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Home My WebLink About11281-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Flail Southold, N.Y. Certificate Of Occupancy No..511365 ........ Date ....... December..16 ............. 19.82 THIS CERTIFIES that the building ............................................... Location of Property . 3.7.60..Camp. ~in¢o.],~. ~.d...,...M.a.t.t. $ .t.uc.k. ~ .................... House No Street Ham/et County Tax Map No. 1000 Sectzon . . 1,2.3, ..... Block .q5 ............ Lot . .0..17 Subdivision ..... .X ....................... Filed Map No..~ ...... Lot No....X. ......... conforms substantially to the Apphcation for Building Pernfit heretofore filed in this office dated .... JUnto. :30 ......... , 198~-. pursuant to which Budding Permit No..1.1.2.8. J:.g. .............. dated .. Gu,J~y ,l.5. ............ 19.8.1., was issued, and conforms to all of the requirements of the apphcable provls~ons of the law. The occnpancy for which this certificate ~s issued is ......... .... con.stru¢.t..lPor.c.h ad.d.i~;ipjn. ~9..e.~$~.i. qg, .d.w.e. 1..1.ip.q. ...................... The certificate ~s issued to . .[qi.c. hael..BeJ-rne. '/o~;n'E-,'/&'~'dZtkb~)2 ..................... of the aforesaid building. Suffolk County Department of Health Approval .... .n./.a. .................................. UNDERWRITERS CERTIFICATE NO ........... !a./.a,. .................................. Rev 1/81 Buildzng Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 11281 Z Permission is hereby granted to: County Tax Map No. 1000 Section ............ Block .... L~./..~; ........Lot No ..... ~.../. ........ pursuant to application dated .......... .~...(x;..'../:d...~........~..C~... ................ , I .~..../..., and approved by the Building Inspector. Building Inspector Rev. 6130/80 FI~,D~SFECTION COMMENTS FOUNDATION (lst) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: 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: I. 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-iS-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 applicabie. B. For existing buildiu~js (pr[o~ to April 1957}, Nan-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. Certtficate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date .. New Building ............. Old or Pre-existing Building(X) ....... =/Vacant Land , Location of PropertyHouse" ~'?~'~' ' 'No, '~'~/¢' /~l ~.~0/~ , .~,, ,C~.~,~r,eet ......... ~'q ¢' ~LI ¢,c(.L /~,(~ . ,l~,.~/ ??,~, ?.~, , .Hamlet Owner or Owners of Property ...... - ............................ County Tax Map No. 1000 Section ..... 2~ .~. ,~. .....Block .... .~?.,~. ...... Lot .... O./,~. ...... Subdivision ................................ Filed Map No ........... Lot No .............. Permit No../,/..'~..~./... Date of Permit .~//../.~./~.l..Applicant ............ 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 pern~m,e~ts all_ap.p~&'~le~codes and regulations. Applicant, ,~ ,~.,~'~ ~/?~.~. ¢ _,~.~: ~. -~,~_¢~' .~f-~ ................... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL File No ................................ Date . /~.,/ ..... 7. ......... ,19 Fl PLEASE TA~/~E NOTICE,,r~4~ ~t, ']'; ~, ~ ,that your application dated.. ~...~.4 ......... 19 &.. for permit to construct. ~,..,r~..~ .~.~. ........................................... at Location of Property ~ ~ ~~~ ~ ...¢~Z. h;us~ ~o ............ Hamlet County Tax Map No. 1000 Section .. ~ ....... Block . .~.~ ....... Lot . .~.( 7 ...... Subdivision ' ' Fite~ap~o...~.~ .... Lot No .................. is returned herewith and disapproved on the following grounds~~~~~ ........ . ~..¢~ .... ~,..~.,.:.? .... ~~~g .......... .. . ' ./~. ?..'.'.'.- ....... Building Inspector RV 1/80 (Building Inspector) [ APPLICATION FOR BUILDING PERMIT BUILDING DEPARTMENT ,~-'-7~ ~,,,~ cd4~d_~-x.-,e SOUTHOLD, N.Y. 11971 TEL,: 765-1803 INSTRUCTIONS Application No ................ a. Th~s 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 dcscriphon of layout of property must be drawn on the diagram which is part of this apF 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 of a Building Permit pursuant to t Building Z~ne 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, building code, housing code, and regulations, and admit authorized inspectors on pre~nises and in buildings for necessary~ions. ..... ........... (Mailing address of apl~licant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build~ Name of owner orpremises . .~ .... ~ ............................................. (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 License No ......................... Electrician's License No ....................... Other Trade's License No ...................... l-,ocation of land on which proposed work will be done....~ .... ~..~. ~. ~ ................... ........ ............................................... ............... House Number Street Hamlet County Tax Map No. 1000 Section .../.~-~.~. .......... Block .. 0 ~ Lot Ol 7 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 ............................. b. Intended use and occupancy ..... ~.. ~ ...... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alterat~_..: .,q ...... Repair, . ............. Rem6val ............. Demolition .............. Other Work..t/'?q.~t ..... (,Description) 4 Estimated Cost .... 1 ....................... Fee .................... '.~.. .......... ' (to be paid on filing this application) ;. If dwelling, number of dwelling cnits ............... Nmnber of dwelling units on each floor ............... If garage, number of cars ....................................................................... L If business, commerciai or mixed occupancy, specify fiature and extent of each type of use ..... ~i~i i i ..... t. Dimensions of existing structure~, if any: Front..5. ~' ......... Rear . .~.~. ......... l~;pth ..... Height .]. ~a ( .......... Number of Stories ./?.2.-- .................................................. Dimensions of same structure wilth alterations or additions: Front ...~.a~q~. .......... Rear . ,3 ~. ............ Depth ,...~.'2 ............. ... Height . .] ./~'. ................ Number of Stories ../'. ~ .,z~...: ............. t. Dimensions of entire new construction: Front ....~. ~ ~. . Rear ............... Depth . ~ ............ ./.o. " Height ............ Number of Stones ....................................... :{]]t ............ ). Size of lot: Front . ~ Rear ..................... Depth .................. ). Date of Purchase. . ........... . . . ............... . . '...NamegfFormer, Owner .......... ~"'["t ............ 1. Zone or use &stnct ~n which premtses are situated ..... /~ ....................... '...,.~>, · · ~ ......... 2. Does proposed construction wolate any zoning law, or&nance or regulatmn ............. 3. Will lot be regraded ..... ~ ......... ~ ..... ' ....Will excess fill be removed from premises: Yes No ~. Nmne of Owner of premises~.'~" ~.~z~ .... Address . .~/g~.. ...... Phone No~ .?.~. ~..~.O. (~. .... Name of Architect ......... I ........ Address ............. Phone No ................ Nmne of Contractor..~ 2] ~ ..... Address: ~ ..... Phone No. ~.~q.q.X ~..Z-..~. [... PLOT DIAGRAM , Locate clearly and distinctly ale buildings, whether existing or proposed, and. indicate all set-back dimensions roperty lines. Give street and block humber or description according to deed, and show street terior or corner lot. from aames and indicate whether 1'ATE OF NEW(I~RK, OUNTY OF~... .............. ~ .... being duly sworn, deposes and says that he is the applicant >ove named. e is the ............................. ~[ (Contractor, a..~, corporate officer, etc.) f said ~)wner or owners, and is duly authorized to perform or have peffonued the said work and to make and file this )plicati~on; that all statements contained ~n this application are true to the best of hi~ knowledge and belief; and that the 'ork wilt be performed in the manner set forth in the application filed therewith. a,orn to before me this ...... ........ ~--~5-i5_o_, su.f~k c,~ - / / (Signature of applicant)