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Home My WebLink About11293-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..gl 0fl.1.0 ........ Date ...... .~.u.~.y...3.0 .................... 19.81.. THIS CERTIFIES that the building ................................................ Location of Property . . .4.0.5. ['t.a.y.~'~.p~.q~..Rp.~.d., .......... I~..~.g.~.J:.g..u.c.k.,. New York House No. Street ........... County Tax Map No. 1000 Section .... 1.q? ..... Block ... 9.8. ......... Lot ...0,2.1 ............ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...d.t~].y..~.? ........... 198..~. pursuant to which Building Permit No ..... ~.~.9.3...Z ......... dated ......... ~.q ~ty, .2. t ........... 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 ......... .. Deck addition to Dwelling Thc certificate is issued to ..... l~d..mp.n.d. Boktna, ......... .................... of the aforesaid building. Suffolk County Department of Health Approval ....... ~/,R. ............................... UNDERWRITERS CERTIFICATE NO .... ~/.~. .......................................... 1/81 Building Inspector Permission is hereby granted to: TOWN OF SOUTHOL~ BUILDING D~pARi~gN~ TOWN HALL SOUTH'OLD, N~ Y. BUILDING PERMIT! (THIS PERMIT MUST BE KEPT ON THE P~E~IS~S UNTIL EULL COMPLETION OF THE WORK AUTHORIZED) ~'0 at premises located at...'.~....5 ......... "~'~'~'~J~'"i CoUnty Tax Mop No. 1000 Section ..... '/'~"Z ........Block 1.4 ,.~... .......... i, Lot No....f--Y.~;~L ........ Building Inspector. Fee $..L...: ............... REV.] 6130(80 FORM NO. 6 TOWN OF $OUTHOLD 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-(S-9 form or equal). 34 Approval of electrical ~nstallation 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 applicable. B. For existing buildings (prior to April 1957}, Non-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 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, C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date ...... .-7./.5. .o,/ ......... New Building .'~1~ I~.L .... Old or Pre-existing Building ............ Vacant Land ............. Location of Property..~. Owner ir Owners of P~S;rtN;'...~..~..f~...~..~.....~.0. County Tax Map No. 1000 Section 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 Certificate ..................... Final Certificate ..... .~' ........ Fee Submitted $... ~,~ 0--0 ~ Construction on above described building and ~'mit meets all ~ble codes a,nd regulations. Applicant. ,~..~ ....... ~. .... FYELD INSPECTION' 1. ?OUNT)AY10'2 ( 1S t) COMMENTS FOUNDATION (2nd) ROUGH FRAME & ?LGMBING INSULATION FER N. Y. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTIq, OLD, N.Y. 11971 TEL.: 765-1802 E.,~mmed ~/7' ~/ ....... Approved~(~. ~ ........ I~.. Permit .......... AppIication No.Z'./'.~Jv. ~.~.~.. ....... Disapproved a/c ..................................... / (Buildin~ Inspector) ~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tins appbcation must be completely filled iix by typewriter or in ink and submitted in triplicate to the Buildi Inspector, w~th 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot t;lan ,hewing location of lot and of buildings on premises, relationship to adjoining premises or public sire,, or areas, and gwmg a detailed description of layout of property must be drawn ell the diagram which is part of this ap[' cation. c. The work covered by this ppphcafion may not be commenced before issuance of Building Permit. d. Upml apprc.'al of tlus application, the Building Inspector will issne a Building Permit to the applicant. Such per,, shall be kept on the premises :wadable for inspection throughout the work. e. No btuld~,~g shalI be occupied or used .'n whole or ~n part for any purpose whatever until a Certificate of Occupan shall have been granted by the Budding Inspector. APPLICATION IS tlEREBY blADE to the Budding Department for the issuance ora Building Permit pursuant to t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for thc construct~ou of buildiugs, additions or alterations, or for removal or demolition, as herein describe TLc~' applicant agrees to cmnply ~,v, ilh all applicable laws, ordinances, building code, housing cod/and regu~tions, and a Onut a utb°r~zed inspect°rs °n Pr em'scs and in buildings f°r necessary i'~ti°ns'X // (Signature ~a~l~cF~a/ft, o~m~me' '~a'c;;~oration) (Mailing address of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build (as on tile tax roll or latest deed) If applicant is a corpora/mn, s~gnature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..... · .~...~..~. ..... .~0. Plnmber's License No ......................... Electrician's License No ....................... Other Trade s Lice lsc No ...................... LocaDon of land on which proposed work will be done ................................................ · ~o..~.7 ./. ............ ~,),,..-r/o. ~. e.~.. ~o..~.& ......... ~_...¢/. )/~ .~..L. .............. House Number Street Hamlet County Tax Map No. 1000 Section .... ./'.c')..~.~ ......... Block . ~d' Lot Subdivision ..................................... Filed Slap No ............... Lot .............. (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: - a. Existing use and occupancy ............. I ................................. b. Intended use and occupancy (-7~ L Nature of ~vork (check which applicable): New Building .......... Addition ...... Alteration .......... _ Repair Removal .... D~mohtton . Otl~er Work ............... .~/ (Description) Estimated Cost i (to be paid on filing this application) ;. If dwelling, number of dwelling, units ............... Number of dwelling units on each floor ................ If garage, number of cars ........................................................................ ~. If business, commercial or mixed occupancy, specify hatnre and extent of each type of use ..................... t. Dimensions of existing structures, if any: Front ...... ' ......... Rear .............. Depth ............... Height ............ '... Nud~ber of Stories ............... ' ......................................... Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ................... ;.. Height ...................... Number of Stories ...................... L Dimensions of enlire new construction: Front ............... Rear ............... Depth ............... tteight ............... Nm~ber of Stories ........................................................ Size of lot: Front .......... . ............ Rear ...................... Depth ......... ..z ............. Date df Purchase .......................... Name of Former Owner .~-,', Zone or use district in which premises are situated ................................... ' ................. / Does proposed constroction violate any zoning law, ordinance or regulation: .............................. Wall lot be regraded ............................ Will excess fill be removed from premises: Yes No Name of Owner of premises .. ~ ................. Address ................... Phone No ............... Name of Arclutect ......... ~ ................. Address ...... '....' ......... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly ali ou'ldings, xvhether existing or proposed, and. indicate all 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. I'Aq'E OF NEW YORK, OUNTY OF . ~lffolk ..... S.S GEOBGE. G,. LESSARD.ZR ............................ being duly sworn, deposes and says that he is the applic.-mt (Name of 'nd/~ idt al sighting contract) )ave named. is the ............ OWNER /Contractor (Contract6r, agent, corporate officer, etc.) said owner or owners, mid is dn'ly authorized to perform or have performed the said work and to make and file this )plication; that all statements coniained in th~s application are true to fi~e best of his knowledge and belief; and that the ark will be performed in the manner set forth h~ the application filed therewith. worn to before me,~3, is D ....... ......... / ' NOTARY ~UBLICi State ot Yerk'J -[AND NOTI~'? BU1LnlNG DEPARTMEN? AT 765-1~G2 9 AM TO 4 ~M FOR TH~