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Home My WebLink About11326-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z10714 Date October 5 ................................ ,19 81 THIS CERTIFIES that the, building ............................................... 54895 Main Road Southold, New York Location of Property ............................................................. House No. Street Ham/et County Tax Map No 1000 Sect]on 062 ..... Block 01 . .Lot 004 Subdivision ............................ Filed Map No. " .Lot No .............. confreres substant~ally to the Application for Building Permit heretofore filed in this office dated August 4 19 8. ! pursuant to which Building Permit No. 11326 Z 81 dated ..... ~..u.g.u.a.t...1 p ............. 19... , was issued, and conforms to alt of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Alteration to Store Front Windows The certificate is issued to JHR Edzard Van Holthe of the afmesaid building. Suffolk County Department of Health Approval N/R UNDERWRITERS CERTIFICATE NO. N/R Building Inspector Rev 1/81 FO~M ~0. ~ TOWN OF SOUTHOLD ~U~LDING TOWN HALt. SOUTHOLD, N~ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PRE~IS~S UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 11326 Z Oote co~,,~ ~-ox Mop No. ~000 Seat,on .... OZ,~. ..... B~a~ ......~ ........... ,'or ~o ......... pursuant to application dated .(Z.~.L.~.......~.....;..~ 19 and approved by the Building Inspector. Fee $.~..:., ............... Rev. 6/30/80 rnspector Permission is hereby granted to: ..... ,. ............... _ ~-/4..z.£..Z~.~./..~ ....... ~.~...., ................. __.............,..._..~. ................ ~. ....... ~ ...................... ~o....,4~.~.....~...~z:~zz.cJ.~.....,~.~.......~ ~"T.,,<,~-..i,...~- .-<~,,~.~o.../...-'-~. ............ .... ,.4.v..z~.~...:.......~..~ ....... FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instruations 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: 1. 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). 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 Planning Board approval of completed site plan requirements where applicable. B. For ex~sting 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 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 certifmate. 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..~..' .~.... ~ .~..~ · ?../~. ..... New Building ............. Old or Pre-existing Building .... ~. Vacant Land ............. Location of Property .-,~ .~.2 ?-~-'~ . .~...~j .~. ~. ~. ~. ~, . ,~. · · .~ House No, ' .............. ~ ................... Hamlet Owner or Owners of Property .. ;~..7/-/~. ..... ,~/~'. D~"/~. ..... ~. ~./.~... ~ .~..~-. · .~/~--'-'~.~..~. ..... County Tax Map No. 1000 Section ...~.')..~...~.... Block ....~.../ ....... Lot..-~.~...~.~ ...... Subdivision ................................. Map No ............... Lot No ............... Permit No.../'~.,~.~,. Date of Permit ~..~'../~,..~/Applicant. ~.~.~.'~O...~..~c.~.., .~.,'... Health Dept. Approval ........................ Labor Dept. Approval ..................... Request for Temporary Certificate ..................... Final Certificate . Fee Submitted $...~./.' .~ ............... Construction on above described building and per,?meets all appl'~c/~s and regulations. Applicant ............ Rev, 10-10-78 FOUNDATION (~st) FOUNDATION (2nd) RODGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL.: 765-1802 Approv .......... Disapproved a/c APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tins application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi Inspector, w~th 3 sets of plans, accurate pict plan to scale. Fee according to schedule. b. Plot plan <hewing location of lot and of buikhngs on premises, relationship to adjoining premises or public stre~ or areas, and giving a detmled descriptmn of layout of property must be drawn on the diagram which is part of this ap~ cation. c. The work covered by this apphcation may not be commenced before issuance of Building Permit. d. Upon appro'.'al of this apphcation, the Building Inspector will issue a Build~ng Penmt to the applicant. Such peru shall be kept on the premtses available for inspection throughout the work. e. No bmldJag shall be occupied or used in whole or in part for any pnrpose whatever until a Certificate-of Occupan shall bare been granted by the Building Inspector. APPLICATION IS IIEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to t Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulatioris, for the construction of braidings, 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 inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer~~ electrician, plumber or build, · ......................................................... of owner ofpr0m,ses .... .... ......................... (as on the tax roll or latest deed) If applicant ~s a corporation, signature of duly authorized officer, (Name and title of corporate officer) Bnilder's License No....