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Home My WebLink About11327-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPAI~TMENT Office of the Buildin§ Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..g.108_35 ......... Date ......... THIS CERTIFIES that the, building ................................................ Location of Property . 6.1.0. ................ .l~J,d. ¢,l.e.'~9.n..I~qO.d ............~?.e.~op.o.P.t,... House No. Street Hamlet County Tax Map No. 1000 Sechon .. 0.~.O. ...... Block .. 05 ........... Lot .. 005 ............ Snbd~vls~on..F. ~..e.e.f,.. ¥;L.e.[d. ................. Fded ~ap No. 1,35.1. '..Lot No. ~ ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated · . .A.q/~g.~.t,.. ! .0 ........ , 198. ! . pursuant to which Building Permit No..1 .1.3.2. 7...~ ............. dated ..... .g .ug.ua..t,. J.0. ........... 19.8.1., was issued, and conforms to alt of the requirements of the applicable provis~ons of the law. The occupancy for which this certificate is issued is ......... ·..a.n...a.c.qe.~.~.g.P.y' . .~.~.qe..a¢.e..s..h.o.d... .............................................. The certificate is issued to ........ O.~J;.q. Fl~.k. &..w.f., ................................. of the aforesaid building. Suffolk County Department of Health Approval ... ~/Jl. ................................... UNDERWRITERS CERTIFICATE NO ........... ~/a~ ................................... Building Inspector Rev 1/81 I~OE~I NO. ~ TOW~ O~ BUILDING D~VART}~I TOWN HALl. SOUTHOLD, N. Y. BUILDING' PERMIT. (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is her*by oronted to: ~t premisos Ioc~tod at ................... : ................................... pursuant to *ppl~c~tion d,ted .................................................. }....., 19 ........ , ond opproved by the Building Inspector. ~ee ~../.0.......% ..... ~lnspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y, 11971 APPLICATION FOR CERTIFICATE OF QCCUPANCY Instructions This applicattou must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tot with tbe following; for new buildings or new use. 1. Final survey of property with accurate Iocatton of all buildings, property lines, streets, and unusua~ eatura[ 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 buddings, IndusTrial buildings, Multtple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building, 5. Subrmt Planmng Board approval of completed site plan requirements where applicable. For exist,ng buddings (pr~or to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p6operty showing all property linej, streets, buildings and unusual natural or topographic features. 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 reforma- tion required to prepare a certificate. 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of celtlflcate of occupancy $1,00 $5.00 Date ......................... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. House No ~) Street , .~ /~ · Ham/et Owner or Owners of Property ...~.~,,..~...~,~.~.~ .... ..~...~ ........... CountyTax Map No. 1000Sec~n ..~..~.¢. ........ Block .~.~. ......... Lot.,~,,e..d~.. ....... S.bd,vmn ........... i,ed ,o. .... ...... Permit No.~...~ate of Permit~.~ ~ '~ ~;'~al"~' f/~.. ' '~//~'/~'~PPl'¢ant ' ' '~t' ' ~ '! ..... ........ Health Dep . Approva ....... 4¥! .............. Labor Dept. Approval ....................... Underwriters Approval ...... . .AJ/~. ............. Planning Board Approval ...................... Request for Tem0orary Certificate ..................... Final Certificate ....~. ................. Fee Submitted $. ~ . .~..: 9.(..3 .................... Construction on above described bu,ld,ng and per~n~?_eets.a~b~md regulations. Applicant .... .~. //.4~ .... ~ .................................. Rev 10-~0-78 FOUNDATION (lst) FOUNDATION (2nd) ROUGH FHAME & PLUMBING INSULATION PER N. STATE ENERGY O,ODE FINAL m o COMMENTS ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL.; 765-1802 Examined ~/~. t/fid ...... , 19~.. .-~ Approved~.~?..t(. (fl. ..... , 1~../. Permit No. ~..~..~..'.~..~'7~/ Disapproved a/c ........ ; ,_. ~ ...... ~... ....... · . . "~- (Building Inspector) ' APPLICATION FOR BUILDING PERMIT Application No ~.