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Home My WebLink About11323-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. ZI0681 Date September 11 198..1 THIS CERTIFIES that the bmlding ................................................ ...... 1.980..5$g~.b.e.o. l~.o. eql, ...... I<~u..v.o.1.,. l~ew ~grk .... Location of Property House No. Street ............. HemZet County Tax Map No. 1000 Section 146 ..... Block 01 .Lot 015 Subdivisio~q.a.g.~. ?..~.~.r.~. ?o. ?.· ............. Filed Map No. 801 .Lot No. 40 conforms substantially to the Application for Building Permit heretofore filed in this office dated ·...g.u.g.u.~.t.. 7 ........ , 19.8. ! pursuant to which Building Permit No ...... 1.1:.3 .2.3.. Z. ........ dated . . . .fi.u.g.u .$.g..~0. .............. 19B.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.c.qe..~.s.o.~.y.. !.C. qa..~..~.~.n. ! ............................... The certificate is issued to .... J s~.an, an.d. Flc~,n ¢ ~ $..B e ~. J. .............................. {owner,~eR ~q~ X X of the aforesaid building. Suffolk County Department of Health Approval ...... .N/. I5. ................................ R UNDERWRITERS CERTIFICATE NO ..... N 1 R .......................................... Building Inspector Rev. 1/81 FO~M NO. 2 TOWN HALL SOUTH'OLD, H~ Y. BUILDING P,E~iT PERMIT MUST BE KEPT ON THE P*P,E/~IS~ES UNTIL ~ULL (THIS COMPLETION OF THE WORK AUTHORIZED) Perm ssion is hereby granted to:-- ! 8uild~n~ In~poctor. ~ ~ilding In~ector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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: 1. Fina~ survey of property with accurate ~ocation of all buildings, property ~ines, streets, and unusual natural or topographic featu res. 2. Final approval of Health Dept. of water supply and sewerage disposal-(S-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 Planmng Board approval of completed site plan requirements where applicable. 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. 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 New Building ............. Old or Pre-existing Budding .~ ........... Vacant Land ............. Location of Property ................................. House No, ~J Street Hamlet Owner or Owners of Property '~:'5 County Tax Map No. 1000 Section / z_f/~_~Z' Block ~ / Lot ..C~. ~'.~,. .... Subdivision .~.~.."~A:..~,.~7~,..~.~.~..~.-..FiledMapNo ~/ LotNo Z'~F--),.... Permit No.~?, ,~, , ,~?,~,. Date ofPermit ~/?/~,,/,..Applicant ,,~'~ i~iiiii' .i Health Dept. Approval ........................ Labor Dept. Approval ................ Underwriters Approval ........................ Planning Board Approval Request for Temporary Certificate ..................... Final Certificate.........,.. Fee Subm.tted $ ~ ~_.~ ......................... ) Construction on above described building and permit meets all applicable codes and regulations. Applicant ~..~ ........................... Rev, 10-10-78 FOUNDATION ROUGH FRAME & PLUMBING INSULATION PER N STATE ENERGY C,ODE FINAL 2nd) ADDITIONAL COMMENTS FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, i'J.Y. 11971 TEL.: 765-1802 . . (Bull g Insp~ctmj ~ APPLICATION FOR BUILDING PERMIT Application No INSTRUCTIONS a. This 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, relattonship to adjoining premises or public stre~ or areas, and giving a detailed dcscrJptmn of layout of property must be drawn ou the dla~am which is part of this apF cation. c. The work covered by this application may uot be commenced before issuance of Building Pe~it. d. Upon appro.'al of this application, the Building Inspector will issue a Building Pe~zt to the applicant. Such pern shall be kept on the premises available for ~nspectmn throughout the work. e. No bmkling shall be occupied or used m whole or in pan for any pnrpose whatever until a Certificate of Occupan sh~l have been granted by the BuQding Inspector. ~PLICAT1ON IS tlEREBY MADE to the Building Department for the issuance of a Building Pe~it 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, ~d admit authohzed inspectors on pzemises and in buildings for necessaw inspections. ~igna~ of applicant, or name, if ~cqrporation) (Mailing add~ess of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build, (as on the tax roll or latest deed) If applicant is a corporation, signatnre of duly authorized officer. (Name and title of corporate officer) Builder's License No. ~5'r_~L-~Z22 Plumber's Licens~ No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work wilt be done ................................................ .. ! ....................... . .................. House Number Street Hamlet County Tax Map No. 1000 Section ...( .c.g(~z Block .... .O'../ ........... Lot..~./..~-. .......... .......... lap rio ................ LO~ .............. (Name) 2. State existing use and occupancy of premises and intel~ed use and occtm_.,ancy of proposed construction: a. Existing use and occupancy ..... ~Z~.' .... .~'-~,~./.(..,c~.,,` ,~e_y-~:.////~.2..~,~. ..................... ! I. Nature of work (check whicl, applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal ............ Demolition .............. Other Work ............... (Description) ' Estimated Cost .-'% · ~ (to be paid on filing ttds application) ;. If dwelling, number of dwelling Cnits .............. Number of dwelling units on each floor ............... If garage, number of cars ..... ! ................................................................. ;. If business, commercial or mixed occupancy, specify hature and extent of each type of use ................... I. Dimensions of existing structure~, if any: Front ............... Rear .............. Depth ............. Height Num her o f Stories ' Dimensions of same structure with alterations or additions: Front ................. Rear ................ Depth .................... ~.. Height ...................... Number of Stories .................... ~. Dimensions of entire new construction: Front ............... Rear ............... Depth ............. Height ............... Number of Stories ...................................................... of lot: Front ~ Rear Depth Size ........... ..................................................... Date 6f Purchase ........... i .................. Name of Former Owner ........................... or use district in which premises are situated Zone .................................................. Does proposed construction violhte any zoning law, ordinance or regulation: .............................. Will lot be regraded ......... . ................... Wilt excess fill be removed from premises: Yes No Name of Owner of premises ...' ................. Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No ................ Nmne of Contractor ......... ................. Address ................... Phone No ................ PLOT DIAGRAM ). I. t. [. Locate clearly ,'md distinctly all ibmldm~,s, whether existing or proposed, and. indicate all set-back dimensions fi'om roperty lines. Give street and block number or description according to deed, and show street names and indicate whether terior or corner lot. ? t-'LO TATE OF NEW Y~q)R[,/ OUNTY OFCCp..~'S'S ......... : .................. ~ .................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) ~ove named. e is the ' (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this ~plication; that all statemcnts contained in this application are true to the best of his knowledge and belief; and that the 'ork will be performed in the manne'r set forth ha the application filed therewith. worn to before me~t/h~ ............ ~..? ...... day o~ ........ ~9 ..~/ NotmY ?,lblic, S*'at~ of N ~e, 52,0344963 Cuf,ol? CO ..................... u. n2~..~ · '~r"' ........ (Signature of applicant)