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Home My WebLink About11055-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z10662 Date Sep. tember 4 .,19.8.! THIS CERTIFIES that the building ................................................ Location of Property ...2.6 .5.0...~ .~.... ~ .e 9 .o.n. 5:. 9..B.a. y...B .~.v.d.: ..... .L .a .u.~.e. 1. :~..N.c. ¥..~.o.v.k. ...... House No. Street Ham/et County Tax Map No. 1000 Section . .~.2.8 ....... Block .... 9.6 .........Lot..0.1. 3.., .0.0.1. ....... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substautially to the Application for Building Permit heretofore filed in this office dated ·. JyI. e~r. ¢¢..1.~ .......... 19.8.1 pursuant to wtfich Building Permit No .... ;1.1.0.5..5..g .......... dated ...M.a.~c..h..1.6. ................ 19S.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 ......... One Story Addition to D~elling The certificate is issued to ....Y~.q ~. 9 ?..C.a..~ .a.l.a. n. 9 ..................................... (ownor.~'ZTl ~zrZt~tTt~ of the aforesaid building. Snffolk County Department of Itealth Approval............N/R ................ f' ............. / BuSlding Inspector Rev. 1/81 FORi~ NO. ~ TOWN ~OF $~U' ~OLD' BUILDING OEFARTMEH TOWN HALL SOUTHOLD, N, Y. BUILDING F,ER~IT (THIS PERMIT MUST BE KEPT ON THE pI~EMIS'; COMPLETION OF THE WORK AUTHORIZED) N? 1:1055Z ~ UNTIL FUL Permission' is hereby granted to: ........ ........ ............................... o~ ~,~,~,~=,,,~ ........... ~.~: ...... ~ .... .. ...... ..~: .......................... '..: .~.~ ~.. .... .. ........... ~ ..................................... : ................... :....: ..... . ...... : ..... ....:..:. purs,ant to application dated ..~~..,..L...~....~....., .... ;.., approved by the ) Building Ihspector. ; /i--- Fee$ ....... ~ .... Rev., 6~30/80 Bud&no nspector FORM NO. 6 TOWN OF SOUTHOLD 13u ilding 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. Final approval of Health Dept. of water supply and sewerage disposaI-(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 topograpl]ic featu res. 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 .......................... New Building ....... ' ...... Old or Pre-existing Building ............ Vacant Land ............. Location of PropertY~e~o~..5' .C).. ~"~....~.~--~..~%/;..~'. i~../~.. ~..~.~'.~)~. .... L..J~ .~.J~..z-~-'... Str~ee¢ Hamlet Owner or'Owners of Property'....~.~.~.O. ,/~...~'... ~. J~T~) ~-,¢~)~/..~. .................. County Tax Map NO. 1000 Section .. J..-~..~. ....... Block ...(~.~. ....... Lot..Q/3.'.q.O...L. Subdivision ................................. Filed Map No ........... Lot No .............. ¢./.0. at, o,,.rm,t Health Dept Approval .................... Labor Dept. Approval ..................... ¢~.~. U derwriterlA rova,' '~. '~"? (~o-2 PlanmneBoardAoorova, n pp .~.i ................... ' ................... ./~..~(~ Request for Temporary Certificate ..................... Final Certificate ....~.. ...... FeeSubmitted,..Z.!°.~. ..................... Construction on above described building anc~ r~init meets all applicable c, oc~s and/regulations. ~j~ DATE COI~ENTS '~ ~' .... ~ ,. ~/~ ~ .~~ ·, ~DITIONAL CO~TS: FIELD I~'~PE~T I 0N FOUNDATION ( 1 st FOUNDAT ION ( 2nd 2. ROUGH FRAYfE & PLUMBING INSULATION PER N.Y. STATE EN,ERGY COpE FINAL FORM NO. I TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined,f'7/~Q.~Q(/./.. I. &' c~ .... , 19./. Approved/5."//..,~a-~ 1~., 19../.. Permit No. ///5~'-~-~:- Disapproved a/c ................ ~---------T ....... ~ ......... / APPLICATION FOR BUILDING PERMIT Application No.d./.(?~.~ ........ INSTRUCTIONS a. This application must be completely filled in by typewriter or 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 promises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- 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 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 Department 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, Ordinancesll~ Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describelI The applicant agrees to comply with all applicable laws, ordinances, building code, housi¢~) code, and regulations, and tdl admit authorized inspectors on premises and in buildings for necessar~spections. (7~ 1 ................... i ........... ~J~'~r'll'~or?O"O"L'~j ~,/, 'l~ff~ (Mailingaddressofapplicant) State wheth~,r applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......