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Home My WebLink About11130-z FO~H ~o. ~ BUlLDINO ~'~'ART'~,~h~ TOWN' HALL SOUTHOLD, N. ~. BUILDING :PERMIT, ~i (THIS PERMIT MUST BE KEPT ON ~HE P'P, EMIS~S COMPLETIO~I OF THE WORK AUTHORIZED). ~ ? 11130 2[ ~ote ....~ ....... ~ ....................... , ]9...~.,/ UNTIL F]ULL Permission is hereby granted to: ..... ~ .~ ~....~. ~.~ ........ . ...... ~o ...... .~,.~z~..~.~z ........ ~~..~.¢....~.~ ............................ ............. (~;~.r~ ....... ~..;......C~~).~ ................ ~ ........................................ ~ p~.~.~ ~o~ ,~ ..~.~..~..~ .......... ~~.~z~...m~ .............................. .............................. Coun~ lox ~p ~o. 1000 S*ction .... ~..~...~. :. Block .: .... .~. ~ ...... ~kot No..~Zl ............. p~sucnt to cpphcct,on doted ,,, ~,< .... i,,,,~,,,,,, 19, ond oppmved by the Building Inspector, ?. 6/30/80 ~ ~ FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z.10.9.72 ..... Date .... .MAY.. 7 ...................... 19.8.2. THIS CERTIFIES that the bmlding s.... (. 2. .) ......................................... Location of Property . ,2. 0..5.7.5. ............. ~.o,u.n.d...Y.i.e.~?. ,Ay.e.n..u.e .......... .S.o.u.~.t.~ .o.l.d... House No Street Hamlet County Tax Map No. t000 Section . ,0.51 ....... Block . 9.4. ........... Lot ...0. ! ! ........... Subdivision .... X ......................... Filed Map No..X. ...... Lotu/~.t. X Requirements for a private one-family dwelling b ~i~'i'd/'''t'd'' conforms substantially to the ~l~Mo~-~-l~rH~-l~rmi't-i~?~l~T~'Ti~i~~ff Certificate of' Occupancy · .. A.p. rtl 1. ~.3 ........ , 19,5.7. pursuant to which t~l~h~4~rrmit No.. ~ ~ 09.7. ~ ............. dated .... .M.a.y.. 7 ................ 19 .8.2., 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 .. ,e. ...... one-family dwelling and accessory one-car garage* The certificate ~s issued to ...... F. rod..M...C, orlt l~v~n;;.,~4~a4~j___ ...................... of the aforesmd building. Suffolk County Department of Health Approval ......... .n ./? .............................. UNDERWRITERS CERTIFICATE NO. n / r *This Certificate of Occupancy pursuant to Buildin~ Permit # dwelling. includes C.O.# Z10750, issued 10/29/81, 11129 Z, to build a deck addition to Building Inspector Rev. 1/81 FORM NO. G TOWN OF SOUTHOLD 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 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. B. 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. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5,00 3. Copy of certificate of occupancy $1.00 Date .. /~ -~ ~ "~'/ " New Building ............. Old or Pre-existing Building(X). ~'~..~, ~ ~Vacant Land ............ Location ofProperty ~'3~'~' ,~'- ~:~5 ~' .~,...~-¢. ,~ ~ ~..~..~.~.~,~' House No, Street , __ Owner or Owners .... . ............ .... ......... County Tax Map No. 1000 Section~,..~?~,-/ ...... Block . , .~. z~. ......... Lot..~, ,/.~. ......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No../z. 4//.¢~.... Date of Permit'~?,~:~¢:>/' App cant . ...~.., .~. Z,i Health Dept, Approval ........................ Labor Dept. Approval ~f .,.. Underwriters Approval ........................ Planning Board Approval , ~/. ........ Request for Temporary Certihcate ..................... Final Certificate ......../// S dS Fee ubmitte ............................ Construction on above described building and permit: mee,s aH appL~cab~e~odes ~',,d r~],ulation - FIELD FOUNDATION (ls%) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1803 Disapproved a/c ........ : .¥:~-~. ......... .................. ......... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date . 'r 'F ............. , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi 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 stre, or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this apl: 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 pern 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 Occupan 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 t Building Zone Ordinance of the Town of SSuthold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describ~ The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary i.~nspections.~,//. ~ . /~ ~_ .._ ~ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, .e~gineer, general contractor, electrician, plumber or build~ ~,,~t,,~o~r~,lv~, (as on the tax roll or latest ee ) If apphcant is a corporatidn, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No....d~.-r.-.~.~.-. .............. Plumber's License No ........................ Electrician's License No ....................... Other Trade's License No ...................... /) 1. Location of land on which proposed work will be done~~. ~'~~J House Number Street e~. County Tax Map No. 1000 Section ...~ ....... Block :~. Lot... Subdivision ..................................... 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 ................. :_. ........~ .... . ...................................... b. Intended use and occupancy..~....~..~~.~..~~ 3. Nature of work (check which applicable): New Building .......... Addition..~ ........ Alteration . .~ ........ Repair .............. Removal .............. Demolition ......... '... Other Work ....... [ ........ (Description) (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 ............................................ I .......................... 5. If business, commercial or mixed occupancy, specil'y nature and extent of each type of use ................... 7. Dimensions of existing structures, if any: Front ............... Rear ....... i ....... Depth ............ Height ............... Number of Stories ............................ I ......................... Dimensions of same structure with alterations or additions: Front ............ ~ ..... Rear ............... Depth ...................... Height ...................... Number o~ Stories ................... g. Dimensions of entire new construction: Front ............... Rear ........ i ....... Depth ............. Height ............... Number of Stories ............................ ! .......................... 3. Size of lot: Front ...................... Rear ...................... ~Depth .................... ). Date of Purchase ............................. Name of Former Owner ........................... i. Zone or use district in which premises are situated ......................... I .......................... L Does proposed construction violate any zoning law, ordinance or regulation: .............................. 3. Will lot be regmded ............................ Will excess fill be removed from premises: Yes No g Name of Ownar of premises .................... Address ............... ' .... Phone No ................ Name of Architect ........................... Address .............. i .... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM I 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. 'rATE OF NEW YORK ........... ~ ................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) : hove named. e is the ' (Contractor, agent, corporate officer, etc~.) f said owner or owners, and is duly authorized to perform or have performed the~said work and to m~e and file this pplication; that all statements contained ~ this application are true to the best of ~ is Bmwledge and belief; ~d that the ,ork will be performed in the m~ner set forth in the application filed therewith. worn to before ........ ...... '1~ ~ C0mm~ss~an Expires March 30, 198~ ~P NO, ACCOUNTANT DATE i OTI-Ff-~i) fD~N G 'D F. PA ~ )~LOW]N~ ~N¢PFCTIONS: FOR POUR~:D CONCRETE ROU6H - FRAM[F,I~~NG ~LL CONSTRUCfflON SHALL MEET 'HE REQUIRLME~-FS OF TF~E N.-~-~L ;TATE CONSTRUCTION & ENERGY ~)~IGN OR CONSTRUCTION ERRORS. C