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Home My WebLink About11218-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy NoT, .1.1.2 ? 5 ........... Date ...... ., ,0~2 c?:,r!b.~..v..2~0. .............19~2. THIS CERTIFIES that the building ................................................ Lo cation o f Prop erty ....9 5 .............. K ~ o 1.],~q o O d..L s n ~ ..............~ a 1; ,'c,:k 'c u c 3,- .... House No. Street Hamlet County Tax Map No. 1000 Section .1.07 ........ Block . .f~6 ........... Lot .... O 0.7 .......... Subdivision . .X ............................. Filed Map No. ;X. ...... Lot No.. ~( ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated . .4¢P.o..:~0 ............ 19 9.1. pursuant to which Building Permit No..~. 1 2.~.[~ .Z ............ dated .... dune. 39 ................ 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 ......... · .~. ~m.at -a 1..&cc¢.~.~o~'¥...2t opn.~,,e. ~h. ed .......................................... The certificate is issued to ......... P.e..g?,?..C.,. ~..C..a.g.h. fl~. $.n.e..$ ,. $74r J..ey. .............. (owner, las~e~or..tan~n~ of the aforesaid building. Suffolk County Department of Health Approval .... n / a ................................... UNDERWRITERS CERTIFICATE NO ............ n/. ~ ................................... Building Inspector Rev. 1/81 BUiILDIN~ ~:P, ERMI~r COMPLETION oF THE WORK AuTHQR~ZED) UNTIL F at p~,emise~ located at C6ur~ty Tok Map No. 1000 Sect on ;../,.~..~...:.i.,.~ Block~ .i,.l pursuant ~o apphcahOn dated .~.......~,~,..,...i,.. .... goijdlng I~spector. : ~' ' '~ ~ ......... ~ot NO..~../.. ......... .} ond Opproved by the 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 Bui{ding Inspec- tor with the following; for new buildings or new use: 1, Final survey of property with accurate location of ali 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 bui[ding. 5. Submit Planning Board approval of comple{ed 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 unusua~ 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 $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $§.00 3. Copy of certificate of occupancy $1.00 New Building ............. Oid or Pre-existing Building ............ Vacant Land ............. Location of Property . ,,?¢~..~,~.. z'/~f'~,,~¢;.~.~../-~,~'. ~.~,...~.4~1~, .... ~,7~'~'~'~'~'~'~'~'~. ,~.~/~¢..~/~. ..... House No. Street Hamlet Owner or Owners of Property ~ .~.~..~..~....~., .'. County Tax Map No, 1000 Section . ,~..~...~ ....... Block .... .~. ......... t. ot....~.. .......... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval .... .~.~.IZ~ ............ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $,. t-~.'~..,..~. ................... Rev, 10-10-78 FOUNDATION FOUNDATION (2nd) ROUGH FRAME & FLUMBING INSULATION PER N. Y. STATE ENERGY C~D~ FINAL ADDI~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ~. ~.~...., 1 .~./ Application No .................. ..... l /. ermitNo. Disappro%ed a/c ....... _~ ~ ......................... Date .. 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 premises 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, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorizedinspectbrsonpremisesandinbuildingsfornecess~ .~. .,. . . .~. . . . .a~. . . ........... (Signature of applicant, or name,~ corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~.~..~'....~.'.. · · .~'....~. · .'~..~.~..~].'~. · .~....~..: ........................ .~..~..~..~..~.f (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....~ ... Plumber's License No ......................... Electrician s License No ....................... Other Trade's License No ...................... i. ocation of land on whio proposed work will be aone. ...................... ....... .-/.o..s~ ........................................... : ...... ,at,,.~...~. r~,,..~..~. .......... House Number Street Hamlet County Tax Map No 1000 Section . ./..~...~. ......... Block ... ~ ............. Lot.. J~. ............... Subdivision ....... . ~. ,~,~ .......................... Filed Map No ............... Lot ............... · (Name), , 2. State existing use and occupancy'of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... d~-f~.' ........................................................... b. Intended use and occupancy . ~. ~'.~'. ~.~. tg.. ~..~,rlg,~.. ~.~..gg'..~.~..~,..~.4P...P~.~..~'..~.~.~..~..~ 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration Repair .............. Removal .............. Demolition .............. Other Work ............... · ' L ?. (Description) - ...... 4. Estimated Cost .~. ~.~. ~' .... Fee .................................. (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, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ................... :... Height ...................... Number of Stories ...................... 8..Dimensions of,entire new construction: Front . .~.lg. ~. Rear . Zig. w * .................. Depth . ~.~ ........... .Heaght . W. ........... Number of Stones .... .~ ..................................... , ........... Size of lot: Front .. ~.~. ~...~i ............ Rear .J.,~. ~. ............... Depth . ~._~. ~... .............. Date of Purchase .. ~.~.. ~. ~ .................. Nam.e of Former Owner .,q~..~.~. ,..1~. ~..~'. Sp. ~ ......... Zone or use district in which p~emises are situated. ~.~. ~# tlte'~n~$w~. ................................... Does proposed construction vi61ate any zoning law, ordinance or regulation: .~e..~. ........................... Will lot be regraded . .~.~ ..................... Will excess fill be remov~dSrom premises: Yes {~} Name of Owner of premise~.,~'~;~.~'.. ~..~..~..~. Address ~1~.~,~.. I~..~.l~r..~l.~. Phone No. ,~.~. ~ .Il Name of Architect ......... .................. Address ................... Phone No ........ ~ ........ Name of Contractor .~. ~J~l~.~ ............... Address ................... Phone No ................ 10. I1. 12. 13. 14. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. ? STA'rE OF NEW YORK .C~ .f.. ~ ~ .................... berg duly sworn, deposes and says that he is the applicant (Name of individual s~gning contract) above named. (Contractor, agent, corporate officer, etc.) of s~d owner or owners, ~d is dgly authorized to perform or have perfo~ed the said work and to m~e ~d file ~is app~cation; that ~1 statements contained work will be perfo~ed in the m~ner set forth in the application ~ed therewith, o~[ ~ co~ Sworn to before me this ~ol~a~ ~, $t~ ~[ Now York I ~. ~705686 .............................. ¢ommlssion Expires March 30, 19~ Notary Public, ...~.~'..~'.9)~Q. i ·. ............... County ~ _ ~ /fJgignature of applicant)