~. ~.. ~l ...... INSTRUCTIONS a. Thru 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 plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buddings on premises, relationship to adjoining premises or public stre~ or areas, and giving a detailed description of layout of property must be drawn on the dia~am which is part of this apr. cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon apprc,,al of this apphcat~on, the Building Inspector will issue a Building Permit to the applicant. Such pern shall be kept on the premises available for inspection throughout the work. e. No budding shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupan slmll have been granted by the Building Inspector. APPLICATION IS ttEREBY MADE to the Building Department for the issuance ora Building Permit pursuant to t Building Zone Ordznance 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 inspectors on piemiscs 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, general contractor, electrician, plumber or build, Name of owner of premises . .x0o. t~/~.;..O../7~.c~ . .~.. t.o.t.]?, e~. ............................................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ...... A-'T.~.&.-~.7.~i' .... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Lor,~;i~ of land on which proposed work will be done. PT.~'...~.-~*.:~3t~-jI/ ............................ - z.w.. ....... p0 .- ........ ............ f.q. ...... House Number ~ Street Hamlet ~O~5 ~ County Tax Map No. 1000~ Section ,m~[' 3.~: 1. :... Block .. ~~4~ Lot. ~ ......... S~d,~,s~, .,~ ,~ ::~/. <:~<~-~:~ ............. V~*~d ~h~ ~... ~7 ....... ~t ............ 2. State existing use and occupanc7 of premises and intended use and occupancy of proposed construction: a. Existing use and occupaucy .... - ¢4~.: ..... z, ........ '¥~. · · ~ ..................... b. Intended use and occupancy . .~b.~& ......................................................... I. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... ~,F/-'d Fee ~.~. ~'~ (Description). ' Estimated Cost (to be paid on filing this application) ;. If dwelling, munber of dwelling ~mits ............... Nmnber of dwelling units on each floor ................ If' garage, number of cars ..... 1 .................................................................. i. If business, commercial or m/xed occupancy, specify ~ature and extent of each type of use .................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth .............. Height ............... Number of Stories ....................................................... Dimensions of same structure w~th alterations or additions: Front ................. Rear ................ Depth ....................... Height ...................... Number of Stories .................... Dimensions of entire new construction: Front ............... Rear ............... Depth ............. Height ............... Number of Stories ...................................................... ). Size of lot: Front ........... . ........... Rear ...................... Depth ..................... ). Date of Purchase ............................. Name of Former Owner .......... ~ ................. I. Zone or use district in which prfimises are situated ................................... ". ................ ->.Does proposed construction violate any zoning law, ordinance or regulation: ............................... l, WilJ lot be regraded ............................. Will excess fill be removed from premises: ~ Yes . No L Name of Owner of premises .................... Address ................... Phone No.t~').'). .O.[.q. ~. ..... 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 ~fll set-back dimensions from roperty lines. Give street and block ~un:ber or description according to deed, and show street names and indicate whether terior or corner lot. r^TF. OF NEW Y20.R. t .- ' OUNTY OF .~..'Y~... iS.S ............................ : .................... being duly sworn, deposes and says that he is the applicant (Name of indMdual signing contract) >ove named. ~ e is the ......................................................................................... (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duiy authorized to perform or have performed the said work and to make and file this ~plication; that all statements contafl~ed in this application are true to the best of his knowledge and belief; and that the 'ork will be performed in the manner set forth in the application filed therewith.' worn to before me this ./(~ ~ day of.'~ 19 otary V ~ubl'~ ..~?..~,~;.,, ...... County I JUD TH T TERRY ' ~ ~otary Public State qf New York ........ ~ ................ ~' ' ': ................ I I No. 52-0344963 Suffol~ Coun~z~_.~ (S~gnature of applicant) CommisSion Expires March 30,