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Home My WebLink About11284-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall SoutHold, N.Y. Certificate Of Occupancy No..Z.1.3.3. ! .9 .......... Date ...... g:. .p .p .z. Z. . .3 ................... 198..5. THIS CERTIFIES that the building .... D.e. C ~ ........................................ LncationofPronertv 380 Sound Ave, PeconSc House No. Street Hamlet County Tax Map No. 1000 Section ...0..~y ...... Block ...0..1 .......... Lot ..... .0.0.5. ........ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore flied in this office dated ·...J.u.l.y...15 ........... 19.8.1. pursuant to which Building Permit No.. 1. .1.2.8fi. Z. ............. dated ....... J..u ~- ¥..1.5 ............. 19 ~3.1., 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 ......... ....cp.n~ ~r.u.q~..d.e. qt~. ~.d.c~ 5, .t ;[.o.i~, .~p..~ .x ~_~s.~5~g..d.~. 9.1.5.~.n. g ........................ The certificate is issued to . .BEAT[liCE D, . .L.Yfl. P,..H. ............ ...................... of the aforesaid building. Suffolk County Department of Health Approval N/^ UNDERWRITERS CERTIFICATE NO ................. N../...~ .............................. Rev. 1/81 Buildzng Inspector FORM NO. ~ TOWN OF ~OUTH01~D BUILDING DJ~PARTM~N$ TOWN HALL' SOUTH'OLD, N~ Y. BUILDING P, ERMI'~ (THIS PERMIT MUST BE KEPT ON THE PRE/~I~S UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 11284 Z Date ....... Permission is hereby granted to: / ../~.~.,.~'.....~.~..~.. ........ - ~.._,..~.~...~, ~. .... ...... ........................................ ~ ................. ~ ................ , ........... ~j ......................... at premises Iocotod · ~.~.~.~ .. ....... : ..... ~ ...... [o ~o..~.~.5.~2 ....... Cou~ Tox ~op ~o. 1000 Section ..... ~.~.~ ...... Block ...... ~ t pursuont to *ppl~c~tlon doted ........... ~.~....2..~....~...~....}:...,,., 1¢~.~., ond ~pprov~ by the Building Inspector. Fee $.../....'~..E. ~i ......... Rev. 6130/80 Buildin r Inspector FORM NO. 6 TOWN OF SOUTHOLD Buiiding Departme.n.~ Town Hail Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. Thi: ~',p211cat~cn must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor'.v~:h the following; for new buddings or new use: 1. Final ~ur,,ey of property with accurate location of all buildings, property lines, streets, and unusual na:ural er toeograohic features 2. Fm~l a~aroval of Health Dept. of water supply and seweraee disposal--(S-9 form or equal). 3. Aoprovai of electrical instaltat~on from Board of Fire Unde-rwriters. 4. Corr~meroal buildlngs, Industrial buddings, Multiple Residences and similar buildings and installa. tions, a ceruficate of Code compliance from the Architect or Engineer responsible for the building. 5. Suom.t Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildlnes and "pre-existing" l. Accura~e ~ze,/ of peoperty showing all prooerty lines, streets, buildings and unusual natural or toprqreohic features. ' 2.Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. D3~a o~ :.ny housing code or safety inspection of buddings or premises, or other pertinent informa- tion required to prepare a ce,d:ificate. .,' C. Fees: 1. Cart~fica[e of occupancy $5.00 2. C~rtmcate or' occupancy on pre-exmtJng dwelling or land use $5.00 3, Copy of ceruflcate of occupancy SI.00 New Budding · . . Old or Pre-existing Building(X) ........ : /Vacant Land ............ Locat,on or' ..... /cZ. Hou~ /Vo. S(ree~ Ham/et Owner or Owners of Property . ~~/C:~ r..~,. . ~.~. .................... County Tax Mae No. 1000Sectlon .~¢/~.~.,. Block ..... / .......... Lot..~;~.../~;~.. Suemv,s,o¢ ,~E¢~g~/.~.... '~:~.4 ~.~.~ ........ Filed Map No. ¢¢¢.X/.~...Lot No.. ~ .......... Hca:ih De~t. Approval ........................ Labor Dept. Approval ...................... ~.. U~de~,'zr~ters Approval ........................ Planning Board Approval Request for Temporary Certificate ..................... Final Certificate . Fee Submitted S ............................. Construc=~on on above described budding and permlt'meets all app~cabl~odes and regulations. Applicant .~¢/ 5 ( :-,- ....................... FIELD IN~?E~'ION FOUNDATION FOUNDATION ROUGH FRAME & FLUMBING INSULATION PER STATE ENERGY G,ODE FINAL COMMENTS N DATE ,, , ~ 2, , ~o ~ N. Y. ADDITIONAL COMMENTS: m ~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL,: 765-1803 19. . 1 ~. Permit No./~t~.~' .~..~..~ Approved .kr..~/V.../..~..., Disapproved a/c ....... ..~~ ...... ~ ......... