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Home My WebLink About11256-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildin§ Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. ~J.0.L~ ~6 .......... Date ...... l').(~ .c ?,.~,~.b.e.r.,..2. t ............... 19 .~} 1. THIS CERTIFIES that the, building ................................................ Location of Property .. 1. z~ 9.0..~ ~. ~.~.a.g~. J~.a.r~ ....................... g¥,t.e.n..t: ........... House No. Street Hamlet County Tax Map No. 1000 Sectiou . .0.2z~ ....... Block . P.~ ........... Lot . .0.1. z~ ........... Subdivision ....... ~ ................. ~ .......Filed Map No. ~C .... :..Lot No... ~ .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ·.. ~']~.1,7.. 2 ........... ,19 ~.1. pursuant to wlfich Building Permit No..I. l ~:~.6..7~ ............ dated ....d g.l.y.. ~.~ .................. 19..0.1, 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 ......... ·...a..d.~g.k, .a;d..d ,.i.tj, qo..t.q..a.n..qx..5..s.t.i.n, g..d.we..1.;L.~.qp.,, ............................. The certificate is issued to ....... 2,~.i. 1..1.i.a.~. ~..J.0..a..n..S.t.r'. 9p.g~ .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N / ~ UNDERWRITERS CERTIFICATE NO .............. Iii/.li ................................. Building Inspector Rev. 1/~1 Petn~is$ion is hereby granted [o r (THIS PERMIT /~UST BE KEPT ON COMPLETION OF Dale at~l~emise~ located at/'/('/i~C') .~i ~..~.~ Coudty To~ Mo o. 1000 Sect,on .~'~..'~;~.~ B pur~ont t~ opplicotion doted ' FiULL ond .approved by the FOB~ NO, S TOWN OF $OUTHOLD , Building Department Town Clerks Office 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 Inspector with the following; for new buildings or new use: ]. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage dispasal--(S-g form or equal). 3, Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, 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. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: ]. Accurate survey,of property 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 buildihgs or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 New Bqilding ................ Addition ... ,.~... ....... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property J~/~ J/;lh,~q~ /,~ ~.~..,,~... i~)y OW er Or Owners Of Property .... ~ J .~ . .. . ~ ........... ~. ;~. ........ Lot No /~. Block No .~.. House Health Dept. Approval ........... ~ ......................... Labor ~pt. Approval ......................................... Unde~riters Approval .............................................. Planning B~rd Approval ............~; ........................... Request For Temporaw Ce~ificate ........................................ Find Ce~ificate ........... ~j ....................... Fee Submitted $ ...~..~.~ ...................... Construction on above described building and permit meets all applicable ¢~es and regulations. Sworn to b~fom m~ thi~ Notaw Pubhc ,.~: .......~.~. ............. Coun~ NANOY E. NO~KLUN ' k ~/~, ~ NOTARY pUBt3C, State of NO~ ~or ' 41336, SCfolkCounty ~ ~, ~;~i~n Exp res March 30 i~ TOWN OF $OUTHOLD , Building Depmtment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This opplicatlon must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new ~se: ]. Final survey of property with accurate location of all 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 installations, 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. B. For existing buildings (prior to April 1957). Non-conforming uses. or buildings and "pre-existing" land uses: 1. Accurate survey.of property 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 in- formation required to prepare a certificate. C, Fees: 1, Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1,00 ........ ....................... New Building ................ Addition ....~ ..... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ....J../..~'..~.......¥..~..F..~..~..d~.....~.,-~_..~...../.~-././.~.....~.....~......./.,~...~.~:.~.. ........................... Owner Or Owners Of Property ..,[4M, i..t.....'T*~**. .............. ~ ................ 7..'..~...~.. ................................................ ............. .~.. ................ /~..~..~.. ..................... Lot No..../..~..?.. Block No.....~....... House No./....~..~.. Permit No ..................... Dote Of Permit .................... Applicant ................................ ~, ............................ Health Dept. Approval ........... ~ ........................ Lobar Dept. Approval ........ ; ....................................... Underwriters Approval ........... ~ .......................... Planning Bocird Approval ,....****---'~ .............................. Request For Temporary Certificate .................. '-'~,~ .................... Final Certificate Fee Submitted $ ...~.~:.?,..~. ........................ Construction on above described building and permit meets all applicable codes and regulations. Sworn to before me this Applicant ....~,.,~d~.~.~:.....~~~ .... ./..'~.. ....... day of ,..~/..~:.<;..~.'~....~.. ................... (stamp or seal) Notary Public .~./..~.. ................. County FIELD INSPECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C~DE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11~71 ~ TEL.: 765-1803 E, aminW . ..... ,19 Application ....... (Building Inspector) APPLICATION FOR BUILDIN~ PERMIT / Date ..... ~- ......... , 1~ ~ INSTRUCTIONS a. This application must be completely filled in by typewriter or inink and submitted in trivlicate 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 pre~nises 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 unti~ 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 authorized inspectors on premises and in buildings for necessary insp?tions. ............ '(Signature o f applicant, o5 ?ame<~alorporation) . .~.,. 53.~,..0. ri .~.. ~...~..7. _ ./!~.s.v? ............ (Mailing address of applicant) State whether applicant is owner; lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... q.c.< .~..e~. ................................................................................... Name of owner of premises .. ~'!]././[.~..~.-... ?...?.0.CEO....~...?..4UP. ~ ................................ (as on the tax roll or l~test deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No....~.6ccP... ~/0c/~./.%~ .... Plumber's LicenseNo ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. ... l¢, ?o, .... . .......................... ....... c? . . .................... House Number Street Hamlet County Tax Map No. 1000 Section ..... .~..~...~. ......Block ..... .ET..~. ......... Lot..cO../. ~. ............ Subdivision ..................................... Filed Mlp No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....t..~ .S.i.~..~'.~ .17..~.~. .............. ..................................... b. Intended use and occupancy (-~ $; d~,~ ~ ,r_~ 3. Natureofwork(checkwhichap~licable): New Building ... 10. 11. 12. 13. 14. ....... Addition .. ~ .... Alteration .......... Repairi .............. Removal .............. Demolition .............. Other Work ............... ~x ~5 '~ (Description) ' ~/ ~'*-o Fee .............................. Estimated Cost .... / ./ ........ : ................................. (to be paid on filing this application) If dwelling, number of dwelling hnits ....... /. ....... Number of dwelling units on each floor ................ If garage, number of cars ' If business, commercial or mixed occupancy, specify nature and extent of each tyre of use ...................... Dm~enslons of existing structure~, ,f any: Front....~.t~ .I)- ........ Rear ....~.~ .[~. ..... Depth..~. fl. ~- ........ HelghL .. ~'~5 .......... Numiber of Stones .... g~:'... ] .7l.-<. ..... ','-'t .................... ."~, ........... Danenslons of same structure w~th alterations or additions Front . ."~ I~- ....... Rear ...c~.q. [/)~.~ ......... , ' tri Depth .... 0ri [{>:'. ............. Height .. ~.~ ................. Numb~er of S o es .................... Dimensions of es[ire new constr¢ction: Front .... .'n. .......... Rear .... 1.~ ! ........ Depth .. [.~. .......... Height ... ~ .......... Num:ber of Stories .... ; :. :. ............................................... Size of lot: Front ...'~0~t ..... j ........... Rear ....'2.0 ( ............... ~_.~pth . .I.~4'._. ( .............. Date of Purchase .. J.~ l.~..i ............... ,.-~.Name of Former Owner .'~fq,clx.~.~... ~... Zone o~ use district in which prdmises are situated .k .~,.q~ t~-~ ~ .................................... Does proposed construction violate any zoning law, ordinance or regulation: . '.~ ........................... Will lot be regraded ....~....i ................... Wjll ~xcess fill be re,moved from premises: ~ Yes No Name of Owner of premises~)i ~!.t(~o') .~.. ~.-'~.~ ~,~..~r~'d~es~ ~. ~.~} ~. On ~ ..... Phone No. 3.Z3.-. ~,~-~'~... Name of Architect .......... ! ................. Address .............. Phone No. Name of Contractor .C....~...~.~.i.~.:. ~]q~r~f.~'x... Address .~ 1.{'.~. O~'~C.. Phone No. PLOT DIAGRAM Locate clearly and distinctly all ibuildings, whether existing or proposed, and. indicate all set-back dimensions from property lin'es. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW. YORK, couNTy,. ~F ..... ~. tI.D.~.. 9..... ~)~.~ .................... berg duly sworn, deposes ~d says that he is the applicant (Name of individual sig~g contract) above named. He is the ....0..~.9.ef7 ........... , ................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the mannir set forth in the application filed therewith. Sworn to before me this ...... ?~t~. .......... day of. i~ .............. 19 ~./. ' ..... . .: .... ~ NOTARY PUBLIC, State of New York (SignaturFu] apphcant) No, 4641~t36, Suffelk County ,~ Commission Expires March 30, 19