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Home My WebLink About11455-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. ZlSf135 Date December 2, 1986 THIS CERTIFIES that the building Masonry Chimney LocationofProperty 1145 Henry's Lane C.u..t.c.h.o..g.u.e.,. N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 0 74 .Block 01 . .Lot 0 03 .'. Subdivision .~/. 9..P.e. c. 9.n.i.c...H 9.m.a.s. .......... Filed Map No. 4. ! .8 J ....Lot No. 1 0 conforms substantially to the Application for Building Permit heretofore filed in this office dated .0 .c.t.o.b..e .r..2. 6. ~ ........ ,1,9.8. ! pursuant to which Building Permit No. 11 4 5 5 g dated . .O.c.~.q b..e F..2. ~.; .............. 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 ......... Masonry Chimney The certificate is issued to JOSEFH & CAROLYNN BETTY ..................... ?oW.b;, ;x ................... of the aforesaid building. Suffolk County Department of Health Approval ........... ~ fi./..~ .......................... UNDERWRITERS CERTIFICATE NO ..................... N./..A .......................... Rev. 1/81 /? TOWN OF' ~OUTHOL~ ? BUILDING D~p,~Rt/~il~~ TOWN ~HALL SOUTHOLD, N,Y. · BUII. DI~4G, P,E~iT (THIS 'PERMIT MUST BE KEPT ON THE pREMISES UNTIL ~ULL ' COMPLETION OF THE WORK AUTHORIZED) N? :~1455 Z Dote' Permissior is hereby granted to: .... I/.~....ZZ~:..~.....~: .... ~ ~o ..~~.~L...Z~~..~....~.¢~~?...~ ............. ........................... ...... ; ......... ; ..................................................................... ~ ~ ... ~ :~ .... ~ ...................... cou~ ,~ ~p uo. ~000 ~t~o~ ~.~.....~. ~k ~, ............ ~ot Uo..~ ........... puriuant to application dated . .;..~..~...~....., 19. , and ~approv~ by the Builfling I~spector. Fee $.. ~ / ~ ~i~ng~l~ector Rev. 6/30y80 ,~ ~: ~ FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall $outhold, 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. 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. Bo 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 lin~s, 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. 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 ...... New Building .... ?. ....... Old or Pre-existing Building ............ Vacant Land ............. ...... Location of Property /,~'..~)... ,~/..~.,'?,,~'..,~. ~.-.. ~<~/(~. ~-. ~ ~ ' Hou~ No, Street Hamlet Owner or Owners of Property . . ,~. ~ ~ ................................. County Tax Map No. ~000 Section . ~ ......... Block .... Z ......... Lot .... ~ .......... Subdivision. ~C~)~/~. ~.~'. .... Filed Map No. ~...Lot No.. ~ ........ Permit No~/~ ~Date of Perm cant ........ 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 a~des and regulations. Rev, 10-10-78 FIELD INSPECTION ~ COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY C~ODE FINAL ADDITIONAL COMMENTS: 765-1~02 BUILDING DEPT, INSPECTION FOUNDATION 1ST []ROUGH PLBG. FOUNDATION AND []INSULATION []FINAL [ ] FRAMING REMARKS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, FJ,Y. 11971 TEL.: 765-1~02 Examined~D/ ...... , I .~./. Approved...-~...../~. ..... , 19~. ,/. Permit No..//.~..~..<.~..-.-.~ ' sa,,p oveda/c ....... ..... / ....... . ?' (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, w/th 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 ou 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 issue a Building Permit to the applicant. Such pern shall be ke~t on the premises available for inspection throughout the work. e. No building shall be occupied or nsed in whole or in part for any purpose whatever until a Certificate of Occupan shall bare been granted by the Building Inspector. APPLICATION IS HEREBY M^DE to the Building Department for the issuance cfa Building Pen'nit pnrsuant to t Building Zone Ordinance of the Town i>f 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 ail applicable laws, ordinances, building code, honsing code, and regulations, and admit authorized inspectors ou premises and in buildings for necessary inspecti;ons. .