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Home My WebLink About11340-zFORM'NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ..... Z107.9.2 ...... Date . .lxJ 9y.e. nll~9 r..Rz3 o..1.9.8..~ ........... 19... THIS CERTIFIES that the building ................................................ Location of Property ,5.80. t'.v.t~,. R.d,~. #2.&,..$ ou. thold.,..~Y ........................... t~ouse glo. Street Hamlet County Tax Map No. 1000 Section g.7.~ ........ Block ...Q~ .......... Lot ...Q3.~3 ........... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... 8/.J_ ~/.~33~ ...... , 19... pursuant to which Building Permit No..&3.3.~.0.~ ............. dated . .8 / 3_$./.81 .................. 19..., 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 ......... ....... ac ce.s~ o~'.y..bug.Ld ±rig.,..2. can. gam. age ................................... The certificate is issued to R~3b@v~;..~±].~_.£s tra~d ..................................... (owner, le~,ee or tenant/ of the aforesaid building. Suffolk County Department of Health Approval .......................................... UNDERWRITERS.CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 l~OIt~ NO. ~ TOWN OF $OUTHOL~D ~ BUILDING DEPARTJ~EN~ TOWN HALL SOUTHOLD, N. Y, BUILDING' PERMIT {THIS PERMIT MUST BE KEPT ON 'FHE PRE~I$~$ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ' N°. 11340 Permission is hereby granted to: ....~.~.~..~.... . ..-~.~ ~. ........... .~.~.:...~~.~.:.'.~ ...,~../~.......z~,....~.,..i..... ................. ~o ..... .~.~.zrc~.....~~r>,~.~...~.....~...~x~... .......... ......... ........................... ..............................................................................................., --~ h...~, ~ .......................................................... ' Z.~,, '' ~'. ........ ~,~ ~ ~ ~. ~ooo s,~,o~ ....~ ....... ~ .~..~.~ ........... ~o~ ~. ..~ pursuont to a~ cot on dated ~....~..~......:..L.. ~....., 19. and opprov~ by the Building IAspector. / ,../?..~ .... ~ ~ ~ / Fee ,uddmO Ink.tot FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new bu~ dings or new use: 1. Final survey of property with accurate location of all buildings, property lines, 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 u~stailation from Board of Fire Underwriters. 4. Com~nercial 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 exisUng buildings (prior to Aprd 1957), Non-conforming uses, or buildings and "pre~existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings arid 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 build ngs or premises, or other pertinent informa- tion required to prepare a certificate C. Fees. 1. Certihcate of occupancy $5 00 2. Certificate of occupancy on pre~exist~ng dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date November 19, 1981 New Building . .x .......... Old or Pre-existing Budding ............ Vacant Land ............. Locat~on of Property 580 ?vt. Rd. ¢f21, $outhold, New York House No, Stree~ ~¢amlet Owner or Owners of Property Robert Tillzstrand County Tax Map No. 1000 Sechon 078 Block 09 Lot. 038 Subdiwsion ............................. Filed Map No ........... Lot No Per ' 11340Z m~tNo ........... Date of Permit . 8./. Z. ~ / .8.1.App licant ..................... Hea th Dept Approva Labor De~t A---ova ........................ P. IJp~ ..................... Underwriters Approval ....................... Planning Board Approval ................... Request for Temporary Certificate ................... Final Certificate X Fee Submitted $ 5. O0 Rev 10-10-78 FIELD I. NSPE~T!ON iD ~,TE COH~II~NT~ FOUNDATION (lst) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY G,ODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 A/f~:'~' TEL.: 765-1803 Examined /. . , t9..~. Approved .......... , Pc=it No.. r /.../. / Disapproved a/c ....... '. ...................... ~ '/ ........ ~ ~. / // · . / (Buihling Inspector) APIJLIC,%T1ON FOR BUILDING PERMIT Application No./../.-~..~.~. ....... Date .... % ./?..~ ......... 19~.'~ INSTRUCTIONS a. Tins application nmst be completely filled in by typewriter or in ink and submitted in triplicate to the Build, Inspector, w~th 3 sets of plans, accurate plot plan to scale. Fee according tc schedule. b. Plot plan <hewing location of lot and of buddings on premises, rel'at,onship to adjoining premises or public stre~ or areas, and gwmg a detaded dcscrlption of layout of property must be drawn on the diagram which is part of this apg cation c. The work covered by gus apphcation may not be commenced before issuance of Building Permit. d. Upon apprc.'al of tlus applicat~on, the Budding Inspector will issue a Buihhng Permit to the applicant. Such pern shall be kept on the prennses available for inspecgon throughout the work· e. No budding shall be occupied or nsed m whole or in part for any purpose whatever until a Certificate of Occupan shall have been granted by the Budding Inspector. APPLICATION 1S tIEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to t Bmldmg Zone Ordinance of the Town of Sou,hold, Suffolk County, New York, and 6ther applicable Laws, Ordinances Regulahons, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The apphcant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on p~emiscs and in buildings for necessar~ inspections. (Signatnre of applicant, or name, if a'corporation) · "' (MailL~g address of applicant) State whether applicant ~s owne~, lessee, agent, arcbitect, engineer, general contractor, electrician, plumber or build~ .......................................................................... Name of owner Of premises . .