-- ................................................. __ Name of owner of premises ...~..[..~.T.O. 12.~.......~.~).~..t~..~, ~.. ~. . .'5D. .................................. (as on the tax roll or latest deed) If applicant is a corporation, s~gnature of duly authorized officer. (Name and title of corporate officer) Builder's License No.. ~.C2{.,71?~..O~.....~..?. J. Plumber's ~icense No. Electricians License No ~.(~/.~0~.. ~3 Other Trade's License No ...................... 1. L~ocatiff~f land on which pr.~posed work~)Lhi,owill be d~ne .................................................. ~/~b(~er'qD)"M l: 'c'~' ' ' ~3~o.~ Hamlet County Tax Map No. 1000 Section .../..'~.. ~. ......... Block ..... .~. ........... Lot.. / 3~./ 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 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair ......... ;.~.. Remo~ai .............. Demolition .............. Other Work ' v/ ,,, ~ c~/ol~ 0,9 ~, .~ (Description) 4. Estimated Cost ..... ~k~..~d. ......................... Fee .... t..~ ................................ (to be paid on filing this application) 5. If' dwelling, number of dwelling units. / Number of dwelling units on each floor.../ If' garage, number of cars ..... ] ................................................................... 6. If business, commercml or m~xed occupancy, specify nature ~nd extent of each typ,e of se .............. / ....... 7. Dimensions of existing structure~, if any: Front... ~ ~. ........ Rear . .~. ~' ./. ...... Depth...~. ~ ........ Height' . .............. Number of Stories ... I. ................................... Dimensions of same structure with alterations or additions: Front ...~i ~".' '] ....... Rear....~.."~ 71 Depth: . ...~..~. ........... '..Height ...... ., ............... Numb, er of Stories . 8. Dimensions of entire new construction: Front... [..'~..1 ....... Rear...l .2-,( ...... 'l~e'p't~' Height /.. ~.[q/2..~... Number of Stories .......... [..,~. ;...., ............... 9. S.ize of 1;i: Fr;~t' '. i ~.... ~ O]~ .~ ........ Rear ....... .~. ~.,..c/, ....... Depth 10. Date of Purchase ........... i .................. Name of Former Owner ............................. 11. Zone or use district in which prelmises are situated ..................................................... 12. Does proposed construction viol~tte any zoning law, ordinance or regulation: .../~/.(~ ............. ~ ...... 13. Will lot be regraded ....... - ~. ......... ~ ....... Will ex~c, ess~ll be removed ~from premises: I r es/ No 14. Name of Owner of premises . .~..l~.O.O--..~.~r:j~l~.Address~.Z.~(.~,T.~'Ui2~/'~g~/~ Phone No..~/.~.~.ff.~.~. Name of Architect .. :,~ ..... , ....... ,..~_~..~... Address . .,~'~ ?~f?.~d,~_~Jx.'~,~ Phone No..~. ...... ; .~.~.,.. Name of Contractor .~.,~ ~ ~ I.K"'~f.~'~/V..[~L/t(,O~ddress . p-/F: ~"[2d.~..................~'...~gehone No. ~.~ 2-..~. ~.. c/.~.6 ~'.. PLOT DIAGRAM {/ ? / Locate clearly and distinctly all i buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block mmber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YJ~RK~/~ ~,~_ COUNTY :s.s ............................ ................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the .......................................................................................... (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 and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me.,th~s i ........... ..... ,day ......... ..... ........ cou t , ~ot~v r,~,~li~, st~,to o~ ~ow ¥or~t .. Z .-,)d..t~ ,c...-~'... ~.. ·/...v.~ ......... i'qo .~20314c)o3 Suffolk Oount~,~ (S~gnature of apphcant) ' C°~nisslon [~pir°o Marc~ ~0, J-9~ / ' ~ / (Signature o, P b~ 0 0 p J£ II