belief; and that the 'ork will be performed in the manner set forth h~ the application filed therewith. ~orn to before me this