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Home My WebLink About11112-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..~. 1. ~..?.4 ......... Date .... S.c. [,-'~.ctt~ 9 ?. 3.6.., .............. 198. k'. THIS CERTIFIES that the building ................................................ Location of Property 4250 Bveakwatc~r Road . Hnt~ituck House No. Street Ham/et County Tax Map No. 1000 Section .. 106 ....... Block . .09 ........... Lot ..... ~.el ........ Subdivision..X. ............................ Filed Map No. X. ....... Lot No. ~ ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated · N.a.v.c.b..3.Q .......... , 19~. pursuant to which Building Permit No.. ] J.1.~.2..Z ............ dated ..... ~ P ~' $-Z.. 17 .............. 19.8. ~, 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 ......... an adder, on to cabi~ The certificate is issued to Cuasle Cannone ........ ..................... io¥.'e;, '/&'dd j, ............. of the aforesaid building. Suffolk County Department of Health Approval ... p/.a. ............................. UNDERWRITERS CERTIFICATE NO ............. ~..q ? 99.4.~. ........................... Rev. 1/81 Building Inspector BUILDING; PERMi~~ (THIS PERMIT MUST BE KEPT ON THE PRE/~ISES UNTIL fiULL COMPLETION OF THE WORK ^OTHORIZED) ~ : N? 111 12 Dote ...... ;...~> ........... ~...~'..- .................. -...'., Permission is herebygra~ted to: F/~ ~/~~ ~ ~'~ f/ . ?&.....~.. ~..~;~..h .'z. ............... ~ ~..':..: ..... , ............. ................................ ; .................. .f..:~ ...................... nremlses located at ................. t.. ......................... , .............. ,... ~ ................. ~ ....................................... ........................................................................................... , .. ................ ?~ .................................. Coun~ Tax Mop No. 1000 ,Section (, {'. Blokk ~.... ............. Lot No. pUrsuont to opplicoHondated 19....~.~nd ~pprov~ b~ tho BU!lding Inspect~oy. Fee $.....:.2.. ............ 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. 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 peopertv 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 $5.00 Date ....... New Building ............. Old or Pre-existing Building(Z,) .... ~ - =/Vacant Land ............. Location of Property ......... "~ ' House Jo, ~ ~ ~1~ ~ ~/ ~ Street Owner or Owners of Property . ~'..(4'. ~S/~: . . .~'./~.-~4/'/~./¢,~ ............................. County Tax Map No. 1000 Section .... ~'.q~. ~. ..... Block ..... ~, ~. ...... Lot...~.O. ~ ....... Subdivision ~ . ............ Filed Map No .... ~. ...... Lot No ...... ---:. ....... No. Z'.//./,¢~... Date of Permit .~.//. ¢~f>/Applicant .~. ~.$'~... ~./¢7/¢/~4>W~I~- ..... Permit Health Dept. Approval - ~ . ....... Labor Dept. Approval ......................... Underwriters Approval .~., .~.~.Y~.~. ~..~....Planning Board Approval ..... :.-~. .......... ~,-~ Request for Temporary Certificate ............. Fee Submitted $. ~. z¢./. : ................. Final Certificate ,- Construction on above described building and permit~meets all app~cable~co.de~ and regulations. Applicant .. ~ .............. Rev. 10-10-78 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, Final survey of property with accurate location of all buddings, 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 Residencee 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 buddings (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 Building .~.%~.A/~/.z~/~/. Old or Pre-existing Building ............ Vacant Land ............. Location of Property .~.~ .~/.~.~r....,~.~..~e../~/...~.~/~.,.. ~.~ .... ~.~. ~.. Owner or Owners of Property ~-.~. :-;~~ ........................ County Tax Map No. 1000 Section . .~ ~ ........ Block ...... ~ ....... Lot. Subdivision... '--~ '~- ............................. Filed Map No. ..... ~ ,...LotNo .............. Permit No!/.~./..'~, .~. , . . Date of Permit .~f~./?./.~./.Applicant... f~...~-~./,;... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval./V...?:..7.qP..~( ....... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and permit meets all applicable codes and regulations. FIELD INSPECTION I. FOUNDATION FOUNDATION 2. ROUGH FRAME & PLUMBING (end) COMMENTS INSULATION PER N.Y. STATE ENERGY COpE FINAL ADDITIONAL COMMENTS: TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL,: 765-180:~ ....................................'....~ (Building Inspector) APPLICATION FOR BUILDING PERM IT Application No...( .(.