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Home My WebLink About11105-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildin§ Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ..... 5;J.qt. 9 9 ...... Date .......... ~ .a.y..1.3. ................ 19..8.1 THIS CERTIFIES that the bmlding ................................................ Location of Property .... 5.0. ¢.e.dar. B.o. ac ~..Road., ........ ~ol~.t.hol.d.,..I~F..~o..r.k ....... House No. Street Hamlet County Tax Map No. I000 Section ... D.Q0 ..... Block ...... Q3 ....... Lot ..... 0. qB ......... Subdivision..C. 9.d.a.r...B.a.a.c.h...P.a.~..k .......... Filed Map No. 9..0 ...... Lot No...6.6. ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... 3, p~'iZ..9 .... , 19.8 .~ pursuant to which Building Permit No .... l.l. 1 0.5..7, .......... dated .... ~.t? .ell.1.. ! .3 ............... 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 ......... Addition of Deck to Frivate One Family Dwelling The certificate is issued to ..... 'Emac s.c..H ...Eapp~a ................................... (owner. ~e~.oJ; ~iltlt)_ of the aforesaid building. Suffolk County Department of Health Approval .... N./.8 .................................. UNDERWRITERS CERTIFICATE NO ..... ii/.R ......................................... Rev. 1/81 Building I~islS~ctor FOI~M lqO. 9 TOWN 'OF 'SOUTH01:D TOWN 'HALl. SOUTHOLD, N~ Y. BUILDING P~ERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL ~ULL COMPLETION OF THE WORK AUTHORIZED) ' 111O5 Z Dote ......~..'~'~'"-~ ............. ~ ........... , Permission is hereby granted to: ......... · .7.~...~.....~..../...../.,~i.~..., ........... ......... ~......~.~ ....... ~..~...~ ........ ~:~.zT2d.~. r2....- ;~ .~.:~ .................. to ..... ~..~.~c.~ ...... ~.~.....~t..&~.~.~....g.~ ...... ~.~.~.x~r~ ~.d~.~..~ .......... ~%~ .... .... Z ................. .~, ................................................ ~-~ - .............. ,....: ............. ~...~ ..................................... .... ~ ....... ~..~..._~~ ........................... : ....... , ................. ,.,..~.....,..,. ............... c~,,~ T~x M~p N~. ~000 S,~, ..... .~.~.:... ~,~k ':~ ........ ~. Lot No..~.~. ........ Building Inspector. / Buildin~ I~ector Rev. 6/30/80 FORM NO. 6 TOWN OF SOU-I'HOLD 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 buildings 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 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, 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 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 certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or ~and use $5.00 3. Copy of certificate of occupancy $1.00 /?. New Building ............. Old or Pre-existing Building . ~... Vacant Land ............. Location of Property ,:~'--~ ~'~ci~h~ &/;tf:,,-/ /(~ House No, Street Hamlet Owner or Owners of Property ....~.~.~.~, ?..~..~.~¢.~.~../.r~'/~ ...................... ~ ...... County Tax Map No. 1000 Section . . . ~: ~.O.. ....... Block . . . ~. ~.. ........ Lot...~?? .~ ......... Subdivision...~?....~. · . ~cH' /~t¢~_/~ .Filed Map No ........... Lot No. . .~ .~. Permit No,/.~f¢.,.~...~-~.. Date of Permit ..~/.~/~..(.Applicant., . .~.~',~.~.~.'.~. ...................... Approval ~' Labor Dept Approval Health Dept .................................................. · ----~ Planning Board Approval Underwriters Approval .............................................. Request for Temporary Certificate .... . .~:-7:. ~ ......... Final Certificate ..................... ~j Fee Submitted $ .... . .'~, :~.-- .................... ~' f Construction on above described building and/~, it me~a~ II ~le codes and regulations. "2V~ Rev 10-10-78 FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:3 Examined~../~. ( .4~... ( .~..., 1~../. Approvea~ ..~.(..~..../. ?..., 1~..(. Permit No./(/~../.~...~. ·~. Disapproved a/c .... (Building Inspector) APPLICATION FOR BUI LDING PERM IT Application No/'.dd~.~.7. ......... Date ..... ~P/. ~ ......... , 19~{. INSTRUCTIONS a. This application must be completely 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 dmgram 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 Building 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 necessary inspections. (Signature of applicant, or name, if a corporation) (Mailing ~a,ddress of applicant) t I q'/t State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................... ......................................... Name of owner of premises .... ~"CT.~X~.?-.~?.. ff....~.~.~..J¢'?.9 ............................................. (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. ~ '-- . .~.~.~..~... · Plumber's License No ......................... Electrician's License No ......... i..~.../[?q..~..~.. Other Trade's License No. ~ 1. Location of land on which proposed work will be done .................................................. ......... ~I;~i ~q~ber Street ................. ~tain'l;; ....)e. ............. County Tax Map No. 1000 Section .... .~4Q;..' ....... Block ...0.~ ............ Lot...Q :~ .......... Subdivision .... .~.~7.~/~....~..<7.~..../../~ .~. ~.~ ...... Filed Map No ............... Lot....'~.~ ......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... ~..~J.~./.[! .t-~. ~7 .................................................... b. Intended use and occupancy ....... ~.?.~..~..~. ..................................................... 10. 11. 12. 13. 14. Nature of work (check which applicable): New Building .......... Addition..~..~..~..~ Alteration ......... Repair .............. RemOval .............. Demolition .............. Other Work ............... (Description) Estimated Cost ................................................................ (to be paid on filing this application) If dwelling, number of dwelling its ..... : ..... ... Number of dwelling units on each fioor ............ If garage number of cars .... ' .... ~ If business, commercial or mixed occupancy, specify nature and extent of each type of use ....~ ...... . ........... Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories ...................... Dimensions of entire new construction: Front ............... Rear ............... Depth ............... lteight Number of Stoies ~ Size of lot: Front .......... : ............ Rear ...................... Depth ...................... Date of Purchase ............................. Name of Former Owner ............................. Zone or use district in which pr~mises are situated ..................................................... Does proposed construction violate any zoning law, ordinance or regulation: ................................ Will lot be regraded ............. ' ............... Will excess fill be removed from premises: Yes No Name of Owner of premises .................... Address ................... Phone No ................ 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 all 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. 15' 4- STATE OF NEW YO)RK, ~, ' - - ....... ~ ......... ;...~.. ~ ..... being duly sworn, deposes and says that he is the applicant ff (Name of individual sigrdng contract) above named. ~ ~/ (Contr~,tor, 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 applicationl that all 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 ' NO. 52-8125850, Suffolk CouJlt,J_ ~' Term Expires March 30, 19~:P"-