The URL can be used to link to this page

Home My WebLink About11307-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of t.he Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No, . ,g,l, 0..6 .~.5 ......... Date ~ugua t; 27 1981 THIS CERTIFIES that the building ................................................ Location of Property .... .~ .9.0.. C..e.n.~..a .1..D.~. z.' .v.e., ........ ~..a.t;.~J: .t; .u.c.k.,...~.e?..~..o.~.k. ....... House No Street Hamlet County Tax Map No. 1000 Section . .1.0..6 ....... Block ., .0.3. .......... Lot . .0.1.6. ............ Subdivision .CAp.~..,, .K.~.d..d..~.~.~ .a.f,.eA ......... Filed Map No. 1.6.7.2. .... Lot No. 11. .5 .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated July 24 .8.1. pursuant to which ..................... , 19 Building Permit No .... ] .1.3.0.7. Z. ........... dated .... .&u. gu. 9.~..3. .............. 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 ......... ........... a.q e..e.$.~.o.r y' .s.~.o.r.aae...~.u.%%~. $.ng. ...................................... The certificate is issued to . .C.a..~.h.e?.~.n..e..a.n.d...C 1.e. 9' .P.o..T..~gp, n,t, .~ ....................... of the aforesaid building. Suffolk County Department of Itealth Approval ..... N../.R .................................. UNDERWRITERS CERTIFICATE NO.. N/~ Building Inspector Rev. 1/81 FO~I~ NO. 2 ~ TOWH HALL ~ SOUTHOLD, N.Y. ~} BUILDING P,E~I~ (THIS PERMIT MUST BE KEPT ON THE P~E~IS~S UNTIL ~ULL COMPL~ION OF THE WORK AUTHORIZED) ~, ~ ~ . . .~-.?~.-.-..-~ ............... Permission is hereby granted to: ...... ~ ./.~......,~.~.,....~',~.~.. .................... ~ .......... ~....,~ ................ ~. ........................................ ............. .......... ..¢~. .~r~ ............ ~..~.,. ............. z....z....~ ............... Co~n~ *~ uop ~o. moo so~,o~ ....... ~...:. ~o~k ...4~..~ ..... :cot ~o....0~ .......... pu~s~nt to opplicotion doted ................... ~....~,...., 1 ., ~nd opproved by the Bulldlno Ihsp*ctor. Fee ~ ................ ~~< ..... Re¥.16/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY h~structions A. This apphcat~on 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: 1, Final survey of property w~th accurate location of all buildin§s, 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 ~nstallation from Board of Fire Underwriters, 4. Commercial buddings, industrial bui{dings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Subn'~[ Planning Board approval of com[)leted site plan requirements where applicable. B. For existing buildings (pr~or to Aprd 1957), Non-coniorming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty show~ng alt property lines, streets, buildings end unusual natural or topograph ic featu res. 2. Sworn s~aternent 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 dwelhng or land use $5.00 3 Copy of certificate of occupancy $1.00 New [Judding .... J/:,.. . Old or Pre~ex~sting Building ............ Vacant Land Cou,ty Tax Map No. lO00Section . ./.0.G ..... Block .... ~..~ ..... Lot ..... Subdiwsion ............................... Filed Map No ........... Lot No .............. Permit No. (/.>.¢.7,. Date of Permit .~/~/~],AppJicant...~,~.O.,~,..~, Health Dept. Approval ........................ Labor Dept. Approval ........................ Undo~rlters Approval ....................... Ptanning Board Approval .................... Requestf°rT~mporarvCert'f'ca[e~ ................... FinalCertJficate ........ Fee Submitted $. .m.. ........ Construction on above described budding and permit meets alt applicable codes and regulations. ~Oplicant ...... Rev. 10-10~78 FIELD INS~;C~N ~o~mmmio ,~ ~ FOUNDA2ZON (1st) FOUNDATION 2. ROUGH FRAME ~ PLUMBING 3. INSOLATION PER N. STATE ENERGY C,ODE (2nd) FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 8OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined/~.Or?2..~.. ....... , 1~/ ~ Approved ~4 .~ · · . ~, 1~. Permit No..~Z.~ Disapproved Application No..//.~..