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Home My WebLink About11139-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ..... Z ~ 0/~.9-9 ...... Date ...... .H.a. ¥..2.1., .................. 19.8.1. THIS CERTIFIES that the building ................................................ Location of Property .... :~.l.4.5.'.~.l.~.,~.a,.h.=.,L...a.n.e.: .... l~at, t;Y~t;uck, lqew York House No. Street 0 0 ~l,a/~let County Tax Map No. 1000 Section 108 ...Block 04 .Lot Subdivision...~ .~ .]..J.a.h. ~...L.a.n..e..E.~ t..a .t;.e.$. .... Filed Map No..6. 0..6.5...Lot No..../~'. ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... /~ p ~cu[. 22 ...... , 19 .Ii I pursuant to welch Building Permit No.. ~-)-~.3. ~..7, ............ dated ..FI.ay..7. ..................... 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 ......... .... ~ ~.~.~.t,.t.q.n..~.f.p.~t.q~.c. ?..~..~??.~ ~.?~ ........................................... The certificate is issued to ...... ~ t~ p.h.~, n.. ?.... ~..t,.~.n.n..o.n ................................ (o wn er, ~ -~e~)' ' - - of the aforesaid building. Suffolk County Department of Health Approval .... ~N./. R. .................................. UNDERWRITERS CERTIFICATE NO ...... .N./..~ ........................................ Rev. 1/81 Building Inspector TOWN O~ ~UTH~O~ ~uILDINO D'iPA Rl~/~ti TOWN HALL · SOUTH'OLD, N~Y. BUILDIN~~ PE~iT (THIS PER~IT MUST BE KEPT ON ~H,E PRE~IS~SUNTIL COMPL~ION OF THE WORK AUTHORIZED) N9 1,11--3~ z Permission is hereby grar{ted to: County Tax Map No. 1{)00 'Section '"' '/~"~,,'.'i' Bl°ek i,'~ pursuant io application dated ~...; ~....~ ....... ~....., Building I~spector. Lot N b. ~,,c~..Z~,. ~. ...... ~4/ an8 approved by the 'Bi/lldingilnSPeetor 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. Commemial 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 featu res. 2. Sworn statement of owner or previous owner as to use, occupancv 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 . .- ;~-,-J-- J- I~,1. New Building ~.,~....~. .... Old or Pre-existing Building ............ Vacant Land ............. Q '"''?Z.,i~,) ' " '~ ; ' Locat,on of Property .. ....... c, ........... House No, '/~reet Ham/et Owner or County Tax Map No. 1000 Section ../~ ....... Block ...~ ....... Lot...~C~.7,.~.,. s,~o.. ~C.9.~ ~ L ~.. ~ .,.(.~ / ~ ...... ,~ M,, ~o ........... Lot No ............. Permit No. '~:~, 7U~e of Permit ........ Applicant ....... ~z~4~ ...... Health Dept. Approval ........................ Labor Dept. Approval ........................ Construction on above de~ribed building and pe~t m~ts all applicable codes and regulations. ,¢ V'j Applicant . . ~-~..~..~. Z~<3~~ ............... Rev, 10-10-78 FIELD "~ /~' ~ .... /, ADDITIONAL COMMENTS: ~ ~ FOUNDATION (~st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING 3. INSULATION PER N. Y. STATE ENERGY FINAL FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL File No ................................ Date ./~/~.~./..~.....~..~.: ....... , 19 ( Location of Property / County Tax Map No. 1000 Section .f~.~... Block ...~ ....... Lot ~.Z / ' ~ ~< .~ ........... Subdivisio ~ ~Filed Map No ................. Lot No... is returned herewith and di~p~roved on the follow~g grounds . ~. fi4 ~R ~/. ~ ¢... ~~ ~.. {. ~/~. ~ ........ ~. ...... ~. ~ ......'~ ........... . / /. ~ / ~ / ~ ~d/~.. ~ .~~n9~7' ~q~...~.2 e~zgS~../: .~..~ ......... ~.[.. </.~...- ................... ~uilding Inspector RV 1/80 FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL.: 765-1802 APPLICATION FOR BUILDING PERMIT 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 g~ving a detai~ed description of layout of property must be drawn on the diagram which is part of this appli- 'ation. c. The work covered by this apphcation 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 buildiug 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 3uilding 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. Fhe applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to ~dmit authorized inspectors on premises and in buildings for necessarynipspections. /~ ............ (Sigttature of applicant, or name, if a corporatiqn)/ (Mailing address%f applicant) 3tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .. .- .............. ................................ qmne of owner of premises.../~.(5..~: · ·~.-/~ ..... /~.~--~ ./J..~/~'..../~..'~....&~'. ....................... (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 ..... ~.~..~. ~ ............ Plumber's License No .......... ./ ............ / Electrician's License No ...... ./... ............ / Other Trade's License No .... ./ ................. 1. Location ofland on which proposed work will be done. ................/~O..-? 5~ ~-~5~/~ ~,~ ............. ~..../.~ .... House Number ~ Street Hamlet County Tax Map No. 1000 Section .... [.d..~. ......... Block ... ~..~. ........... Lot...O.~p. 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 ...... .,~. '.c ./ /. r :.-r-...(~..,~'. ~....~::.,57../~. (.C..~....2~. ~: .., ............. b. Intended use and occupancy .~.... ,~..~...C./~ .....,42 ~p~r~. /../.~.(¢.~. ................................... 3. Nature of work (check which apblicablc): New Buhding .......... Addition ...... Alteration · · · Repair .............. RemovaI ............ Demolition .............. Other Work.. ~.'~ .... ~...,ff..~ ./.~.'~..~. (Description).. ;. Estimated Cost ....... : ...................... Fee .................. (to be paid on filing this application) L If dwelling, number of dwelling pnits ............... Number of dwelling units on each floor ............... Ii' garage, number of cars ..... . ................................................................. L If business, commerciai 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 ...................................................... Diinensions of same structure with alterations or additions: Front ................. Rear ................ Depth ...................... Height ...................... Number of Stories .................... L Dimensions of entire new constrhction: Front ............... Rear ............... Depth ............. Height ............... Number of Stories ...................................................... L Size of lot: Front ... n. · .~, ............... Rear ...................... _Depth .............. ..., ...... ). Date of Purchase . .,~,~ :..i Z~. .............. Name of Fox, rrb, er Owner ~,q~,~/~.T~:~..~.... 1. Zone or use district in w~ch premises are muated ............. .~ .......................... L Does proposed construction violate any zoning law, ordinance or regulation: ................................ L Will lot be regraded ......... i ................... Will excess fill be removed from premises: Yes No L Name of Owner of premises ..................... Address ................... Phone No ................ Name of Architect ' Address Phone 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 llr~es. Give street and block humber or description according to deed, and show street names and indicate whether terior or corner lot. rATE OF ~EV~YORK,~.., , .... · .~~ar~-t,~.r.f~;~~,.c.o~.t;~c.t~ .......... being duly sworn, deposes and says that he is the applicant oove 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 make and file this pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the ~ork will be performed in the manner set forth in the application filed therewith. worn to before me this : , lqOtar~ Pubh¢, State ,of New Yor~ ~ ~-~41175 S~folk Count~ ~ ~ ~ ~o~i~i°n expires ~r'sO'lgr~ (Signature of applicant) NOTE a= MONUMENT SUBDIVISIONMAPFII ED INTHE OFFICE T~E I. oc*qTIOI~ OF W~ ~D C~PO0~ ~THEC~ERKOFSUFFO~K COUNTY ON ~OW~ HE~EI~ ARE ~0~ FIE~D O~E~V&~O~ F~B, I~ 19Y4 AS YI~ENO ~06~ A~DIO~ F~O~ DATA O~TAI~D ~0~ OTH~ UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE HEW yORK STATE EDUCATION LAW REVISIONS 765-1802 9 AM TO 4 PM FOR THE ~?LLOWiNG I NS pECTIONS: FoUNDAT,ON . TWO RE(~UiRED FOR poURED coNCRETE 2. RouGH - FRAMING & pLUMBING ~3. iNSULATIOF4 4. FINAl- - coNSTRUCTION MuST BE coMPLETE FOR C, O, ALL coNSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N,Y, STATE coNSTRUCTION & ENERGY ES NOT RESPONSIBLE FOR ,~,G; o~ CONSTRUCT'ON E~o~. 'x LL DRAWING NUMBER