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Home My WebLink About11109-zFORM TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Z10650 THIS CERTIFIES that the building ................................................ R.O.W. End of Pvto Rd. ~)12, Southold, New York Location of Property ............................................................... Street Ham/et House No. 087 06 004 County Tax Map No. 1000 Section ............ Block ............... Lot Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated April 8 81 11109 Z ..................... ,19... pursuant to which Building Permit No ...................... April 15 81 dated ............................ 19,.., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which fids certificate is issued is ......... Addition to Dwelling Margaret Wagner The certificate is issued to ..................... [o~n'ok,~i,~.gairt~) ...................... of the aforesaid building. Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 FOEM TOWN '~F BUILDING DEPAR'~'M~N1 TOWN HALL SOUTHOLD, N~Y. BUILDING P,E~T (THIS PERMIT MUST BE KEPT ON THE Pl~,i:~l-~ !S, UNTIL I~ULL COMPLETION OF THE WORK AUT,LtORIZED) ~ · ..~..~.~..~ ...... N?11109 Z Date .... ................. ~ermission is hereby granted to: ........ ~..~....~..,. .............. .,,~....~ ................ . ........ ..~m~z~...:..~:~,.~..,~ ......... ~ ~..~¢.~ ...... ~ ~r~,~.,o~o~ ~...~..~:-:.~.~.m ....... ~..~.~.-?-¢~..-~ ....... ~.~ ................ ............. . .................. ~r~.~......~..~..o Coun~ T~x ~*p ~o. 1000 S~ct~on ......... BI~ ............ Lot ~o.* .~.~.~ .......... opproved by the ....., Buildln~ Inspoctor. ~ ~ $...~ .................. ~: ~ Buil~n I~w~tor Rev, 6/30/80 ~ ', FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions A. This apphcat~on must be filled in typewriter OR ink. and submitted in duphcate 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 features. 2. Finat 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 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 New Budding ............. Old or Pre-existing Budding ............ Vacant Land ............. Locat,on of Property .~/-.~.../~..//./..~/.../~.~.~/..~./..e..l~../?.~...5'..~.u?. ~.o.&.]? .. .... /.'~o..~.-.~..~..~..~.~...~.i.: .T./'¢.~) Hbuse No. Street Hamlet Owner or Owners of Property .../~. ~. ,/~'..~. z~/¢ ?. TT. .... .~./~r.d..itl.% ./~ .................... County Tax Map No. 1000 Section .... .0..~.~7. ..... Block ..... .0...~. ..... Lot... ?..0.~. ....... Subdivision ............................... Filed Map No ........... Lot No .............. Permit No. ///..¢? ~..Z,. Date of Permi '¢¢..~.~/.~ ,/.?'..Apphcant /¢ /~, .~.//' 4, -,¢- -/D,f~J' /¢~¢, (~, Health Dept. Approval ...... .~.: ,/(~.' ........... Labor Dept. Approval ........................ U nderwriters Approval ....... .,~/.~ .~: ........... Planning Board Approval .....,.......~. .... .. · Request for Temporary Certificate ..................... Final Certificate . ' ................... Fee Submitted $ ...... . .~.~..(? ............... O.O,~, Construction on above described building and permit meets all applicable codes and regulations. Applicant. ..~. ~2-~1 ~--..% ............. . .~...'..~~ ......... Rev, 10-10-78 l0 FOUNDATION (1st} FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765~180;3 Examin , , Disapproved a/c ....... -..-':7~"J . .~'. ........ ~ ........ ' / APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No./.ff/.~...~... ...... Date .. :/.Oq .......... , 19 ~./ 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 detaded 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 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 ?flmi~, authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) d?x.v..~./.~.. ~ c :../?.~.....././..:..~7.~.. ......... (Mailing add~ess of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................. g. v.,. ~..a.<-,./~' ................................................... Name of owner of premises .... ~. ~.'..../~/..4.6.~ ./(./q./.~ ................................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ...... .................... (Name and title of c~rporate officer) Builder's License No ...... /.-~ ................. Plumber's License No ..... ~ ?. ~/.(. 0..-~ ......... Electrician's License No....~.q .o.o..~.5 ?. ......... Other Trade's License No ...................... 1. Location of land on which proposed work will be done... 5./f...../~.. ~./.A)..?.,q..~..//./?..~/.... ?..o..//.~.. ............. ............. ..................................................... House Number Street Hamlet County Tax Map No. 1000 Section ..... ~.7 .......... Block .... .~. ..... o ....... Lot .... 7 ............. Subdivision .................................... Filed Map No ............... 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 .... .~eO~(.~.... 3. Nature,of work (check which applicable): New Building .......... Addition .......... Alteration ~ Repair .............. Rem6val .............. Demolition .............. Other Work ............... (Description) 4. Estimated Cost .......... o o Fee / (to be paid on filing 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 an'd'extent of each type of use .: .................... 7. Dimensions of existing structureS, if any: Front ............... Rear .............. Depth ............... Height Number of Stories ' Dimensions of same structure with alterations or ad'ditions: Fro~ft ................. Rear .................. Depth ....... . ............... Height ................. : .... Number of St0ri~s ...................... 8. Dimensions of ent. ire new construction: Front .., ·, Rear ............... Depth ............... Height ............... Number of Stones ........................................................ 9. Size of lot: Front ~ . ......... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ............................. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ........ A/~. ................ Will excess fill be removed from premises: Yes 14. Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect .......... ' ................. Address ................... Phone No ................ Name of Contractor .... ~: ~.~(f. ~..tr.~. x~..-4..~.'P.A'._F. Address ....~:2.. ~ ?..7'V ....... Phone No...~ .~. ~.. o~.(~ PLOT DIAGRAM Locate clearly and distinctly all! buildings, whether existing or proposed, and, indicate all set-back dimensions from propet~y lines. Give street and block ~umber or description according to deed, and show street names and indicate whether interior or cbrner lot. STATE OF NEW Y6~K,/ / /? ~' ,~ ~ COUNTY OF ~ a.~ .,. .......... f..].~..(~., .~.... being duly sworn, deposes and says that he is the applicant (Nanhe of individual signing contract)\ above named. He is the .................... ' lC-- - (-°n-~tr-~, i....~<:~...~..~.; .-~.. ~;~t 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 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 .......... ..... Notary Public, . ................ i ..... .~dLq~-W--~c4~. County -.-, ,-~ c/ NOTARY pUBLIC, Stqto of Sew Y~ .... ~" ............. ~o. 52-8125850, Suffolk C°unrl'j/,,'%.. ~.o~.~J~tuz~ u~. ~py~x~,a.t~ , Term ExpireS Match 30, I,