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Home My WebLink About11061-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy / Date /~ ttq ' / t(L~ ........................ ' ......... l~.Z THIS CERTIFIES that the building ................................................ Location of Property '~7'~c St/lxi LAN~ /-t~e Ho: ....................................................... Street Hamlet County Tax Map No. 1000 Section ....~. .... Block ........ / ......Lot..../.~. .......... Subdivision. L~.~7'.. (-/x.~ .~./.~..L).~. ~: ........ Filed Map No. {.~..~. ~..Lot No...~. ?..~. ..... conforms substantially to the Application for Building Permit heretofore fried in this office dated fi. Ph .. / .~, 19~/-ursuant [ { 0(0 [7___ ..................... p to which Building Permit No ...................... dated ........ ~..fi./.../.(?. ......... 19~./, was issued, and conforms to ail of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ...J~. ~.zv.~....r.~.~'~" ~*'~'~,,/<- ~"~ - ~<'< ~,-,,,~,) Thecertificateisissuedto -'/-tt Ot'~ l~ f_ .f? ~ t,/ ,xt O ~/ ~ ..................... io'~'&'t.'--::-': ':! ! :.L' ..................... of the aforesaid building. Suffolk County Department of Health Approval A//or UNDERWRITERS CERTIFICATE NO ............... ' ................ ................... ? Building Inspector Rw. 1/81 l~OK~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, Nm Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~EMISES COMPLETION OF THE WORK AUTHORIZED) UNTIL FULL N°. 11061 Z Permission is hereby granted to: to [: ..... ,: ............................................... ~. .............. E ....... ~ ...... .~ ..... Building nspector. Fee $ ........................ Building 'Inspector Rev. 6/30/80 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. Finai survey of property with accurate [ocation 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 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 approva[ of completed site p~an 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 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 informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 ~/~Date ......... ? ........... New Building ............. Old or Pre-existing Building ........... Vacant Land ............. Location of Property ~.~..Z~.~ ~/~ .~---_~.. House No. Street Ham/et Owner or Owners of Property ................... · ...................... ........ Block kot .............. Subdivision. /~ ~gA ~ .Filed Uap No. t 2¢¢.LotNo' X¢ &, Permit No. ~.(. P.~.~. ~,te of ,ormit ~/~/~...~p,l,cant..~.. ~Q~ .......... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ~ Planning Board Approval ..... Request for Temporary Certificate ..................... Final Certificate ~ Fee Submitted $ ............................. Construction on above described building and per_mit meets,~ll applicable codes and regulations. .............. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 (Buildin~ Inspector) APPLICATION FOR BUILDING PERMIT rote ..../Z.-.,d..-:r7 ........ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building .nspector, 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 streets )r areas, and gMng a detailed descriptiou of layout of property must be drawn on the diagram which is part of this appli- 'ation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit ,hall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy ,hall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the 3uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. Fhe applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to ~dmit authorized inspectors on premises and in buildings for necessary inspections· (Signature of applicant, or name. if a c6rporation) 7.:. . . , . . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~mne of owner of premises ..... ~d)7. ~.' . .~.)? .~..,~. o. {~....',~..~7 ...................................... (as on the tax roll or latest deed) tf apphcant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..... ~ Plumber's License No ......................... Electrician's License No ...................... Other Trade's License No ...................... I. Location of land on which proposed work will be done .................................................. ..... .7. . ......... ........................... m;',;i ' 7 ..................... Street Hous~ Number County Tax Map No. 1000 Section ....... 7. ~. ....... Block ....... ~ .......... Lot.../...~. ............ Subdivision....~. ?. 5'..7~..~ee.~..~.,~...~.~. 4Z. ......... Filed Map No .... 0..0.Z .4 ~.4,.. Lot ...~..~..~. ...... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......... ~,,,,?'_'_'_'_'_'_~ ~_..~.....~ ..................... b. Intended use and occupancy ..... ,,~:~..d¢~.. ....../.?~.'- 'J- ~ (~~..~,~-~... ................. 3. Nature of work (check which applicable): New Building .......... Addition...~ ..... Alteration .......... Repair .............. Removal ............. Demolition .............. Other Work ............... [. Estimated Cost ......................... Fee .................. *... ......... (to be paid on filing this application) ~. Il'dwelling, number of dwelling units ....... /. ...... Number of dwelling units on each floor ...... t.. ........ Il' garage, number of cars ............ ; ........................................................... ¢: .If busine,?s, commercial or mixed occupancy, specify nature and extent of each type of use ............ . ......... .'~.-' Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... _I:]~igl~t~';...............Number of Stories ........ . . ..O.~..~. ....................................... Dhnensions of same structure with alterations or additions: Front .. ~ .............. Rear ......... ' ........ Depth ...................... Height ...................... Number of Stories ..... ~4% .e~...i ........ I. Dimensions of entire new construction: Front ............... Rear ............... Depth .............. Height ............... Number of Stories ............ O.?.~- .............................. . ........ t. Size o~lot: Front ...... Rear ...................... Depth ............ . ......... i. Zone or use district in which premises are situated ............................. . ........................ L Does proposed construction violate any zoning law, ordinance or regulation: ................................ L Will lot be regraded .......... fi/.~ .............. Will excess fill be removed from premises: yes No L Name of Owner of premises . .~,q~r..~.,~.,~.,¥.o.~..Address ?,~..a-d-..~/..~.~'. ,,~ .Phone No...~.,g,&.'~ ~.~. ?.-2.. Name of Architect ........... ~ .........."-' Address ....... ~ ...... .,o~.... Phone No ............... --- ' Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly alt buildings, whether existing or proposed, and, indicate all set-back dimensions from *operty lines. Give street and block number or description according to deed, and show street names and indicate whether terior or corner lot. rAJ'IS OF ~EW..Y-~RK,~ ~/ o - OUNTY OF .~.. (Name o~ inaiviaum sig~ contract) cove named. being duly sworn, deposes and says that he is the applicant .e is the ........................ ~Z~ ................................................ (Contractor, agent, corporate officer, ,etc.) f said owner or owners, and is duly authorized to perform or have performed the said work and to makeiand file this pplication; that all statements contained in this application are tree 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, ..... ........ P hlic. ....... ...... _. . . county , , Term Expi,res March 30, 19~L (pi BOHN & BONACCI, P.C. CONSULTINGSURVEYOR$ 72 E, OLD COUNTRY RD. MINEOLA, N.Y, 11501 516-742-4007-8 516-921-2211 LOTS' -~ ~ ~ BLK. MAP Of:/_~/~ C~ 0~ ~J-~5~/tq~/T DATE /0 - 27-~o BLk, / LOT{S) (~