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tlus application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi Inspector, w~tb 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 strer or areas, and gwmg a detailed description of layout of property must be drawn on the diagram which is part of this apr cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon apprc.'al of tlus apphcation, the Building Inspector will issue a Building Permit to the applicant. Such peru shall be kept on the premises avadable for inspection throughout the work. e. No braiding shall be occupmd or used m whole or in part for any purpose whatever until a Certificate of Occupan shall have been granted by the Budding Inspector. APPLICATION IS IIEREBY 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 the construction of bmldtngs, 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 adnut authorized inspectors on p~emiscs aod in buildings for necessary inspections. .. ........... d ~Signatu~of applic~t, or name, if a corporation) .... (Maitiag address'°/f al3plicant ) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build, (a~5~'h the tax roll or latest deed) If applicant ts a cor~poratmn, s~gnature of duly attthorized officer. (Name and title of cmporate 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 ................................................ .............. .... House Number Street .............. Hamlet " ................... County Tax Map No. 1000 Section .... .~..~..~. ........ Block .... ~../ ........... Lot...0..0.~. ........ Subdivtsion . . P..g~:~,~2'/..e4q~....r~~ ...... Filed Map No...//~. ...... Lot .~g'. ~7.7. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Emstmg use and occupancy. .................................. b, Intended use and occupancy ....~..~/~..~..~. ................................... }. Nature of work (check whict: applicable): New Building ............. Alteration .......... Repair .............. Relnoval .............. Demolition .............. Other Work ............... ,,.~ ~,.' .~. ~ ~:. (Description) Estimated Cost cff~,--'4~' - ~ ' F ' (to be paid on filing this application) ;. If &uelling, number of dwelling it:nits ...... ./ ........ Number of dwelling units on each floor ................ If garage, number of ears ........... ~ .......................................................... i. If bus:ness, commercml~ or mixed occupancy, specify nature and extent of each type of use ":' '~'"'oepm i~.' .~J'~ .~i ' t. Dimensions of existing structures, if any: Front....IZt, ff ......... Rear ... ~2r.~ ........ ;'~.....' ' ' Hmght ............ Number of Stories ............. , ................................... Dimensions of same structure with alterations or additions: Front .... ~ ./. ~. f ..... Rear ...... ./~..5 ...... Depth ...... /.~ .............. tteight ... ~.,~7 ...... ' ....... Number of Stories .... j ......... ~, ...... L Dimensions of)~ntire new construction: Front . .ff. [.~. ........ Rear .... f~. ........ Depth ...f. Pl. ........ Height ...t/. .......... Number of Stories .......... /. .............. ~ ................. : ........ ,~.. ). Size of lot: Front ....... .~. ?. ........... Rear ....... ¢'~.....: ....... Dep[h, ff~/-~-. ,,~/~...~',~4~ . . ). Date of Purchase .. .......... ~. Name.of Former Qwner ~, ~,'7~qg-e~',: ................ I. Zone or use district in wl~ch premises are situated. ,~~ ?.~..~ ...... ' ................. !. Does proposed construction viotate any zoning law, ordinance or regulation: .... ~']. tY7. ..................... L Will lot be regraded ...... ~ ............... Will excess fill~be re, c~oved from premises: Yes L Name of Owner of premises fi2 .~.,. ~... Address ~.~.,~.aw4~.f-'~ .... Phone No. .... Name of Arclfitect .......... '... ~' ............. Address ...... ' .... ' ......... Phone No Name of Contractor ......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from roperty liiies. Give street and block.'number or description according to deed, and show street names and indicate whether terior or corner lot. ' ................................................ veing amy sworn, deposes aha says that he Is the applicant (Name of indMdual sighting contract) e is the ............. ~ .............................................................. (Contractor, agent, corporate officer, etc.) £ said owner or owners, oa~d is duly authorized to perform or/:ave per, formed th~ said work and to make and file fids >plication; that all statements contained in this application are true to ~l~e best of his ,knowledge and belief; and that the 'ork will be performed in the manngr set forth fl~ the application filed therewith. mom to before me this i ............ .... :. .,~lic,,,.. :. ;,/..,,,,Q~ .... ~-n.~.,, · County ............. ' Term [x~lte* ~ar , [/ {/ ff/,t (Signature of applicant)