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Home My WebLink About11239-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building ........ &c..c .e.s.s. o..p y..ga. .z p.b.q ..................... Location of Property ~&Js'e'do: ' 79.5. .G..i.e.n..C. 9.u.~' ................ C.u..~.c.h.q$ .u9 ............ . Street Hamlet County Tax Map No. 1000 Section .Q .83 ........ Block . .0..1 ........... Lot ....09.8. .......... Subdivision...V..~.s.~.a...B.L.u.f..f ............... Filed Map No. 5.0. .6.0 ....Lot No..2 ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... q u..n.e.. 2. .5 ......... 19.8. 1. pursuant to wltich Building Permit No.. ! .1.2.3. .9 .Z ............. dated ..... ~.u..~ y..2. ................ 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 ......... Gazebo accessory structure The certificate is issued toDr. John A. Loreto ..................... io;;.'o;, ................... of the aforesaid building. Suffolk County Department of Health Approval ....... i~ ? A ................................ UNDERWRITERS CERTIFICATE NO ............... ~/. g ................................ Rev. 1/81 Building Inspector BUILDING' ~ERMIT ' BE KEPT ~' PRE'SE : (THIS PERMIT /~UST 'ON THE COMPLETION 0¢ THE WORK AUtrHO',RIZED)~ 11239 UNTIL F~LL at p~emise$ located at ....... coud~ TaX Mop No. lOO0 Section .x~.E;¢..)..:;.~.~ Bloc .?...~,0~:...;.... ~Lot NO. ¢..0~.~ ........... '' ' · ~..~ ~ ['~ } 19~, and ~pprov~ by the pU~s~ont tO application :dated .... Bul ~ng Idspector Rev 6130180 , FORM NO. 6 TOWN OF SOUTHOLD Building Depar~men~ Town Hall $outhold, N,Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANt Instructions TOWN OF $OU~IOLD A. Ti~is application must be filled in typewriter OR ink, and subr~itted in duplicate to the Building Inspec- tor w~m the following; for new buildings or new use: 1. Final sur,'ey of property with accurate location of all buildings, property lines, streets, and unusual natural or tooograohic features. 2. Final aDprovel of Health Deer. 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 building~ and installa* tlons, a certificate of Code compliance from the Architect 'or Engineer responsible for the building. 5. Submi[ Planning Board approval of completed site plan requirements where app!icsb!e. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildines a~d "pre-existing" land uses: - 1. Accurate survey of peoperty showln9 all property lines, streets, build(ngs and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Data of 3ny housing code or safety inspection of buildings or premises, or other pertinent informa- tion requlred to prepare a certificate. / 1. Certificate of occupancy $5.00 2. Cardficate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 New Building .~,~, .2-, ,~.'~,, Old or Pre-existing Building(Z) ......... =/Vacant Lend -i ........... County Tax Map No..1000 Section ............./~ Block , ~ ~ Lot ., ,~ .... Subdivision .................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit ....... :, .Applicant .................................. Health Dept. Approval ........................ Labor Dept, Approval ......................... Underwriters Approval ........................ Planning Board Approval .................. Request for Temporary Cartificate ..................... Final Cerdficat~ , , , ~,.. Construction on above described building an4~perr~if?~ee/~s all app~i~cab~Je~codes and regulations, PO ~cant . _......,~.~. ~:., .~ ... X .......................... . ..... FIELD INSPECTION 1. FOUNDATION (1st) FOUNDATION (2nd) 2. COMMENTS ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CpDE FINAL ADDITIONAL COMMENTS: TOWN OF SOUT OLD OFFICE OF BUILDING INSPECTOR ' P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765q 802 This is to advise you that the ~ob ,,~, n,,4~ Permit No I,.-.,a~. ~ ..... -~ ~ - ' '~ t~"~ ........... ~"g a fin~al~ins~ectio~ ~.~ .'~ .~s compie*ed and ....... c / .~=o no~fM/ oeen done. In order to complete this file, it is necessary that a Certificate of Occupancy be issued. F!ease fill out the enclosed form(s), return same to the above office with a check for $5.00 payable to the Town of Southold. Please indicate to whom the Certificate of Occupancy is to be mailed and arrange with this office for an inspecfion date. ' Thank you for your prompt attention. Very truly yours, Victor Lessard Administrator VL:ec Enclosures FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 ('~ TEL.: 765-1802 Examined. ~5~_~ Disappro~6e'd a/c ....... : .