~.7 ...... INSTRUCTIONS a. Tlns application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildl Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan s'mwmg location of lot and of buildings on premises, relationship to adjoining premises or public stre~ or areas, and gwmg a detailed description of layout of property must be drawn on the diagram which is part of this apt' cation. c. The work covered by this apphcation may uot be commenced before issuance of Building Permit. d. Upon apprc,'al of this application, the Buil&ng Inspector will issue a Buikhng Permit to the applicant. Such pern shall be kept on the premises avadable for inspection throughout the work. e No buildiug 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 IIEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to t Building Zone Ordinance of the Town of Sonthold, Suffolk County, New York, and other applicable Laws, Ordinances Regulatmns, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The appbcant 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., inspecti,o/~ /~(Signature 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, .............. f). ................................................................... Nane of owner of pr0mise, ... C.°,.~.' .~..~.e../,7/'.r/.. ~...~.... ~/~/~..~ ..... ,/..c5: .6..3..05.. .~/..,~. ........... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly anthorized officer. (Name and title of corporate officer) Builder's License No ...... ~..~..'7~. ......... Plumber's License No ......................... 'fl Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work wilt be done ................................................ ft~)!~e~/,j~;~t;;r .............. ..~.~ a .~f.Q./.. 5~: .............. ~%~'~ {. ~.~ ~-.~ ......... Street Hamlet County Tax Map ¢. 1~ Secti? .../¢~ .......... Block ...~ ........... Lot..e<~. ......... Subdivision .~/ff..~.~<~ .............. Filed Map No..,.CZ.~ ..... Lot .~Xff~ ....... 2. State existing use and occupancy of premmes and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... < ..... /.. ~ .~./. t 0~.. ~..0 ~... 3. Nature of work (check which applicable): New Building .......... Addition .. ~.. .... Alteration .......... Repair .............. Rem6val .............. Demolition .............. Other Work ............... ~ Estimated Cost ......... /. ~.'~. ~. ..................... Fee ......................... ~ ........... I (to be paid on filing this application) {. If dwelling, ntnnber of dwelling iunits ............... Number of dwelling units on each floor ................ If garage, number of cars .... : .................................................................. i. If business, com, mercialexisting or mixed occupancy, specify hate. re and extent of ea, c!~ ty~.~of use ................... 7. Dimensions of structur6s, if any: Front...~ ..... Rear .~ ...... Depth. Height ............... Nun?bar of Stories ....................................................... Dimensions of same structure with alterations or additions: Front ................. Rear ................ Depth .................... :.. Height ...................... Number of Stories ............. ,¢, ,~ .... L Dimensions of entire ncw consth~ction: Front /G..ff~.... Rear../~ ~ ... Depth , Height ............... Number of Stories ...................................................... ). Size of lot: Front ...................... Rear ...................... Depth .................... ). [)ate 6fPurchase ............................. Name of Former Owner ........................... I. Zone or use district in which premises are situated ................................................... 2. l')oes proposed construction violate any zoning law, ordinance or regulation: .............................. L Will lot be regraded ........................... Will excess fill be removed from premises: Yes No L 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 all. buildings, whether existing or proposed, and. indicate all set-back diraensions from roperty lines. Give street and blockinumber or description according to deed, and show street names and indicate whether terior or corner lot. : rATE OF N,E~RI~,/~ v~ S S ' OUNTY OF, .... ,zO: ' .......... ~...../.7~ .... . . ... being duly sworn, deposes and says that he is the applicant (Name of individual sighting contract) >ore named. ~e is the ..................... ! ............ ~ .............................................. i (Contractor, agent, corporate officer, etc.) f said owner or owners, ahd is duly authorized to perform or have performed the said work and to make and file this 3plication;,that all statements con*ained in this application are true to the best of his knowledge and belief; and that the ork will be performed in the manndr set forth in the application filed therewith. worn to before me this ......... q~ ..... dayoi...~:.~..,19c~/. °ta,~rsuP~u,,~lic, · w-'3 '~ '3-'~: · · '-,-4 ~ -~3Rqt4rf~JzmcPl · County ~~¥,~k ,.,~... ~. (Signature °f applicantl ....... NO, 5 -2 81~'5850, Suffolk Count. Term Expires March 30,