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Home My WebLink About11104-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Z10653 Date ...... .B.e.p.g.e. ¢.b.e.p...3 ............. , 15'[.. THIS CERTIFIES that the building ................................................ Location of Property llh5 itenry's Lane~ Pecontc, New York 11958 House No. Street Ham/et County Tax Map No. 1000 Section 07/4 .Block 01 .Lot 003 . Subdivision .~. ?.c.o.n.J:.c...H.o.m.e..~ ............... Filed Map No. 6.1. 8..1 .... Lot No. J P ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated lqa p c h 18 , 198. ~.. pursuant to which Building Permit No. 1 I 1 04 Z dated.../[ ........... p r i 1 13 ........ ...... 198.1. ., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy ~r which t~s certificate is issued is ......... Accessory Building The certificate is issued to ....~.o.a.e.p.l.~..B.e.~..~7..a.n..~..C.a.~..o.~..[¢.y.n..n..B.e..t) .~y ................. (own~;~l~.~ ~r~t~rIOz~ X of the aforesaid building, Snffolk County Department of ttealth Approval UNDERWRITERS CERTIFICATE NO. Rev. 1/81 FORM NO. ~- TOWN OF SOuTHOLD,i: BUILDING D~PARTMEN~ TOWN HALL SOUTHOLD, N~ Y. BUILDING' P,ER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 11104 Z Dote ...... ~,,,~.r,;,,~....../....~.. ............. l~..~ Permission is hereby granted to: .... ...zz~.~,..,-5,.,,.~....d',~,~ ................... Z.~.~.~.~.c...~..~..,~ ........ ......... ..... ~t.~Z~:...~ ...................................~ ........................ ~.~ ...................... ~ ...................... ~t prom[~os Io~t~d ~t ..[~...~ ...... ~.... ~.... · ,~ ....... ~ .................................... 2 ........................ , .................. ~ .................. , ......................................... ~c.~...~.z~.. :m.=.=.....~L.~/.~2 ............ :; ..... ~,;,.~.....z.~.....~ ............ co~ ,~ ~,p Uo. ~00o so~,o~ ..... ~.~.~ .... ~o~k ~.Z .............. Cot ~o. r~ ......... Building Inspector. Fee $..dl ................. / ~ Buildlngil~ector Rev. 6/30~80 I:ORN1 NO, e TOWN OF SOUTHOLD Building Department Town Hell Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. Th~s apphcation must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor w~th the following; for new buildings or new use: 1. Final survey of property with accurate location of all buddings, 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 Planmng Board approval of completed s~te plan requirements where applicable, B, 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 buddings or premises, or other pertinent informa- tion required to prepare e 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 pete..~.~..~.¢~..E./. ........ New Building ........... Old or Pre-existing Building ............ Vacant Land ............. House No. Street Hamlet o~,~, or O~,,~ o~,,o~,t~ .. ~.~ ~. ~~ ~Z~. ~.~Z~ y ............ · " .~ ......... Lot .... County Tax Map No. 1000 Section ~ ........ Block ............ Subdivision ...................... Fded Map No, . .Lot No. ~ ......... Permit ~. ~ZApplicant~ ~~ .~~. ., .... Perm,t No.Z~/~ZDate of ~,. ~,.. . Health Dept. Approval ........................ Labor Dept. Approval ...... ~ ............. Underwriters Approval ........................ Planning Board Approval .. ~./ ........... Request for Tempora~ertiflcate ..................... Final Certificate ...... ~. .......... Fee Submitted $ ,~: .~ ................. o. ......................... Rev 10-10-78 ~ ~ FOUNDATION (1st) FOUNDATION {2nd) ROUGH 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.: 765-1803 Examinec[~_..~.r..~../..5'... , 19.~. Disapproved a/c ................. ~ .................. ~ ...................... 7~'~. ......... ~.. - ...... ,, (Building Inspector) Application No. ~./..~.(?.~.. ........ APPLICATION FOR BUILDING PERMIT Date .~.~.,r~.~/?....~.?..., 19 INSTRUCTIONS a. This application must be-~:oml6I~'tety filled in by typewriter or in ink and submitted in triplicate to the Building 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, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. 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 shall 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 shall have been granted by the Bui/dmg Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building 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. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessa~.~r~_~> ~~a'~ ~); ~lame, if a corporation) . . . . {~tailing address of applicant¢/ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ·. ........................................... Name of owner of premises . .x,,/~.$"..(,. '.~ .~.... ~.~.'.7~.. ~/....~....~.(~3'~F~..~. ~. 7( ~'~J...~T.'77 .~.~ ............ (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 .... . .Z>~.~.~ .~.. ~ ........ Plumber's License No ......................... Electrician's License No Other Trade's License No ...................... 1. Location of land on which proposed work will be done. . . .~.~ ./7'~-'~/~ //'/.6:-.... ~J..~:~..,z × ~....~.~.: ..................... ./~.~...~/...c< .......................... House Number Street Hamlet County TaxMapNo. 1000Section .~..~-.~..~. Block ....... ( .......... Lot..~'..'..-~.. ...... Subdivision..~.~.~;SF~. ,4.//. C~... ~,el4V.~.,~ .......... Filed Map No..~/. ~5~f. ....... Lot ....... /..~. .... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... tdff. ...................................................... b. Intended use and occupancy .... ~.-q.~(. ......................................... 3. Nature of work (check which applicable): New Building ....... I/.. Addition .......... Alteration .......... Repair .......... Removal ............. Demolition . ~ (..~. (D::cipti~). · Other Work ............... 4 Fst'mated Cost Fee ~ (th be paid on ~ing this application) 5 If dwelling number of dwelling units / Number of dwelling units on each floor -- If garage number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ r)imensions of same structure with alterations or additions: Front .. ;...T .......... Rear .................. Depth ...................... Height ........ , ~......~ ..... Number of Stories ...................... 8. r)nnensxons of e~nt,[re new constructxon: Fro. nt . . . ,~?.../~.... Rear ... ~'.~. ........ Depth ./~. .......... Height ..... ~. ........ Number of Stones .... -.... -. ......y ......................... ._.. ~ ........... 9. Size of lot: Front . ~.~. ..... > ...... Rear /~. .... Depth_ ~_~/s~..~ ..~ 11. Zone or use district in which premises are situated ...... ~.'~. ~. .............. ., ........................... 12. Does proposed construction.yio!ate any zoning law, ordinance or regulation: 13. Will lot be regraded . ~~' .... ' ................... Will excess fill be removed from premises: ~Yes Name of Architect .. ~ . ..~. '~ ... Address ~ ~ '~' . Phone No. Name of Contractor .' f/. . .~.~ .... Address ... ~. ~. ..... '~ ....Phone No. · PLOT DIAGRAM Locate clearly and distinctly ail' buildings, whether existing or proposed, and. indicate ail set-back dimensions from property lines. Give street and block .number or description according to deed, and show street names and indicate whether interior or corner lot. I,,ql ' Lot /o '" \ /oot I ' STATE OF NEW YDRK, S · .~.~£bZ~,~./ .... ~' ' '.' ' 'd; ......... being duly sworn, deposes and says that he is the applicant ~ove ~/amed(.Nam6ff individual sigmng contract) · He is the ............................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that ail statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this Not!tl~,Public, ......... ~ .... .. ~,-,~.. County.. pUBLIC, State *I, rq~w Yott~/ ............. · ~IOT~,[~¥ ....~ .., ~ ,~ / fe~ignature of applicant) 52 8125850, Su~t0ik ' No. ' , .,~Fc~~' ~" ~ - Term Fxpires Nlarch 3O, I~T~',,c il :' i , I I