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Home My WebLink About11227-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ....... Zq q. 6.5.2 .... Date ............... Ap~.i.~.. q. 9 ......... 19 83. THIS CERTIFIES that the building Aeeessary Location of PropertyHouse' 3.3.900.No. ma in. ~o o d..~12'lj ¢~o.~Ll.~Street ........................... h3r~ie~ County Tax Map No. 1000 Section .... Qc)7 ..... Block ...... 02 ....... Lot ....... 0.~.5 ....... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... ~IaT..fl 3 ........... 198~. pursuant to which Building Permit No, ~ ~ 2277' dated Jul~r ~1 198~1 , 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 ......... An addition to an existing accessary garage Robert Richmond The certificate is issued to '[o~n'o'r, 'l~*b~;e'~r't~t~a'~'tl ....... of the aforesaid building. Suffolk County Department of Health Approval N/A UNDERWRITERS CERTIFICATE NO ...... N/g_ Rev. 1/81 (THIS PERMIT MUST BE KEPT QN ~HE PRi~)SI~i.UNTII~ F~LL coMpLETION OF THE WORK ^uTH~I:TED) : ~ :;' · 11227 7.. Permission, is hereby granted to: ~.;...{~ ........................ , 19. ! C~afity Ta~.Map No. 1000 Section . .~,~? B!o pOrsOant t~o application dated B~ild~ing Ifispector, Fee ~;../...!..; ............... NO: ~.~Z .~. ............ and' approved 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 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 natura~ 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. 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. Co Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dweIHng or land usa 3. Copy of certificate of occupancy $1.00 $5.00 Date.. ~-/(/?.. New Building ............. Old or Pre-existing Building(Z). ~)./~._ _= ~Vacant Land '. ............ House No, Street Ham/et Owner or Owners of Property .......... /~ / C'/~/'/d County Tax Map No. 1000 Section O? 7 Block O ~L~ Lot Subdivision ................................. Filed Map No ........... Lot No .............. Permit No.././.~, ,~. ?..g Date of Permit .~?~./..~.[...Applicant .H,/,/.Z-..Z.f,~ .~t. .'~,'..~¢~. ,/~..~-./'..~.,~...~.'~./~'. ;', . Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. Underwriters Approval ........................ Planning Board Approval .................. Request for Temporary Certificate ..................... Final Certificat~ ............... . Fee Submitted $. Construction on above described building and permit~meets all app~cable~code~ and regulations. Applicant . . ~. ................... FIELD IN~?ECT~ON COMMENTS FOUNDATION (1st) FOUNDATION {2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 ~an~ined- ~b~ /. ' 190~' [ -~v ,proved .~...[ ....... 190~ Permit No./.. ~.d.7 (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building spector, 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 areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- tion. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspect.or will issue a Building Permit to the applicant. Such permit all 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 all have been granted by the Building Inspector. APPLICATION IS HEREB~ MADE to the Building Department for the issuance if a Building Permit pursuant to the tilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ~gulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. te applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to :mit authorized inspectors on prbmises and in buildings for necessary inspectio.ns. (Signature of applica~nt, 6r name, if p ' ) ·(Mailing address of applicant) iate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ?.y..r(.V.~ .c.?..~. ....................................................................... ,~. ...... ~e of owner of premises. ~ ?.(~. ,~..~, 7C., ~, .~/~ q,~, .... · (as on the tax roll or latest deed) iapplicant is a corporation, signature of duly authorized officer. (Name a~ate officer) Builder's License No. ~' f ~ Plumber's License No ......................... Electrician's License No.. ~ .................... Other Trad¢'s License No ...................... Location of land on which proposed work will be done. ??.,..J'./~(-~..~..T. 79~....C.' .Y./.--'(.d.~.o..~.~...~7. .............. · ~ ?.f.?.q ................... .~.T:...g ..,T ...................... .c.v..~.~?. ?..~¢7 ................. House Number Street Hamlet County Tax Map No. 1000 Section .... .q../7. t ....... Block ..... ~. ~. r ....... Lot ..... ~./../~ ......... 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 . . ?~...~.;,~...~7./'M.~..~T...~...Fff(~.~.?.~..~..~.?p?..~ ............................... b. Intended use and occupancy~ . ~ ................................................. 3. Nature of work (check which ap'plicable): New Building ..... ..... Addition ......... _ Alteration .......... Repair ........ ~ ..... Removal .............. Demolition .............. Other Work ............... i (Description) 4 Estimated Cost . .. : .......... e ' ................. ! (to be paid on filing this application) 5. If dwelling, number of dwelling Units ........... Number of dwelling units on each floor ................ I~' garage, number of cars . .J..i ................................................................... 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 ~..~q~'~ .(.~-c- ~t~./. Dimensions of same structure with alterations or additions: Front Rear Depth .................... ... Height .................... Number of Stories ...................... 8. r)imensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stones ........................................... / ............ 9. Size of lot: Front .... /..O.ff,..6'!/ .......... Rear .... O. ................ Depth .................... 10. Date of Purchase ... ~.rPJ~.../.~.ZT./. ............. Name of Former Owner . fa.,...~.q,~FA(~./. ........ . ...... 11. Zone or use district in which premises are situated. ~.~. ~.~./o~?(/~.~. ...................................... 12. r)oes proposed construction violate any zoning law, ordinance or regulation: .~.q ............... . ............. 13. Will lot be regraded . ~..o ..... : ................... Will excess fill be removed from premises:- Yes Name of Owner of premises A~. P. .............. Address ................... o ................ Name of Architect ....... ~ . Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all! buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and blockinumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF N W r0Rr,. (Name of individual signing above named. He is the ........................................ nt, corp . of said owner or owners, and is duly aul'i~m or have performed the said work and to make and file this application; that all statements conthined 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 this ~ ~'~OTA~ POBLIC, State of NoW Yolk , ff~/~ , .v,.--z ..... . ......., t~ignature of applicant) ! . [16. ~-sl2sss0, Suum~ t~rkV/~ ' ,~-:~":'" · ;.".- L ': -. '..'.,~l)gt;)~L ~ .'. :......,.... .. ~..,.~ ...,, ' ,.'.~' . . .,7~5-).~0~ ~ ~,~ 'to'~ .p~: ~o~' ~ET:' .~ ..,.?- ' ~.foU?.p ~qR~t~. '.' · ., . ,~ ._ 3: tNS~ATI??. '-".. · .-" -." · t