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Home My WebLink About11146-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z12928 Date .. October .24 ..... 19.8. q THIS CERTIFIES that ' ' Addition the buridmg ................................................ Location of Property .2.7. 5..CAp. cj ~,p.a,],. Pr.l.v. ~ .......................... ~[g ~ .t~_.~.tl¢ g .... House No. Street Hamlet County Tax Map No. 1000 Section ... ~. ! .5 ...... Block ...... .06 .Lot 010 Subdivision .... N.a..~.~.l.~.u. 9.k' .g.s..t.a.~.e.s. ....... Filed Map No..4.4.5.3....Lot No....6 .......... conforms substantially to the Application for Building Permit heretofore fried in this office dated .... .H.ay.c..h..1.1 ......... 19.8.1. pursuant to which Building Permit No..1.1. ~ .4.6.Z. ............. dated .... .N.a.y.. ! .3 ................. 19 .8 J., 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 ......... One family residence wzth addition . The certificate is issued to Mary E. Raynor (owner, ~t~ ~e~X X X X X of the aforesaid building. Suffolk County Department of Health Approval N / A UNDERWRITERS CERTIFICATE NO ...... N/A Rev. 1/81 Building Inspector FIELD iN~F~LW[iON 1. FOUNDATION ( FOUNDATION ( 2. ROUGH FRAME & PLUMBING INSULATION PER STATE ENERGY FINAL FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 5..., ..?/ ^pplication ........... )isapproved a/c ........ --.-...-...~. .......... .~ ........ ., ~.~ ~' ' (Building Inspector) " APPLICATION FOR BUILDING PERMIT' INSTRUCTIONS a. This application must be completely filled in by typewriter or~i.n ink and submitted in triplicate to the Building nspector, with 3 sets of plans, accurate plot plan to scale. Fee according ~o schedule. b. Plot plan showing location of tot and of buildings on premises, lelationship 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 the applicant. Such per, nit ,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 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 buildings, additions or alteratigns, or for removal or demolition, as herein described. rhe applicant agrees to comply with all applicable laws, ordinances, building code, housing code, an~d reg~atious, and to admit authorized inspectors on premises and in buildings for necessary inspections. -- - ..... . ....~m~...~...4...c..~oww..~.. ................. (Sigr~ature of applicant, or name, if a corporation) 5.. (Maihng address of applicant) gtate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electfician, plumber or builder. Nmne of owner of premises ...... ~ .h., .~.x.( .~ ~._.t34~ rq. 0 .Y~.~.. ............................................ ~ (as on the tax roll or latest deed) tf applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. ~/':a/~.~:'7.....~.~.' .'~'.~.~.~.. i... Plumber's License No ......................... Electrician's License No. '.~. 4 q,?f-.~, f. ff ('. i ........ Other Trade's License No ...................... 1. Location of land on which proposed work will be done. · .............. ............ ............. House Number Street tlamlet County Tax Map No. 1000 Section ... !./..~..~ ......... Block . O fo Lot. (~'O Subdivision .[~..~. J./.~ ......./~ ~ T-/aC'~--~'~ Filed Map No...'~.<f. 5.-.~. ...... Lot ............ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............ ./.-'~.. ~ .'52..~..~. (~..'~. ~..~. ?....~ ................................ b. Intended use and occupancy ~x .~-..~. ~..b. E'-w . ~.'~., ). t. 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal ............ Demolition .............. Other Work ............... I~- Fee/~.~. ~' (Description) Estimated Cost .... ./..~/~ e .a. I ............................. , (to be paid on filing this application) ' 1 If dwelling, number of 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 structures, if any: Front ..... .U-..G. ...... Rear .... / .~] ~. ...... Depth....q. Q f.'....... ...... Height ............. Number of Stories... .I ............... ~ ..................... ~ ......... Dimensions of sa~e structure wi!th alterations or addi[ions: Front ..... .~. (~ .........Rear .... .~. Depth ..... ~q P'~ ....... ~t' i.-c HeightF! ...... ~k~'.., ............ Num!~.e~' o,f Stories. ~e' j ...... ! ~-]" ....... Dimensions of~nt're new c ru tion: rent ..... Lo. ........ Rear .....~tm.... ...... pth .... t .......... Height ....).g. ......... Numlber of Stories ......... ~. ............................ ~ ........... Size oflot: Front )..(~.S-7~. .... Rear . ."2..O ........ Depth iil..c~..~i~".'.} ......... Date of Purchase ........... i .................. Name of Former Owner ............................. Zone or use district in which pr~mises are situated ...... ~ ............................................. Does proposed construction violate any zoning law, ordinance or regulation: ..../~ .O ...... . .............. Will lot be regraded ....... JS}. O ................. Will excess fill be removed from premises: Yes Name of Owner of premises b3.~( .~..~ .~ .~.~ ~ ;.. Address .~r/~.q~.. t.T't~ .... Phone No..~..o~.~: ~.,,.5.'. Nme of Architect ...... -.-4 '! ................. Address ................... Phone No ............... Name of Contractor . .~....'¢. ~.~.,r~,~.,~ ............ Address . .~Y~..& .~'..~ '?..%~-J%... Phone No..~..q ~.-: .~q Locate clearly and distinctly all :operty lines. Give street and block ~__~n.~r corner lot. PLOT DIAGRAM buildings, whether existing or proposed, and, indicate all set-back dimensions from lumber or description according to deed, and show street names and indicate whether \ rATE OF NEW YORK, OUNTY OF ................. .& .... ~?.) .A.~..~.... ~. .... ~ ¥ ~rq ~ ................. being duly sworn, deposes and says thane is the applicant (Name of individual sig~ing Contract) ~ove named. (Contractor, agent, corporate officer, etc.) said owner or ownem, ~d is du~y authorized to perform or have performed the said work and to m~e ~d file this 9plication; that all statements contained ~ this application are true to the best of his ~owledge and belief; and that the ,ork will be perfomed in the m~ngr set forth in the application filed therewith. worn to befo~ me this ~ignature of apphcant) [ Quohhed m Su~folk/¢,archCOunt? ~Comml~ion Exp*tes ~~ DA'rE- B. : N~:i:IFY BUILDING DEPARTMENT 7&~1~C~ g A~ TO ~ P~ FO~ THE FOLLOW~G INSPECTIONS: FO~ POUR:D coNCRETE 2. ROUGH - FRAMING & PLUMBIN~ 3. INSULA 4. FINAL - COF~STRUCTiON MUST BE COMPLEBE FOR C. O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. ~ATE ~ONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR ~iGB OR COBSTRU~ION ERRQRS.