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Home My WebLink About11226-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building InspeCtor Town Hall Southold, N.Y. Certificate Of Occupancy No... E.I.o.~ !~ ........ Date ..... dU.1..y..3J., ................... 19.8.1. THIS CERTIFIES that the building ................................................ Location of Property .... 645..~ater~.eclge..W~Y.,. . ~o~4i~[2p.l.d, .N.e.w...Yp?.k. .......... House No. Steer Hamlet County Tax Map No. 1000 Section .... 0.8.8. ..... Block ... 9.5. ......... Lot 061. I Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .~.u.n.e~..1 .7 ......... ,19. ?pursuant to which Building Permit No. 11226 g dated ..... 41~.lY.. J ................ 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 ......... ................... ~eck..gfldl.t&on..t;.Q .Dw.~.ll~g ............................... The certificate is issued to ..... ~ 0 ¢..h ~ 9 .u.ct.~. a.'... [oi$n'e'r, ~isddds ~b3id;)-'-'2 .................. of the aforesaid building. Suffolk County Department of Health Approval ..,/~/.~ ................................... UNDERWRITERS CERTIFICATE NO ..... Jt/R .................... : .................... Rev. 1/81 ............ ~,~..,$:~. . ~ .... .~ ..... Building Inspector TOWN O~ SOUTUO'~L~ ~ t, SOUTH'O[~, N. y; (THIS PERM T MUST BE KEPT ON rB,E PnmlS~ UNTIL~. FbLL; COMPLETION OF THE woRK.AUTHORIZED) } Permission is hereby granted to: Date ,.,,: ~.,,,,-~ .~. ....................... at premises County Tm( Map No. 1000 Section ..~r' ~'~r~''~''''i'''' B OC~ pursuant tg apphcat~on dated .... ~,....,~. B~ilding I~sPector. and Opproved by the nSpector Rev. 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 .... r'~.~..~..O. .'~-..~'.! ....... New Building ............. Old or Pre-existing Building ...~¢~-~'i. .... Vacant Land ............. Location of Property..(O .~..~....~..~..--~..~..~-'-'-'-'-'-'-'-'-~...~.~. ~....b~)St~t, ......... ~..0..u~'..~..~.~ ......... House No, Hamlet Owner or Owners of Property . . .'~. ~) .... .~..~..O.~/..~.l.~ ...................................... County Tax Map No. 1000 Section .... ~)o~' ....... a lock ...~. ~ ......... Lot .... .~.l~. ! ~ J ..... Subdivision ................................. Filed Map No ........... Lot No .............. .... .... ?:.t.-.¢l. ......... Permit No 1~ ~' ~ Date of Permit . .Applicant . Health Dept. Approval ....... ~.~... ............ Labor Dept. Approval ........................ Underwriters Approval ..... /~ .~7.,· ............... Planning Board Approva . .~,~z~ ............... Request for Temporary Certificate ..................... Final Certificate .. ................... Fee Submitted $.. ~.~-..~. ...................... C st uct'o above described building and'~J ~l~erm[t meet~ll applicable codes and regulations. Applicant Rev. 10-10-78 FIELD INSPEC~(~N" FOUNDATION FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL COMMENTS DATE ~ ° ADDITIONAL COMMENTS: .~, FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 ..... Approve ......... ...... ,l .,'e,nitNo. ~isapproved a/c.. ................................ /(Building Inspector) Date .............. 19 INSTRUCTIONS a, This application must be completely filled in by typewriter or ~n ink and submitted in triplicate to the Buildi 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 stre~ or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this apr~ 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 peru 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 Occupan shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance ora Building Permit pursuant to t Building Zone Ordinance of the Town of 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 all applicable laws, ordinances, buildin, g code, ho]~g code,, and regulations, and admit authorized inspectors on premises and in buildings for necessary in p c ' . (Signature of appli~?r ~'~J~o~ati~on) State whether applicant is owner, lessee, agent, architect, engineer g~"~ral .... t' ' ' contractor) electnman, plumber or build, (as on the tax roll or latest deed) If applicant/is~ corpor~q~n, signature of duly amhorized officer. ....... .... ...... (Name and'tffie of cof'porate officer) Builder's License No...-....~../~;Q ............ Plumber's License No..-- ....................... Electrician's License No,- ...................... Other Trade's License No - 1. Location of land on which proposed work will be done ........... ~.'/~'-.~. ~. ;~.~,E~.~...C,-.~.....GJ.,~. ~. ........... ......... ........... ................. - ...................................... .. House Number Street Hamlet County Tax Map No. 1000 Section . .O.. ~. ~. ........... Block .... 67.~.~J. ......... Lot,, .~. ?f.//./. ......... Subdivision ..................................... Filed Map No ............... Lot .............. (Name) 2. State existing use and occupancy of premises and intended use and 0c(;upancy of proposed construction: a. Existing use and occupancy ......... , ........................ b. Intended use and occupancy ............................ ~ ........... ). 2. 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work. . (Description) Estimated Cost Fee -- . .................. ~.. .......... (to be paid on filing this application) If dwelling, number of dwelling t~nits ............... Number of dwelling units on each floor ................ If garage, number of cars ..... ~ .................................................................. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... Dimensions of existing structure~, if any: Front ............... Rear .............. Depth ............... Height ............ '... Number of Stories .......... i ............................................. Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... ]. Height ...................... Number of Stories ..................... Dimensions of entire new constrilction: Front ............... Rear ............... Depth ............. Height. ......... [.0.~' · 4. Number] of Stories ............ Rear ]~.t7 t ............. 'Depth~ ......... [.~. ~ ............... Size of lot: Front .................................................... Date 6f Purchase ........... .................. Name of Former Owner ......................... ; · Zon~ or use district in which premises are situated...: ...................... .................. Does proposed construction viol~te~ any zoning law, ordinance or regulation: ...................... Will lot be regraded ......... : ................... Will excess fill be removed from premises: Yes No Nmne of Owner of premises .................... Address ................... Phone No ............... Name of Architect . D ........ ... i .k~.. i .,....:... Address ,~ ................. Phone No ................ . Address ~d.~. S~cv[f'~_. ~.t0&.. Phone No. ¢~. Nme of Contractor · .......... F -V. '" Locate clearly and distinctly all roperty lines. Give street and block ;terior or corner lot. PLOT DIAGRAM :buildings, whether existing or proposed, and, indicate all set-back dimensions from tumber or description according to deed, and show street names and indicate whether TATE OF NEW ~'~K,, w,~ , _ _ ...... ..... (Name of individual sig~ing contract) ~ove named. : ...... being duly sworn, deposes and says that he is the applicant e is the ..................... ! .....~.'"... ~ ..................................... .~ .............. f said owner or owners, and is duly authon-"~d ~5'perform or have performed the said work and toJmake and file this ~plication~ that all statements con~ained in this application are truc~ to the best of his knowledge and belief; and that the 'ork will be performed in the m~ner set forth h~ the application filed therewith. worn to before me this ............... ~ .day o~ ..... .~[ . ~.., 1~. ~: ] ~ ~ 52.8125850, Suffolk C~ ' ~ ,' I~ ~p~res March 30, 19..~