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Home My WebLink About11317-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No, Z10767 Date Noyember 9 ., 19..~1 THIS CERTIFIES that the building ................................................ County Tax Map No. 1000 Section .... 1.~../4 ..... Block ..... 07 ........ Lot .... O!0,;~.... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Apphcation for Building Permit heretofore filed in this office dated Augu$t 5 19.8.I. pursuant to which Building Permit No. 11317 Z dated .... A...~. 8.~...6 ............... 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 ......... Addition of Deck and Carport The certificate is issued to Edzard. Van Ho.Ithe .................... ~o¥,'*'r.~ ................... of the aforesaid building. Suffolk County Department of Health Approval ........ .N/.R. .............................. UNDERWRITERS CERTIFICATE NO ....... .I?/.R ....................................... Building Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N~ Y. BUILDING P, ER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 11317 Z Date ...~/./~.~.,~../.~.........~.,. .................. 19....~.../ Permission is hereby granted to: ................... . .~z..~./...-Y~/.~.~......,.~.~..~... ........ ,,, ......... ~.~......~.~....E~ .......... ~ .................................... ~z~ z~ ~. . . ..~ [ [ /~ ~. .. .~ .............. ~.~.~ ~ . . . . ~ ~. .~ ~ ....... ~t premise~'l~ted ~.~.,..,~~/~,~.~.,..~.,.~.....~.~.~... ................................................. County Tax Map No. 1000 Section ../Z~ ............. Block ...~..~ ......... Lot No.~Z~.'.~...=.~/~, ~ to application dated ..~.~Z~ ...... ~ ............., 19.~, and approved by the ~pursuant Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. APPLICATION FOR CERTIFICATI F OCCUPANCY instructions A. This apphcation must be filled in typewriter OR ink, and subr )licate to the Building Inspec- tor with the following; for new bl~iidlngs or new use: 1. Final survey of property with accurate location of all build )roperty lines, streets, and unusual na tu raj or topograpb m featu res. 2. Final approval of Health Dept of wate~ supply and sewerage ~sal-{S-9 form or equal), 3. Approval of e~ec~ncal installation from Board of F~re Unde~riters. 4. Commercial buildings, Industrial buddings, Multiple Residences and similar buildings end installa- tions, a cer~l[ica[e of Code comphance from the Architect or Engineer responsible for the building. 5. Subm,~ P ann ng Board approval of completed site plan requirements where applicable, B.For ex~stmg buddings (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 unu~al natural or topographic features. 2.Sworn sla[ement of owner or previous owner as to use, occupancy and condition of buildings, 3Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- bon required to prepare a cert~[ cate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre existing dwelhng o~ land use $5.00 3 Copy of certificate of occupancy $1.00 New Bufichn~/ .......... Old or F re-ex~sting Budding .......... Vacant Land , . House No ~reet ~ ' ' ......... Hamlet o. O no.. ............... ...... Subdw~sion .Fded Map No ..... Lot No. Permit No.//J/Z.. Date of Permit ~/., .Applicant .~...~. Health Dept. Approval ~ - -' .Labor Dept. Approval Underwriters Approval .... .Planning Board Approval ~. ,. ~ ....... Request fer Temporary Certificate ....... ~ ......... F nal Cert f cate ............ Fee Suhm,tted $ ..... ~..L::-(~ ............ Construction on above descr '¢' ' ' /~ ~ .. ~r~ c~tmdmganap~me~sa~p~ablecodesandregulations. FIELD,INSPeCTiON COMMENTS FOUND~,TION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: t II FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Ex amined ~.-Mf .r.~. ....... 19~./. ipproved~..~. ...... , 19~../. Permit No.~./...~../..~7...~ / Disapproved a/c ....... '. .... . APPLICATION FOR BUILDING PERMIT Z. Application No.; ............ INSTRUCTIONS a. Thru 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 g~vmg a detaded description 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 apprc:al of this application, the Building Inspector wilt issue a Building Permit to the applicant. Such peru shall be kept on the prennses available 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 HEREBY 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 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 respecters on premzses and in buildings for necessary inspections. ~ /3 (~ignature of apphcant, or name,, if a corporation) ' (Mailing addres~ of applicant) " ' ' State whether apphcant ts owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build, ............. L?. .a.e. 50.0 .................................................................. Nane of owner of premises .Z',~ .~.. ............................................ (as on the tax roil or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ........ ?( .t.W ........... Plumber s Licens.~ No ......................... Electuc~an's License No ....................... Other Trade's License No. Location of land on which proposed work will be done ................................................ ...: ............ .............. se Number/~Fx.o-~,/~/x~ ,~' Street' ' ' 55/' Hamlet ...... County Tax Map No. 1000 Section ...//¢ .......... Block .... 7 .......... Lot.t~/O' ~- --'.~ Subdivision ..................................... Filed Map No ............... Lot .............. (Name) 2. State existing use and occupancy of prenuses and intended use and occupancy of proposed construction: - y t. Nature of work (check which applicable): New Building .......... Addition.. ~ .... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 15-,' ' Estimated Cost ~.~.'.'.~. ~' Fee (to be paid on filing this application) ;. If dwelling; number of dwellinglunits ............... Number of dwelling units on each floor ................ If garage, number of cars .... i ................................................................... i. If business, commercial or mixed occupancy, specify ~ature and extent of each type of use ..................... I. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories ...................... t. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ L Size of lot: Front .......... i ............ Rear ...................... Depth ...................... ). Date df Purchase .......... i .................. Name of Former Owner ............................. · Zone or use &strict ~n which premises are situated .......................................... > Does proposed construction violate any zoning law ordinance or regulation: t. Will lot be regraded ........ ~ ................... Will excess fill be ~emoved from premises: Yes No L Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect ........................... 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 hnes. Give street and block'number or description according to deed, and show street names and indicate whether terior or corner lot. TATE OF NE~//~0,R,K, ~ iS S ........... .,-~. ~,,. ..... i .................... being duly sworn, deposes and says that he is the applicant (Name of individual sigping contract) )eve named. eis the ............ ............................................................... (Contractor, agent, corporate officer.,.etc.) t' said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this ~plicationi that all statements contained in this application are true to the best of his knowledge and belief; and that the 'ork will be performed in tl~e mannOr set forth in the application filed tl:erewith. worn to before me this