(..~..~' 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 ~ving a detailed description of layout of property must bc 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 shail be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy ,ha/1 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, NewYork, 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, buildiug code, housing code, and regulations, and to ~dm~t authorized inspectors on premises and in buildings for necessary it~spectigns. .................. (Sign,ture of applicant, or name, if a corporation) (Mailing address of applicant) grate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................ ~. ~/..~P..~.~. ............................................................ "/amc of owner of premises ....~...P-: ff...~.e.?.;../)./..~. ~'. .... .~..~../~...A/fi../'f/..&-'.. .............................. (as on the tax roll or latest deed) [f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) · , · ~rzz~* .//.~..f~.~- /,,r/~/z~t,~-'~/~,vT- /~/~/ Builder s License No .......................... Plumber's License No ......................... Electrician's License No...Z.~.. ?..7-.~..~-......,~ .,z..~..~. Other Trade's License No ...................... I. Location of land on which proposed work will be done.. ~.~..4.~..~..Sf-/../?../.-~.~..... ~.q~.(~ ............ fi fWf ( . ..... .... .. ,o~e ~.mb~, q~SO ~;~ ........ Hamlet County Tax Map No. 1000 Section ...... / 2 ~¢ Block ~ Lot. Subdivision ~-~- . ...... Filed Map ~o ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occapancy of proposed construction: a. Existing use and occupancy . . .~(~...... .. ...... . ~.&/~ b. Intended use and occupancy .............................................................. 3. Nature of work (check which applicable): New Building .......... Addition ...... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... ~'~-/~ D /.~.7...~..' (Description)_ t. Estimated Cost... fl ................................. Fee ................ (to be paid on filing this application) {. If dwelling, number of dwelling units ....... ./ ....... Number of dwelling units on each floor ..... ./ .......... If garage, number of cars ..... .i ................................................................... 3. If business, commercial or mixed occupancy, specify nature and extent of each type of use ~ 7. Dimensions of existing structurels, if any: Front...~..~.: ........ Rear . ,2-..°. ~. ........ Depth . A,'g.'ff,'~.: ..... Height ...Z.~.. ~.x-.4 ?.... Num, ber of Stories ....... 4 ./'f. ~ ......... ~ ...................... / .......... Dhnensions of s/amc structure with alterations or addition~: Front ..o~..~ ............. Rear . .-¢..~. ............ Depth ...g~'.~. ................ Height ....z'.--3./7 .~../. .......... Number of Stories .... .~?.~f. · .~'~.., ........ t. Dimensions of entire new constmctmn: Front .... A~. ........ Rear .... ./. ......... Depth .............. Height ...Z ~../ ........ Number of Stories ....... ~.~.~ .......................................... L Size of lot: Front ........... ~ ........... Rear ...................... Depth ..................... ). Date of Purchase .2./..~',~..i.~ ................. Name of Former Owner ..¢..~.~..G~.. [. Zone or use district in which pr~mises are situated ..................................................... ~ Does proposed construction violate any zoning law ordinance or regulation: .~. t. Will lot be regraded ........ ,4K'. ~'. '. ............... Will excess fill be removed from premises: Yes No ~- Nam fO fp i ,7'/~.g..,'~.~g fi., ~'/~.a,~VA~.Add sd'.~.~' ~K,t/'(.~..~'. ~..,e,-'~Phon N · eo wnero remses . . . res .. . e o ..... . .......... Name of Architect ........................... Address ................... Phone No ................ Name of Contractor ~ .'~.,~./q.., .,,f(?.~'4~./<....~.,,g ..... Address 4~. ~'.~..~.~..~. ......... Phone No. ~..~..~. :'..~?..~..~. PLOT DIAGRAM' Locate clearly and distinctly all 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. rAX OF ' S S ou ,rr¥ .....~ ,~ -~ ~ ~V},~J~..,.~./~...% being duly sworn, deposes and says that he is the applicant oove named. ...................... ............................ f s~d owner or owne~, ~d is d~ly authored to perfom or have performed the said work and to m~e and file ~is pplication; that all statements con[ained in this application are true to the best of his knowledge and belief; ~d that ~ork w~l Be perfomed in the manner set forth in the application filed therewith. worn to before me this ~o, 52-812585~j Suffolk