The URL can be used to link to this page

Home My WebLink About11114-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildin§ Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..~.1.0.~38 ......... Date .... p.e.qe.m..b.e.v..3..0 ................ 19 .8.1. THIS CERTIFIES that the, building ................................................ Location of Property . J.q $ 5 ............ F.a.q .~ 9r.~...&v.e.n.u. 9 ............. .~.a.~..~.t.~.u.c..k .... House No, Street Ham/et County Tax Map No. 1000 Section . .1 2.2. ....... Block . . 9.2. .......... Lot. 9. .q ............ Subdivision .... ~. .Filed Map No. X . .Lot No. X conforms substantially to the Application for Building Permit heretofore filed in this office dated .... gp.v.$]...8. ....... , 19 ~.1. pursuant to which Building Permit No..1.1. 1. .1.6..g. ............ dated .A.p.v..J..]...1.7 .................. 19..8.1, 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 ......... .... .a.q. o¢.d.~.t~,.op..~..o .a.n...e.x.~.s.e..J..nt¢..d..u.e.l.l.t..nf~.. ................................. The certtficate is issued to ..... .F.v.a.n.k...d....g..a.n.efl. k..t...&. ,¥ ,j.~,e ........................... (owner, ~X~¢~l~ of the aforesaid building. Suffolk County Department of Health Approval .... I,I / ~ ................................... UNDERWRITERS CERTIFICATE NO....~..-~.2~.7.6.9 .................................... Building Inspector Roy. 1/81 FOI~M NO. ~ TOWN or SOUTU0~.~, BUILDING D~PARY~N~ Town HALL SOUTH:OLD, N~ Y. BUILDING P,E~!T COMPkETIO~ OF THE WORK AUTHORIZED) pursuant to applicotion,dated ... ~ ............. ...: ......... ~ , 1 ~ ,, ~nd opprovod by tho 8ulldln0 In*p~ctor. 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 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 Planning Board approval of completed site plan requirements where applicable. For existing buildings (prior to April 1957}, Non-conforming uses, or buitdings 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-exist~ng dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 New ~":"~; - ...... ~ ............. Old or Pre-existing Building(X) ...... ~/Vacant Land .. Location of Property ./..~)..'~, ,~7 ............ iz~¢/3~¢~. ........ ~ . Hou~ No. Street Ham/et Owner or Owners of Property ...~. ~..~-~ ¢.~'~Z ~ .~, U County Tax MapNo. 1000 Section ../~ ....... Block ...~ ........ Lot...~,~ ....... S bdi i i ~ Fil d Map N Lot No U vson ................................. e o ......................... Permit No././.t.]../~..~.. Date of Permit .~.~.~./~J..Applicant ..~'.~.~¢z¢¢-~...~,~2 .......... Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. Underwriters Approval ~.. ~..c~..~..~7.(-4'.c~ ....... Planning Board Approval ...'-T .............. ,,., Request for Temporary Certificate ..................... Final Certificate .... ~ .......... - Fee Submitted $....~.~.: ~.~....¢-¢. .............. Construction on above described building and permit'meets all app~cable~co_des and regulations. Apphcant., .~.,~ .~:...~ ............ . ..... THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY, ,85 JOHN STREET, NEW YORK, NE~W YORK 10038 Jt~*'~ 25 ~ ~981 and found to be in compha~ce with the requirements of this Board. Pe~ ll nol be o]l~red in ony monn~r; relurn {o ?he o~ice o~ lhe goord i~ ~nco[~red. [nspecIo~s mGy be idenh~led by lhelr credenho~ COPY BUILDING [HIS IN ANY MANNER. FIELD INS~C'flON FOUNDATION (1st) FOUNDATION (2nd) 2. 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.: 765-1802 ixamined/~..~. ,..f--:.../.,.~'., 19 ..~./ ~,pproved /~.~f..(~.. '~7" I~'/' Permit No.././..Y./. ~ ..~ )isapproved a/c ......... .': .......................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No /11 I ~ 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, retat,onship to adjoining premises or public streets )r areas, and giving a detailed description 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 th~ 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 tile 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 Connty, New York, and other applicable Laws, Ordinances, or t~egulations, for the construction of bnildings, 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 ldmit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) · .... ....... /(0/7,~5~)// (Mailing address of applicant)/~,,~ ~ grate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) (Name a~>ff fftle of 0to,orate officer) ,/ ~ Builder's License No ...... . .~..'.~ Plumber's License No ......................... Electrician's License No..~.., .~..~ Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. .... /. . ................ ;47 ¢. . ....... .,f. ?:. .r. ? l'7. ............. House Number Street Hamlet County Tax Map No. 1000 Section .. l vc-"'/-'~ Block OD'"-- Lot (37--O 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 C b. Intended use and occupancy Nature of work (check which applicable): New Building .... Addition Alteration ........ Repair .............. Removal .............. Demolition .............. Other Work ............... /f, ?. / (Description). Estimated Cost .............................. Fee ......................... (to be paid on filing this application) If dwelling, number o f dwelling units .... ~ ..... Number of dwelling units on each floor ................ If garage, number of cars ..... ~ ................................................................... If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... Dimensions of existing structur4s, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories .... / ~ ............................................... Dhnensions of same structure with alterations or additions: Front ................. Rear ................. Depth .................... ~.. Height ...................... Number of Stories ..................... Dimensions of entire new construction: Front ............... Rear ............... Depth .............. N..gn) be, r o ....~.. ........... Height ............... f Stories ........... "'~' ' '" .................... 'o Size of lot: Front ............... Rear ......... , ............ ~,~"'" £ · '" ;4 .t-'r ._' '/ ........ Date of Purchase ....... /~.ff.7. ................ Name of Former Owner .r;~ ~'O,q-'A4x~...~, ....... Zone or use district in which premises are situated ................................................... Does proposed construction violate any zoning law ordinance or regulation: ..... /~'.0. ..................... Will lot be regraded ......... ~ ~ ............... Will excess fill be removed.from premises: ~ No Name of Owner of premises .¢~'t~.r4t/b'r~..,z~j/,/ZO-~(~ddress ,/fid'J{. 77.././././~2.T..&r..¢./.~-.-.-/~hone No. ~. Name of Architect ......... : ................. Address ................... Ph&ne 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 -operty lines. Give street and blocklnumber or description according to deed, and show street names and indicate whether terior or corner lot. I~ATEOFNEW(SYORK~/ ,~ ',,o ..... c nt;ic'ti ........ being duly sworn, deposes and says that he is the applicant oove named. e is the .................... ~ .................................................. / ~ntractor,Tent, corporate officer, etc.) f sa~d owner or owne~, ~d ?s d~l[ auJ~o~~¢rm or have performed the said work and to m~e and file pplication~; that all statements contained ~ this application are true to the best of his knowledge and belief; ~d that ~e ~ork w~l ~e performed in the manner set forth in the application filed therewith. worn to before me this ........ ~ ......... dayif..,~ ......... 19.~/ : , NOTARYI PUBLIC~te of New Yor~ ~ ~ ~ (8i~ature of applicant) No. 52-8125850, Suffolk Cou~ Ter~ Expires Uarch 30, 19 ~