The URL can be used to link to this page

Home My WebLink About11145-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildin§ Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Z10617 Date August 5 ................................ ,19 81 THIS CERTIFIES that the building ................................................ Location of Property 360 Lakeview Terrace East Marion, New York House No. Street Hamlet County Tax Map No. ] 000 Section . .0.3. 1. ....... Block ....... .0.9. ..... ]Lot ......... 0.1. .2 ..... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated May ?2 1981 11145 Z .................... , ... pursuant to which Building Permit No ...................... dated . . . O.a.y.. ~..~ .~ ................. 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 ......... Deck Addition to One-Family Dwelling The certificateisissuedto Walter and Linell Gaipa (owne~x~nt) of the aforesaid building. Suffolk County Department of Health Approval .... ~/..~ ................................... UNDERWRITERS CERTIFICATE NO. Building Inspector Rev. 1/81 TOWN OF BUILDING TOWN -HALL SOUTH*OLD, BUILDING i PERMITi (THIS PERMIT MUST BE KEPT ON' T, HE PP, EMIS!S UNTIL EULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby gra~ted to: pursuont to opplicotion~doted ............ ~,~*,.:,~ ........., 19 ~, ond opproved by the ~ildln~ Inspector. Fee S-fl. ................... 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 buddings or new use: 1. Final survey of property with accurate location of a~l 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 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- t~on 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 $5,00 Date . New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property . ~.-~'? House No..~~~ ~ Street ~ ~ Ham/et Owner or Owners of Property ........ ~.. ~e~ ~ .... ~/~Z~ .: ................... CountyTax Map No. 1000 Section . .~.~./ ....... Block .. ~.'~. ........ Lot, .~/~ ....... Subdivision ................................ Fded Map No ........... Lot No .............. PermitNo. //"..~.~-.~.. Date of Permit .O~¢~/.Appllcant .~)~.~-~'~;;;~... ~.'./~./~?.L~:.. ........ Health Dept. Approval ..................... Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ................. , ~.. Request for Temporary Certificate ..................... Final Certificate . .~ ........... ~.~. ~O/'. Fee Submitted$.,~.; ........................ ~[ ,'L~ ~ Construction on above described building and~rmit meets~able codes and regulations. ~)1' ¢ j/ .,,,,c,.t.. ................... ¢ .... Rev, 10-10-78 FI~LD ±NS~CI'±ON FOUNDATION (ls5) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION FER N, Y. STATE ENERGY ODE FINAL ADDITIONAL COMMENTS: t ~ F O R ~.'1 NO. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.; 765-1802 Examined.. · ./~../q.~.../..2~..., 19 O(n/... Approved../~.~.~'...{.?..., 190~../. Permit Disappro/ed a/c ..... ~...~ ................. APPLICATION FOR BUILDING PERMIT Application No../, .g'./, .~.dT..~. · . Date ....... , 19 INSTRUCTIONS a. This application must be completely filledqn by typewriter or in ink and submitted in triplicate to the Buildi Inspector, with 3 sets o! plans, accurate plot plan to scale. Fee according to scheduie. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stre~ or areas, and ~ving a detailed description of layout of property must be drawn on the dia~am which is part of this apF cation. c. The work covered by this application may not be commenced before issuance of Building Pe~it. d. Upon approv~ of this apphcation, the Building Inspector will issue a Building Pe~it to the applicant. Such peru shMl be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in pug ~or any pu~ose whatever until a Ce~ificate of Occupan shall have been granted by the Budding Inspector. APPLICATION IS HEREBY MADE to the Buildh~g Department ~or the issuance of a Building Pe~it pursuant to t Building Zone Ordinance o~ the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for ~e construction of buildings, additions or alterations, or for removM or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and,mgulati.,ns, ~d admit authorized inspectors on premises and in buildings for necessa~ inspections. ...... ............ ,, __ (Signature of ap~c~t, or n~e, if a co p ' ) ~a,hng address of apphc~t) State whether applicant is owner, lessee, agent, ~chitect, engineer, general contractor, electrician, plumber or buil& N~e o[ owner of premises ................................................................. (as on the tax roll or latest deed) I[ apphcant is a co~poration, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ...... .7.~. (..~. ........... Plumber's License No ..... :7..; ?~ ............. Electrician's License No ....................... Other Trade's License No. 1. Location of land on which proposed work will be don~<¢3. . ./,.~..~.~'..~'~... ~, .4~. ff.~-. ........ ': ............. ......... ............ ................. House Nmnber Street Hamlet f County Tax Map No. 1000 Section ................ Block ............. Lot ......... ' Filed Map No Lot Subdivision .................................................................. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........... .,.~.~..~t, ./~...~,./.t.~,. ......................................... b. Intended use and occupancy ...... ......................................... . . . ... ....... . ..... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .... ' .......... Demolition .............. Other Wo rkO{-"ZZ).~. I-.Estimated Cost .......... q ............................................. '. ........... ~ (to be paid on filing this application) 5. If dwelling, number of dwelling ~nits ............... Number of dwelling units on each floor ............. If garage, number of cars ..... : ................................................................ 5. If business, commercial or m/xed occupancy, specify nature and extent of each type of use .................. I. Dtmensmns of ex~stmg structures ff any Front .... Z-~. ........ Rear ........... Depth ./<:P..~ .... Height ............... Number of Stories ..... ~. .............................................. Dimensions of same structure wish alterations or additions: Front ................. Rear ............... Depth ............ .. .... . . .. .Height .............. ..... ~... Number of Stories ................. .. 3. Dimensions of. entire negconstmction: Front .... /~ ........ Rear . ../~.../ ........ Depth . ./~.. 7. Dateofmurohase....a/Z,r: .......... · 1. Zone or use district in which premises are situated ................................................ ~.. Does proposed construction violate any zoning law, ordinance or regulation: .......................... Will lot be regraded .. ,4drd...; ................... Will excess fill be removed from premises: Yes NO Name of Owner of premises ~...~'.~./?.~/ ...... Address ~,~,t~'~..,'~.. ~.~.~.-..~..'.~tt:. Phone No...~77:q~.6..L: .... Name of Architect ............................ Address ................... Phone No ................ Nmnc of Contractor ..... ~.z~. 6:'...6F~.. ........... Address ................... Phone No ................. PLOT DIAGRAM Locate clearly and distinctly all lbuildmgs, 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, '~. OUNTY OF..q"'//,~..~.o,~: -.-. 11. 'i~'~ !. ./~..~.. ......... being duly sworn, deposes and says thatt~is the applicant (Name of individual signing contract) ~ove named. (Contractor agent corporate officer otc ) ~ said owner or owne~, md is duly authorized to perform or have performed the sgid work and to m~e and file 9plication; that all statements contained ~ this application are true to th~ best of his ~mwledge and belief; ~d that the ,ork will be performed in the mmn{r set forth in the application filed therewith. worn to before me this ............ l~..~ .day o[.. ] ........ .19.~/ · ' ' (Signature of applicant) ter~ [a01ros March 30~ I~