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Home My WebLink About11238-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Cerfi[icafe O[ Occupancy No Z13320 Date April 3 19~..5. THIS CERTIFIES that the buildingg.~.~ 3: ~ .~ Y..5. .h .e.d ................................... Location of Property . 1. .6 .~.5..5. ~ S.s.b. ? .e..~.o. ~..d ................... .~. ~..~ .~.~.~ ~..c ~ ............ House No, Street Hamlet County Tax Map No. 1000 Section ..... l?.Zt ....Block .... .0.2 .........Lot 01 1 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated · ...J.u r~ o..~q .......... 19.8. I pursuant to which Building Permit No. ! J .2.3.8..Z .............. dated ........ .J.u.~.y...2 ............. 19.8. ~., 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 ......... The certificate is issued to SYLVIA AFFENZELLAR (MRS DAVID) (owner,/essee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ....... iq.../.3, ................................ UNDERWRITERS CERTIFICATE NO ............... N ./)- ................................ Rev. 1/81 Building Inspector Permission ~s hereby granted to: (THIS PERMIT MUST BE KEPT ON THE PREi~iS~ · COMPLETION OF THE WORK AUTHORIZED) at premises Co~rlty Ta;X Map No. '1000 Section pur~oant tb application dated BOildl g Inspector. : and,~pproved by the FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall ~,outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY ~nstructions TOWN Or ~OU:;~>I hl This application must be filled in tvpewriter OR ink, and submitted4~7,!~c=t= 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 Amhitect 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: I. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic 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: I. Certificate of occupancy $5.00 1 2. Certificate of occupancy on pre-existing dwelling/ land 3. Copy of certificate of occupancy $1.00 use--Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Date ......... ,/.fi', ~, 7, ,X/ff,,~4 ~ ...... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. ..... Location of Property... Z~ ....... ~ ....... ~ ..... Hou~ No. ~ Street 'Hamlet OwnerorOwnersofProperty /Z~ ~ ~L~/~J County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No. ?.Y?.~:z...-/(..Lot No .............. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and permit meets all apglicable codes and regulations, Applicant .......~/'~~' / .,~y~.,_~ .~. ?..~'".'".'".'".'~.. ................. ,-,. TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 Enclosed please find an application for a Certificate of Occupancy. The final inspection has been made and in order to issue the C.O. we will need the enclosed application filled out and return- ed to us along with your check for $5.00. Thank you. BUILDING PERMIT FIELD 4 1. FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY G~ODE FINAL COMMENTS ADDITIONAL COMMENTS: FORUM ~0. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×om,ne 'o ............. Disapprove~ a/c ........................ T,,,,,.,.,,.,.,.,,.~'------"~. ........................ .....~.. ................ APPLICATION FOR BUILDING PERMIT .......... ........... INSTRUCTIONS a. This application must be completely filled in by typewriter o~. in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee accordlng 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 drown on the diagram which is part of this application. 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 shail 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 authorized inspectors on premises and in buildings for necessary inspections. ......... ........ ................... (Address of applicant) State whether applicont is owner, lessee, agent, architect, engineer, get~eral contractor, electrician, plumber or builder. .............................. ................ ....................................................................................................... Name of owner of premises ...~.~.../.~.~..Z:'.~.' .......... ~..~.~..~.~./~..~.~.../~.~./....~:~.. .................................................................. [ if applicant is a corporate, 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 ............................................... 1. Location of land on which proposed work will be done, Map No.: ..~.,..~..~...~..../.....,~,~...~.T~.. Lot No ...,.~..~.~.... Street and Number .......... ~ ........... ~--~..~.q....~.~.~_._.~._. ........ ~.,.,...~/~..~.~..~' ...¢~.Z~...~...~...~..~.. ....... /~/~_ ~ / x Mdnicipality 2. State existing use and occupancy of premises a, nd~Jn~.ended use and occupancy of proposed construction: b. Intended use and occupancy ......... .~..~....~..-~ ....................................................................................... 3. Nature of work (check which applicable): New Building,. ................. Addition~.. ................ Alteration ................. Repair .................. Red, oval ....... Demo t or ........ Other Wore ...................................... ~ .~,' (Description) ' 4. Estimated Cost ............. .~..v..,.~..r. ................................. rea .J.,, .................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ..... , ...................... ]f 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 sanqe structur~ with alteratiqns or additions: Front ....... ~..,~'~. ..................... Rear ....,~'..~ ................... Depth ............ ~..~...t. ............ Height .....~..~.. ................. Number of Stories .............. / ................ 8. Dimensions of entire new construction: Front .................... . ............... Rear ............................ Depth ........................ Height .................... Number of Stories ............................................................................................................... 9. Size of lot. Front ............. ~..~ .................................... kec .......... .~,..~. ...................... Depth ~ .... 10. Date of Purchase ................. ' ....................................... Name of~Form~er/~Ownfer,~,,. -~ ,] - ...}. ................................................... 1 1. Zone or use district in which premises are situated .................~..~..~.C~...¢..'lJT. z..~.../., ................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .......... , ,'~,."~. ....................................... 13. Will lot be regraded . ........................... <~, ./,. ~2_~ _/,LWill excess fill be removed from,.~,..~.~,,~,wVpremises: (,) Yes ( ) No 14. Narne of Owner of premises ...~¢..,~Z..f./.9.../.~,/f.c~.~..'Fr::f~..z'~... .......... Address/.'/~././..f¢~r.~.~:..&.. Phone No. Name of Architect' . ............................................................. Address ................................ Phone No ....................... N o.~....f~ .~.% .~. ~....~. / Nome of Contractor ........... ............. Address ¢..~.;/...,..... Phone PLOT DIAGI~,M 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 STATE OF NEW2r'0~,K, -- .z [SC' COUNTY,)F 'm ................ :.I..,.~~..~~ ..... beiag duly sworn, deposes end says that he is he applicam (Name-of i/,dividual signing contract) above named. He is the .................................. ~ ....... ~ ................................ :r. ........................................................... · ................... f ~ (Contractor~agent, corporate o ricer, etc.) of said owner or owners ~ i, dtjl'~7--~Jfhr~rl-z~'~6 perform or have performed the said work and to make and file this application; that all g~:~'~e~eg~:~' c~)nteined 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 be~for, e me this , / ~ ....... ............. ...... Z/ public, ........ . oanV ............................. \'NO, 52-8Z25850, Suffolk , \ Term EXpires Mar~h 30, I~