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Home My WebLink About11050-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Btlildin§ Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z10603 Date . .J.u.l.y. 26 1951 THIS CERTIFIES that the building ................................................ Location of Property 475 aid Farm Road Southotd, New York House NO. Street Ham/et County Tax Map No. 1000 Section .. 0.63 ...... Block .. 0.7 ........... Lot ... D.24 .......... Subdivision ............................... Filed Map No ...... '...Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated March 10 ,19 .8?pursuant to which Building Permit No. 11050 Z dated............................Marcia 12 198. 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 ......... Deck extension on p.n,e..F.a.m.f.l.y D.w.e..1.1i.n.g The certificate is issued to ....... .D.a.v.i.d...R.....W,i!.l.i. a~ .m.s ................................ (o wne~ ~mex~x ~x x of the aforesaid building. Suffolk County Department of Health Approval ...... N/R ................................. UNDERWRITERS CERTIFICATE NO .... N,/.R .......................................... Rev. 1/81 Building Inspector BUILDING P~ERMIT: (THIS PERMIT MUST BE KEPT ON THE PREMIs~s UNTIL ~ULL COMPLETION OF THE WORK AUTHORIZED) ~ 1,1050 Z Perrhission is hereby granted to: .... ': : . ;. . . .. . .. . . ......... ~.~ ....... ,~...Z../.. .............. ,....? ................ ,~.w.x../.:~. ~..~./~.....m.,~ ..,~./., ................. ~o ...... .~.~.~.7.~,.~.~ ....... ~.~..~.~-.4~..~.~...,../.~....,~z~zx.,~.~ ,~..~z~.;~ ....... ~...~zZ~...~~ ........ ~,..,t...:;..~:.~,~Z ...~.ZLz~X ....... ~, prem,~.~ ~o=~.d ~ .................. :J~..~ .................. ~-....~ .... ............................................................................................. y.?"~'~ ............... ~ ~ L.~.~.~. ....... cou,tv ~ ~op ~o. ~ooo s~cno~ ..... ~.~.~....~. ~o,k .,..,.0.~- ...... ~[ot Uo. pursuant (o application doted .. :~......~. ~.....~...~....., .. and opproved by the Building I~spector. ....... · Building ilnspecto~ Rev. 6/30/~80 FORM NO. 6 TOWN OF SOUTHOLD 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 featu res. 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. 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 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 Date. , · 7Z-~, ~/~", ? ............. New Building ............. Old or Pre-existing Building . .-'. ,~ ....... Vacant Land ............. Location o f P, ro perty...~. :7..~.~ .............. /~.t P. ~.~,~...~. q .~..C¢. .......... ~., .~1..T.~...~.~ .~.-~ House No, Street Hamlet ty .'~.../~.V.¢..O. '.~, ~/I Owner or Owners of Proper ................................................. County Tax Map No. 1000 Section . . .~. ~; .~. ....... Block . .O. 17. .......... Lot..o. ~ .~. ......... Subdivision ................................. Filed Map No ........... Lot No .............. . Permit No..//'.~,o..~.',~., Date of Permit . .Applicant .~...~,, .%% .~..Le'~ .r~... Health Dept. Approval ........................ Labor Dept. Approval ........... Underwriters Approval ........................ Planning Board Approval ................ Request for Temporary Certificate ..................... Final Certificate .. ./. .... Fee Submitted $ ~ ~ ¢plicabl codesand regulations. Construction on above described building and permi s :abl~cod~ ~,~ Applicant ........... .~. ................. Rev. 10-10-78 FIELQ Ik~PECT ION COMMENTS FOUNDATION (Jst) FOUNDATION 2. ROUGH FRAME& PLUMBING (2n~) INSULATION PER N.Y. STATE ENERGY C0~E FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 pp oved ig&. Permit No.. (L )isapproved 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 Building nspector, with 3 sots 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 )r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli~ ration. c. The work covered by this application may not be commenced before issuance of Building Pe?mit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit :hall 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 ;hall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the 3uilding Zone Ordinance of the Town of South0id, 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. Fhe applicant agreas to comply with all applicable laws, ordinances, buildi~code, housing code, and regulations, and to ~dmit authorized inspectors on premises and in buildings for necessary ins~ecr~ns. / , .../p~..,, .a.?./.,,..07.< ec/.~..~.e..../Y?~..~. ....... (Mailihg address of applicant) ~tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nameofownerofpremises .?~..~7.~. ...... ?.~:.~.~.r.~.~7.-{ .............................................. (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 ..... ~ .~.~. ............... Electrician's License No. Other Trade's License No ...................... 1. Location of land on which proposed work will be doric.. ~ <~.. ~.~. f.<~. ..... ~.' .~.~. ......................... House Number .... ~ ......... Street Hamlet County Tax Map No. 1000 Section .. ~. O~ .~.. ......... Block .... 0.7. .......... Lot...~...~..~. .......... Subdivision ..................................... Filed Map No ............... Lot ............... (Nmne) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... ,~.~.~. './.~. ~.c.:~'....o..z~..~...~..~..X~. f..L.~..... ................ , ............. b. Intended use and occupancy .... /,i .2z.~.,.~2,:.,.-' .,~?. ~ .... .~. ?.~.~.. ./: . T~. . . ~.~. . ?. .r?-. .~.~. .~.~'.~)~.. . . ............ !' . 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair Removal - Demolition Other Work .~.~-e~.~f.-~.4 .~../~ (Description) ¢. Estimated Cost ................................... Fee ........................ (to be paid on filing this application) ~-' Number of dwelling units on each floor -- L If dwelling number of dwelling units ............................ If garage, number of cars ). If business, commercml or m~xe occupancy, specify nature and extent of each type of use .... ] ................ L Dimensions of'existing structureS, if any: Front ............... Rear .............. Depth ............. Height ............... Number of Stones ............................................. Dimensions of same structure with alterations or additions: Front ................. Rear 'l ............... Depth .................... ... Height ...................... Number of Stories ..... / ............... 3. Dimensions of entire new construction: Front ..... ,'..~. .......Rear .... ./.~. ....... Depth ... ~. ~. ....... Height ..... Number of Stories ....................................................... L Size of lot: Front .... /.ff.~...i ........... Rear ...Z.~ ............... Depth ... ~'~..;~. .............. ). Date of Purchase ........... ................. ame of Former Owner .. . .,~../.~.'./0~. ~ ........ I. Zone or use d~stnct ~n winch premises are sxt ated....~'..~SqY. O .g~..~.~. .~. ....... L Does proposed construction violate any zoning law, ordinance or regulation: ....'~..~. ........................ 5. Will lot be regraded ...... d<.~. .................. Will excess fill be removed from premi~ es: Yes No ¢. Name of Owner of premises ~2"~ . .~..4.z.~O~.'.4 .... Address .~. ~...~-~...~..,~n..,.*o.. Phone ?'o. ~.~.7., Nmne of Architect ... ~ ...... : ................. Address ......... Phone l' o ........... Name of Contractor ~..~d,<,q.!..,(~t.~r,e-.' ...... Address ~. i~i ~--'.. Phone ~ 'o?..~c?...'-?.<~A... ' 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 umber or description according to deed, and show street names and indicate whether ~terior or corner lot. TATE OF NEW YORK -- -- ~ /jr'~'. -- 'OUNTY 0F..~ j S.S .... .~."*-~27f.~..~4~..~Zg. ~?.~. ~..~.'g.4L .~'. ........... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) ~ove named. (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this pplication; that all statements contained in this application are 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 metMs , .... i~t~;e' g; applicant3