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Home My WebLink About11127-zFORM NO, 4 TOWN OF SOUTHOLD BUiLDiNG DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No .... Z.! 0. ?.0.4 ....... Date .... B.op tem.be~'. 2.9 .............. 19 THIS CERTIFIES that the, building ................................................ Location of Property ..... .1500..T.vuman.~, · · Pa.[h, · E,as g. lq.a~, J. on.,..New. Jerk .... House No. Street County Tax Map No. 1000 Section . . .03 .1 ...... Block .... 1-2 ......... Lot ...... 0.1~ ....... Subdivision ........................... Eded Map No ...... ;..Lot No .............. confolms substantially to the Application for Building Permit heretofore filed in this office dated .... .~.pvil. 2.9 ...... 19.8.~pursuant to which Building Permit No ...... .1.1.127g ......... dated . .May..4 ..................... 19. B.], 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 ......... ........... p.e.c, g ;.t).qn., ...................................... The certificate is issued to .... G e ol~ge. F....Bchm± g I; ................................... (owner, lessee or tenantl XXXXXXXXXXXX of the aforesaid building. Suffolk County Department of Health Approval ........ ~I./.R .............................. UNDERWRITERS CERTIFICATE NO ...... N/I~ ........................................ Building Inspector Rev. 1/81 FOI~M BUILDING TOWN HALL SOUTHOLD, N,. Y. BUILDING PERMIT ...~' ......... ~ ,~..~1 N? 11127 Z ~t~ .,..~.~ , .......................... Permission is ..... ~ ........... ~ ........ ~..~ ...... =.. ..... ~.~~ ~...~ ...... ~ . ..~.~z..~.:~c.~ ......... ~.~..... ~ ~., ...z.~.~ ......... ~...~ ...................... ........... ~r~:~.~....~Z~5 ...... ~ ......... ~ ............ ~...? ........................................ ~ ~o~,~o, ~o~o~o~ ~....z.~.~. ...... ~~: .... ~~ ................................. co~ ,~ ~ ~o. ~o0o so~t~o~ ..~x .......... ~o~ ,..~ .......... cot ~o...DZ¢ ........ pursuant to application ' dated ~.,.,.; ....... ~:.,,~......, 19 }~ and appr~ by the Building Inspoctor. ..... ................................... ~ Building, In~ector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town $outhold, 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 features. 2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approva~ of electrica~ installation from Board of Fire Underwriters. 4, Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a ceruficate 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 3. Copy of certificate of occupancy $1.00 or land use $5.00 Date .~.~ .-~f../~. 0~./'. ........ New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property., ~.,~.O..O .......... .~./I~..~... ~--~*¢*./~..- .~'., . House No, .~~ Ham/at Owner or Owners of Property ~¢-4~..~.. Z..~.~· .................................. County Tax Map No. 1000 Section ..... -~./ ....... Block ..... /. , .'1~-. ...... Lot ..... ./../-~. ....... Subdiwsion ................................. Filed Map No ........... Lot No .............. Permit No, ./~/~ .~.~ Date of Permit~.~.z¢,/¢/...Applicant ~~. ~, .2~,,~'/~'' Health Dept. Approval ........................ Labor Dept. Approval .......... Underwriters Approval ........................ Planning Board Approval .............. Request for Temporary Certificata ..................... Final Certificate ............. Fee Submitted $ ,~..?'~'. · .................... Construction on above described building and permit meets all applicable codes and regulations. FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180;3 xamined, ..¢. .... 19. ~.pproved ,~.(~...Z~.. ., l~'/._._Permit~ No.. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No.../~..././~. ;../] ....... Date .~)', ? ...... 19~/. 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 giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ;etlon. c. The work covered by this application may not be commenced before issuance of Building Pe.rmit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit ;hall be kept on the promises 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 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 buildh~gs, additions or alterations, or for removal or demolition, as herein described. rhe applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to on for necessa~, inspections. ~dmit authorized inspectors premises and in buildings (Sig~ure of app!icant, oLname, if a co?oration) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plmnher or builder. Xl,ne of owner of premises..&/{ ?.r). ).'h.P,..4 ~t~rQ'.~.~.(~.....~.~'..~....~..~f. .......................... (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 .... :~' i Plumber's License No. Electrician's License No...~..~..//.~ff.~. :-. ....... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ................................................ .... /4:.o. .o. . . .V~:.~..~. :~.,~ ~. ~ .... p~ ~ ......... F.-.~. .~.¢. . . . .,ff. .,~ ~.,.~. .. ,..Z~ ..ff.... 1/. ~. ~. ? ....... House Number Street Hamlet County Tax Map No. 1000 Section .... ~ [ ........... Block ..... /i .Z~-. ......... Lot ..... / ~ .......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and ~ccupan~y ~f premises and intended use and ~ccupancy ~f pr~p~sed c~nstructi~n: a. Existing u se and occupancy ..... (-~./G,.~.--~.. Z .~.,'?..~/.~...~....~..<'.~./ff'./d~2.~..: ....................... b. Intended use and occupancy . · ..~' .~<~.~..>x~../. ............. - ..... ~.~. ................. Nature of work (cheek which applicable): New Building .......... Addition ........ Alteration ........ Repair.. ............. RemoVal. ...... If dwelling, number of dwelling units .... 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 wiih alterations or additions: Front ................. Rear ................ Depth .................... i.. Height ...................... Number of Stories .................... Dimensions of entire new construction: Front ............... Rear ............... Depth .............. Height ............... Numiber of Stories ....................................... ,. ~,. } ............. Zone or use district in which pr4mises are situated ....... .~'.,~..'[ ./5~..~C'. ................................. Does proposed construction violate any zoning law, ordinance or regulation: ..................... ~ ....... Will lot be regraded ........ .~.q ................... Will excess fill be removed from premises: ~ No Name Of Owner of premises~¢~¢-.~ .45[~.. Address/.~.OP.'~.~.~..P(: Phone No. ~.7 7;7 .o.~.&q... Name of Architect .......... ~/I ................. Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ ...... Demolition .............. Other Work ............... (Description) ............. Fee ....................... * ........... (to be paid on filing this application) ......... Number of dwelling units on each floor ................ PLOT DIAGRAM Locate clearly and distinctly all;' buildings, whether existing or proposed, and, indicate all set-back dimensions from ropel~y lines. Give street and block 3umber or description according to deed, and show street names and indicate whether tteriororc.ornerlot. ,~ e.~ 3 t ~Z. Or-d~ / .~.- LO'2trueSt TATE OF 'NEW ][/O,~l~Ko~" .;- - OU~Y OF .~~ ..... ~'~ (Name of individual signing contract) oove named. e is the..~ ................... [ ................................................................... (Contractor, agent, corporate officer, etc.) f said owner or ownem, ~d is duly authorized to perform or have perfomed the said work ~d to make ~d file this Oplication; that ~1 statements contained ~ this application are true to the best of his knowledge and belief; and that the 'ork will be performed in the m~ner set forth ~ the application filed therewith. worn to before me this ......... 9g.I: ...... · ..- ............. q .... ~0~ARy POe[lC, St, to o1 ~ew Yor~ · ; .o L2-4524711 i QuahhcO ~n Suffolk County Corem ssmn Expires March 30~