~ S~grmtur6'of applicant, o~.~ne, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build. ame owner ofpr,m,s0s. ........................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of coqmrate officer) Builder's License No. ~.~.~...,~. ........... Pluluber's Licens* Ns El~ctncm~ s Lccnsc No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done...&/~../T. "~'/~) ·//Z'.~Y..,'ff/.~/.:~...~.,~., ............... . ./?~.~. a,~,,,. .~. . . /.Z,:(~. . ./Z ~ ~. Z. .............. House Number Street Hamlet County Tax ]Vial, No. !OOO Section .... .ff z.~. .......... Block ..... /.. .......... Lot .... ~.~ ........... Subdivision . .ff. ~.~.~2..,st.r./~.. ~..~.z'"/,~.z~.~': ........ Filed Map No....~/f/'..oW-'/.. ..... Lot.../.~. ....... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . .-~.. ¢¢..,-.¢%~.~//.,~,t.,-~. ................................................ Regair .............. Rcmlov,~l .............. Dcmolkion ............... Other ~,¥ork ............... ~<~0- , , . .~. ~/~ . (Descfipt. ion) (to bo paid on filing this appliCation) ;. If dwelling, number of dwelling units ............. Number of dwelling units m~ each floor .... ~. ......... If garage, number of cars .... ' .................................................................... L If business, commercml or m~xed occupancy, spemfy n[tnrmand extent of each &jpe of use ............. ~ ....... I D~jnensmnsof~x~mngstmctures,fany:Front .... ~..' ..... Rear ..~ ......... Depth.. llm~ht .~ ........... Nmll her o f Stories . . ~ Dimensions of same structure With alterations or ad~tions: Front .... ~. ......... Rear .. ~.~ ........... Depth.. ~.~ ............... Hmght ..~ ................ Number of Stones .... ~ ............... ~. Dimensions of entire pew cons[r[~ction: ~ont .., .... , ........ Rear ............. '.. Depth .... - .......... ~Jeight ............... NUmber of Stories ..... ........... ~ ..... . ....~ ................. y ........... L Sizeoflot: Front . .~...i...'.' .......... Rear.../~ ............. Depth ..~ ............. ). Date df Purchase .......... ~ ................... Name of Former Owner. ; .................. ' .......... 1. Zone 9r use district in which p~emises are situated.. ~ ............................. ~ ' ......... . ........ D,oes proposed construction viqlate any zoning law, ordinance or regulati~n: .~% ......................... ~. ~ill 10t be regraded ...~2 .................. Will excess fill be removed from premises: . Yes No L Name of Owner of premises .~X~..~Address ~/~5~q.~q Phone No.. Name of Architect ......... i ............ : ....'.. Address . . ~(~, . . &Phone No ................ Name of Contractor~W~'~..~.~ .... Address ~~ ~.~Phone No..7~ g2 ~. PLOT DIAGRAM Locate clearly ~d distinctly ~1 buildings, whether existing or proposed, and,indicate fll set-back dimensions from roperty Hnes. Give street and blocl number or description according to deed, and show street names and indicate whether .tefior or conler lot. rATE OF NE~V YORK, ' S ' OUNTY OF .... ii~k'c'o~'t;~c'ti being duly sworn, deposes and says that he is the applicant )ore named. / 7,g ' e is the ......... ....................................... , ............................. (Contractor, agent, corporate officer, etc.) f said owner or owners, m~d is duly authorized to perform or have performed thc said work and to l~ake and file this )plication; that all statements con:tained in this application are true to the best of his knowledge and bet{cf; and that thc 'ork will be performed in the manner set forth in the application filed therewith. worn to b'efore me this , ....... , .,~ ~.."'~..~ .... Oay;f .... - /'-) ,q ~.~.., 19oO/. otary Public ....................... ~County ~ ~OTAR~ PUBLIC, Stero of How York No, 52-8125850, Suffolk Co ty