~.~..o..~..~ .%.: .C~....~.,..~.\ .L..~X'.'-a.Wl.~ ................................. (as on the tax roll or latest deed) If appbcant is a corporation, s~gm, ture of duly at, thor,zed officer. · (Name and title of corporate officer) Builder's License No.. )'.k ~ ................. Plumber's Licens? No ~ Electrician's License No ....................... Other Trade's License No ...................... 1. Locanon of land on Milch proposed work will be done ................................................ ......................... ......... .k, l ................... House Number Street Hamlet County Tax Map No. 1000 Sect,on ....0..~..~. ~ ........ Block ....C?.~ ........... Lot...~. ¢~..~. ......... Subdwmon ..................................... Filed Map No .............. Lot .............. (Name) 2. State existing use and occupancy of premises and intende~se anti occnpancy of proposed construction: a. Existing use and occupancy .... . .--~-...r~,~,-~', .?..,:~..~.~4'./.~.~,,7...<,..~,,~,. ,~...~.,~/...~..~...~ / L Nature ofxvork (chcck which apphcable): New Building . ~..?.rT?~../':~Addition .......... Alteration ' Demolition Other Work Repair .............. Removal ........................................... (Description) Estimated Cost .~ :~..~. 'q~..~.., . .~..~:~ .......... Fee .~ ~ 1~, ~ ~ .... (t.o be paid on filing this ~pplication) ;. If dwe!ling, number o f dwelling,units ..... ~ ....... Nnmber o f dwelling nnits on each,fie.or.. 7. ;". ........ If garage, number of cars .... ~ .... ' ' · ....................................... i. If business, commercial or nnxeld occupancy, specify hature and extent of each type of us~ .... --.., ........... t. Dimensions of existing structures, if any. Front ............... Rear .............. Depth ............... Iici tit I {~ Nul beret Stones ~. · .~ .................... D mensions of same stn~cture w. ith alterations or additions: Front . .'~-, .~- .... '...'.. -. Rear ...'~..~. ......... ;... Depth ..... .r ............. t. · Height .... :1./~ ............... Number o~ Stories ..... ! ....... ' .......... I. Dlmensmns et entire new constrnchon: Front ,.."~'~:~ ........ Rear ...Z-. ~. ........ Depth . .-r ............ Height ............ nmber of Stories .................. I .............. } ...... , ............... ). Size of lot: Front . .7_.."~g:~ ............... Rear .'~i~....7.,"~t.D .... Depth ./~.'~ .............. ). !)ate of Purchase .... ~ ..................... f.>. Name of[orm~e4:l,O~ner t ............................. I. Zone or use district in which prcnfises are situated...l'Nd~-. ~..~..~ .~. ,.r~77.. { .~..t ............ ' .................. 2. Does proposed construction violate any zoning law, ordinance or regula,lon: .. [X~.l ~:>. ~ ....................... L W~II lot be reg~aded ........ ~ ............... Will excess fill be removed frmn premises: Yea No L Name of Owner of premises .................... Address ................... Phone No ................ Name of Arclutect ........................... Address ................... Phone No ................ Name of Contractor .......................... Ad& ess ................... Phone No ................ PLOT DIAGRAM locate clearly and distinctly a buildings, whether existing or proposed, and.indicate all set-back dimensions fi'om roperty hncs. Give s~reet and block;number or descrSption according to deed, and show meet names and indicate whether terior or corner lot. TATE OF NEW YORK, 'S.S OUNTY 105 ....... .~, ...... ........... i1. -' .' . ................ being ~iv~du~contract) drily sworn, deposes and says that he is the applicant )ove named, ~ e is the ........ ~ ~ (Contractor, agent, corpmate officer, etc.) f said owner or owne~, and is duly authorized to perform or have performed the said work and to make and file this )phcaflon; that all statements contained in ~hts application are t~ue to the best of his knowledge and belief; and that the 'ork will b9 performed in the mann{r set forth iu the application flied t~,erewith. worn to before nle this o Ii 'F-~ ........ :d~'~'¢~s~ ....... x ...... 'County 0 I ~ ~ ' ~,~ ~7~0~. ~u,oa c,~,,v .. (SignaOre of applicant) ....... ;..,o. ,o, " :"' ' ........... -0