~.-,-~... ................ Plumber's License No ......................... Electrician's License No ...................... Other Trade's License No ...................... Location ofland ou which proposed work will be done. . ./~. .~. ./. .~. ........~.fl. ' ..... ?.O...t-/..7~..&.~..~.. ......... House Number Street County Tax Map No. 1000Secti;n ...O..~...~ ......... Block ... Subdiwsion ..................................... Filed Map No. (Name) Hamlet ........... ?.c..,'.... ...... State existing use and occupancy of premmes and intended use and occupancy of proposed construction: a. Existing use and occupancy .... e t~..~/¢ffi~..~.. .... .~.ff..o..~. .................................... b. Intended use and occupancy ... ~../~.~,,~.~. ~ .... ~../..~..~./.,~.y.,~. ............................... · Nature of work (check which applicable): New Building .......... Addition~. ......... Alteration .......... Repair .............. Remoyal .............. Demolition .............. Other Work ............... ' ! )~_/~.r~ ~ (Description) ."~, -/-- ~/. ?. -- Estimated Cost . ,a,4.?.O.O., ................. Fee ..................... ¢ .......... (to be paid on filing this application) If dwelling, mnnber of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of ears ..... ~ ................................................................. If business, commercial or mixed occupancy, specify hoture and extent of each type of use .................... Dimensions of existing structure~, if any: Frdl~t ' Rear .............. Depth .............. Num,>er of Stories Iteight ........................................... Dimensions of same structure wiO~ alterations or additions: Front ................. Rear ................. Depth" Height Number of Stories Dimensions of entirc new construction: Front ............... Rear ............... 'Depth .............. Height ............... Number of Stories ............. :' ................................... Size of lot: Front ........... ! ........... Rear ...................... Depth ..................... Date 6f Purchase ........... . .................. Name of Former Owner ............................. Zone or use district in which premises are situated ................................... · .................. Does proposed construction vmlate any zomng law, or&.nance or regulation: ................................ Will lot be regraded ......... ' ................... Will excess fill be ~emoved from premises: Yes ~l'j.o~ Name of Owner of premises ./.ff~..~.~.'~.. ~.~...~.//~ne~.~dress .... .-~.~O. )r'ttgt~ ~. .... Phone No..,~....--~.W .~...~/.~,. Name of ,A, rehitect ........................... ~ .~.O..~t~AddressAddress .................. Phone No Name of Contractor . ~~.... · Phone No. Td_:C,-:..z.Z*.. roperty lines. Give street and block terior or %.prner lot. PLOT DIAGRAM Locate clearly and distinctly all ,bmldmgs, whether existing or proposed, and, indicate all set-back dimensions from mmber or description according to deed, and show street names and indicate whether 7}(TTY~.. :b.~ ................. being duly sworn, deposes and says that he is the applicant (Name of indMdual sign'ing contract) 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 ahd to make and file this ~plication; that all statements conthined in this application are true to the best of his knowledge and belief; and that the 'ork will be perforlned in the manner set forth in the application filed ti~erewith. worn to before me ~ .' . ...................... day of,..~[~.. ..... 19... ~ otary Pub!ic~~..~~ ..... County ~ ff-- Nota~ Public, State of New Yo~k -- ~~ ~ )~ _ , No, 52-03~963 Suffolk CoUn~ · '~' · · ~' fi' ~ ~ .... ~' ~'~ ~ .... ~ .... Commission ~?res March $0, 1~ , ~, / (Signature of applicant) N 2Q 50 ~0 W 200,0