~-.. ~ .................... ~g Inspector) !' APPLICATION FOR BUILDING PERMIT Application No..///../f..4'~../~.. ..... INSTRUCTIONS a. This application must be completely filled in by typewriter or in 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 apl7 cation. c. The work covered by this application may not be commenced before issuance of Building Pemqit. d. Upon approval of this application, the Building Inspector will issne a Building Permit to the applicant. Such pern 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 tile Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for tile construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary-igspections,~ ..... (Signat~ of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build, (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 LicenseNo ......................... Electrician's License No ....................... Otller Trade's License No ...................... Location of land on which proposed work will be done ................................................ ................... House Number Street Hamlet County Tax Map No. 1000Section ...~.0.5. Block O.'" Lot Subdivision .............. ['"~/'/5.~-'.rz~,--~..Q. ~4../~. ,'~,~. ........Filed biap No..577.0.(.2.0 ....... Lot ............. (Nmne) State existing use and occupancy of pre~nises and intended use and ~pancy of proposed construction: a. Existing use and occupancy .... .~.. ?...~..~. ~....(~.. ...... (.5~.~. .... .~.'..~.(;kS..~. 7.~..~?~..~.~.. b Intended use and occupancy 'CY- 5~'--~'-fC'- -~. L Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair ............ ./ Re,n~al .............. Demolition .............. Other Work ............... ' Estimated Cost Fee ........... , (to be paid on filing this application) ;. If dwelling, number of dwelling ~nits ........... Number of dwelling units on each floor ............... If garage number of cars i. If business, commercial or mixe occupancy, specify ri0ture and extent of each type of use ................... Fro t ' Rear D pth I Dimensions of existingstmctures, if any: n ............................. e ............ Height Number of Stones Dimensions of same structure with alterations or additions: Front ................. Rear .............. Depth .................... !.. Height ...................... Number of Stories .................. ' ' Froflt Rear Depth L Dimensions of entire new constructmn: ......................................... Height Num'ber of Stories ). Size of lot: Front ....................... Rear ............... . ....... Depth .................... ). Date df Purchase ........... i .................. Name of Former Owner .......................... 1. Zone or use district in which promises are situated .................................................. Do s prop sed con uction iol'ate any zoninglaw ordinance o gulation: ) e o str v ~ , r re ............................. t. Will lot be regraded ......... : ................... Will excess fill be removed from premises: Yes No' [. Name of Owner of premises ...i ................. Address ................... Phone No ................ Name of Architect .......... ' ................. Address ................... Phone No ................ Name of Contractor ......... i ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly allI buildings, whether existing or proposed, and~ indicate ail set-back dimensions from roperty lines. Give street and block number or description according to deed, and show street names and indicate whether ,terior or corner lot. TATE OF NEV~,,Y~tRK., , -- 4.. oFr k' o ........................... 't .................... being duly sworn, deposes and says that he is the applicant (Name of individual sig~ing contract) )ove named. , e is the ~ ~ ~ , (Contractor, agent, corporate officer, etc.) f s~d owner or owne~, ~d is duly authorized to perform or have performed the said work ~d to m~b and file >phcatmn; that all statements contained ~n thts apphcat~on are true to fl~e best of his knowledge and belief; and that the 'ork will be performed in the m~ner set forth ~ the application filed therewith. ~om to before me this : ...... ....... o a P )lic, .......... ' . .. County ~ ~ARY PflBLJ0, ~ of no~ Y~ (Signature of applicant) ~LO~G (.\',J ELL'3 ';