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Home My WebLink About11469-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupency No, . Z1136.~ ........ Date .D.e. gember 16 ..... 19.8.2. THIS CERTIFIES that the building ............................................... Location of Property . .~en~Ln~ul.~ .]~g~ Fishers Island ' House No. ' .......................... · ..... $~reet .......... Ham/et County Tax Map No. 1000 Section . .3.0 ........ Block ...3. ........... Lot. 21 Subdivision ............................... Filed Map No. :...:...Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated · .. September. ,LO..., 19' .83, pursuant to which Building Permit No. ]~.4.6.9. g. ............. datedqOVeraber. 2.0. ................ 19.8.~., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... .... add. and. enclo$.e..~, p.o.~g .h. aqd alteration, The certificate is issued to . .Scu~er..~ld.. ~usan Sincl.a. ir .... i,;.;.'~;.'.'J-~'~ J:':2Z~., ...................... of the aforesaid building. Suffolk County Department of Health Approval . .~'~- ............................. UNDERWRITERS CERTIFICATE NO ~./.,~ .~C..~Building Inspector Rev. 1/81 FO~ NO. 2 TOWN OF soUTHOLD .UiLDiNG TOWN HALL SOUTH'OLD, N, ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL EULL COMPLETION OF THE WORK AUTHORIZED) N°. I1469 Z Permission is hereby granted to: tO .. ........................................................... ~. ........................... ?~'~ ~,n ........ ~ ...................... ~ ......................... at premises located at ............ :..;.: ....... , ....... ,.....:..::..: ........ :..~.., ...................... ..................... - c~..~ ~.~ M.~ No. ~00 S.~o.. .? mo~ ..... ....~ .......... ~ N... ............ pursuant to application datad .................. ~.~.. guildin, InSPectOr Building Inspector. Fee $.. :~ ,: ................ 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 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. B, For existing buildings (prior to April 1957), Non-conforming use~, or buildings amd "pre-existh~§" 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 buiIdings. 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 tand use $5,00 3. Copy of,certificate of occupancy $1.00 Date .~.l'~-¢/ 8. ~. .. New Building ............. Old or Pre-existing Building(X) ........ ~/Vacant Land" Location of Property ......................................... .~....n).., p/.~...~. ~.~ ? ............ Hou~ No. ~ Street * , Hamle Owner or Owners of Property ~~..~ ~~.. ~~ ....... County Tax Map No. 1000 Section t O Block . .~ Lot... Subdivision. ~ ,~/~ ~.% ~.. ~ .... :.~3/~.~...Filed Map No. ~ .~., .Lot No .... ~ ~ ...... Permit No. Date erm cant ........................ Health Dept. Approval ........................ Labor Dept. Approval ...................... U~?~i~er~ppr~val ....~ ...... , .....~_..... ~., .Planning Board Approval ................ Req%est for Temporary Certificate ......... %...[.~ ..... Final Certificate ./% ..... - ........ * , Fee Submitted $ Construction on above described building and permit'meets all appl~cable_~codes and regulations. ' ' ".'" ....O" ~ O~'~' '~~- ~ ........... . ..... '1- I~OEM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN 4~LERK'S OFFICE SOUTHOLD, N. Y. £×omined ......................................... 19 ........ ~proved . , 19. C~... Permit No ................. d.. ................ o~,.~mo,ed ~/~ ............ :'~::='=:::'::~7'"'~ .................................... {8uildin~ In~poctor) App~icetion No .................... /, ........... APPLICATION FOR BUILDING PERMIT ................ Ig..P/..... INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building 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 streets oF areas, and giving o detailed description of layout of property must be drawn on the diagram which is part of this application. 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 permit 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 Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The appllcont agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit' authorized inspectors on premises and in buildings for necessary inspect, ions. [ (Signc~re~c~ applicant, or name, if a corporation) .............. ........... (Address of applicant) ~ ~-~ ~ State whether~'~//"~¢---applic~t~t is owner, lesse~y agent, architect, engineer, general contractor, electrician, plumber or builder. l.f applicant is a corporat~ignature of duly authorized officer. '( ~[Nal~e and title of corporate officer) Builder's License No...Z,,~..?.~.. ................................... Plumber's License No ..... ~.~..~......~...~...' s ~ ................... [ 000 ,-"' '0-- ~-- ~/ .o -,,;.:::~r...,~..~. ,c. .................. ~o .~ , o - ~-- ~-~ Electrician's License No. Other Trade's License No ............................................... 1. Location of land on wh~/~roposed work will be done. Map No.: ........................................ Lot No ......................... Street and Number ~..~~...G~/~.....~. ............................................................................................... Municipality 2. State existing use and occupancy of~es ~~ use and occupancy of proposed constrbction: ' a. Exisiting use and occupancy ..................... --~ ....................................................................................... b. Intended use and occupancy ...~.~ ....... ',~ ...................................................................................... 3. Natd~'e of work (check which applicable): New Building'. ............................ Alteration ..'7.: ....... . Repair .................. Removal! .................. Demolition .................... O~er Work .............................................. : (to be paid on filing this application) 5. If dwelling, number of dwelllng units .......... ~... ............. Number of dwelling units on each floor ............................ If garage, number of cars ...4 ........................................................................................................................................ 6. If business, commercial or .m~xed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Numloer of Stories ..........~,~. ................................................................................................. Dimensions of same structur~ with alterations or additions'. Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Numbe! of Stories 9. Size of lot: Front ................, ....................................... Rear .......................................... Depth ................................ 10. Date of Purchase ....................................................... Name of Former Owner ........................................................ 11. Zone or use district in whichlpremises are situated ..................................................................................................... 12. Does proposed construction v.iolate any zoning law, ordinance or regulation: ........................................................ 13. Wdl lot be regraded. ............~, ,,,~ ,~ ~ ,"2P .......... Wdl excess fill be removed from~.~ ,~ ,,p-rem~ses: ( ) Yes ( ) No Nome of Architect ............. : ............................................... Address ................................ Phone No ....................... Name of ....... , ......... PLOT DIAGRAM Locate clearly and &stmctly all buffdmgs, whether ex~stmg ar proposed, ced md~cate al/ set-back dimensions from property lines. Give street and blbck number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ..... ~,~f.Q ~.k .......... S.S ................... .~...a.~.z..9....~..a...~.c~.b....e.~..~.~..! ........................................ being duly sworn, deposes and says that he is the applicem (Name of individual sighing contracf) above named. : He is the ~ ....................................... Qontractor (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge end belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this Not(l, Public, ................ ~ .......... .c..S...q.t...t..°...$..~. County ........./-- (:"i" "'tu--of~g~J f:~ opplicant) ..................... · MAR~'I. PANKIEWICZ I ~' NOTARy PUBLIC, STATE OF NEW YORI( '! i NO. ;12-8267B50 _ SUFFOLK COUNTY J COMMiSSiON EXPIRES MARCH 30, 19,~.~