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Home My WebLink About11150-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No, Z 1.3.1. 9..9 ........ Date ......... .Fg.b.: .....6. ............. 198.5.. THIS CERTIFIES that the buildh~g ..... A¢¢ .e.s s.o.r, y ......... .. Location of Property 2625 Cox Neck: Rd. House No. Street Ham/et County Tax Map No. 1000 Section ..... .1.1.3 .... Block ...... .0 .7 ....... Lot ..... .09.8. ........ Subdivision....X . .... ..... .Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .M.ay ........ 5. ...... 198..1. pursuant to which Building Permit No ..... .1.1.1. 5. Q .~ .......... dated ....... .~.a.~ ....... .1.4 ........ 19..8 ,1, 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 ......... Agcessory. Storag9 Building .(..a.n..d..F.e.B¢~..) ......................... WILLIAM At .J.R....& .F..P~.~.C.~$ B..L.~.N.D.S..A.Y .... The certificate is issued to ..................... ~d~ner,,~zm~c=~maant~ ' ' ' of the aforesaid building. Suffolk County Department of Health Approval ............. ,N/.A. ......................... UNDERWRITERS CERTIFICATE NO .................... N[A ........... Building Inspector Rev. 1/81 FO~M NO. , TOWN OR i BUILDING ,TOWNHALL SOUTH'OLD, BUILDING P,~RJ~IT: (THIS PERMIT MUST BE KEPT ON ~H,E PREM S~S UNTIL COMPLETION OF THE WORK AUTHORIZED), ~! ~ULL N'? 11150Z Dote ' -- ......... ~. .... · ......,..~:....~.. ! ...................... , ~9 .... Permissionisherebygrorftedto: ~,...~zz.~.~r......~c~.....~.....~..~~.~...~~.. . ~ ~~---~....~ ........................................ : ............ ~ ....... ~ ........ ~ ........ ~ ........................................ CoUnty Tax Map No. 1 00 Section ........... ~. BI~ ............. t N~ ............ pursuant to applicotion ~dated ................................. , 19. and opproved by the Building Inspector. )g Inspecfor FORM NO. 6 TOWN OF SOUTHOLD Buiiding Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. Th~s apohcat~on must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor ,.v~tn the following; for new buildings or new use: 1. Final su~,'ey of property with accurate location of all buildings, property lines, streets, and unusual natural or tooograohic features 2. Final a~proval of Health Oept. of water supply and sewerage disposal--(S-9 form or equal). 3. Approval of electrical installation from Board of F~re 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 buiiding. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existmc~ buddings {prior to April 1957), Non-conforming uses, or buildinas and "pre-existing" land uses ~ 1o 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 buddings or premises, or other pertinent mforma- t~on required to prepare a certificate. / Fees' 1. Certificate of occupancy $5.00 2. Certd~cate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Ne'.,/ Bud,,mg ............. O~d or Pre-existing Building(Z) ........ =/Vacant Land ............ ~oea,,oo o; Property ~.~.~.~.. ~ .';~.....~C ....... ~ ~~ .......... Hou~ ~Vo. S[reer Hamlet Owner or Owners of Property .~~ .~, ~~.~ ,~~.~.; Countv Tax Map No. 1000 Section ..J.j~ ......... Block .~2 ........... Lot..OP.~ .......... Subalws~on ................................. Fi~ed Map No ........... Lot No .............. Health De~L Approval ........................ Labor Dept. Approval ......................... Undenvnters Approval ........................ Planning Board Approval .................. ~ .. ~ Request for Temporary Certificate ..................... Final Certificate . ~ ..... - ......... , Fee Submitted S ...~'.0~ ...................... Construction on above described building and per4it'meets all app,Li, caz~codes a0d-r~gulations' co ~ ~%~qfl - .-. .... ~ ....... : ..... ,..~; ...... /../,... .................. Rev, I0 10-78. FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME & FLUMBING INSULATION FERN. STATE ENERGY C,~DE FINAL (2nd) ADDITIONAL COMMENTS: APP~O¥~ A5'~ NOTED -. FC .~ "~nA~A F4~, & PLUMBING,~ 4. F~~z~ ....... '-' " [ L ' ~:' ~ -i~ c,-'AI L MEET ON~TRL;C7 IO~4 & ENER6Y ~SPoNSIBLE FO CODES, NOT R- , , , DESIGN OR CONSTRUCTION FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined 4 .?./~../..~. .... , 19 .~./. ^pproved .... ' Disapproved a/c ........... ~ ~ ....... ~ ......... // ................. J. 2T7.. ~ ............... ' .. (Building Insuector) APPLICATION FOR BUILDING PERMIT Application No.. ~(./..?..~. .... Date . ?'/7 5~ "!93'/ INSTRUCTIONS a. This application must be completely filledqn 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 str¢~ or areas, and giving a detailed description of layout of property must be drawn on tl~e 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 apphcation, the Building Inspector will issue a Building Permit to the applicant. Such peru shall be kept on the premises avaiiable 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 Buildh~g Department for the issuance of a Building Permit pursuant to t Building Zone Ordinance of the Town of Southold, 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 appllcant agrees to comply with all applicable laws, ordinances, building cod,e, housing code, and regulations, and admit au,horized inspectors on premises and in buildings for necessary inspectio,ns/ ........... ~.~ f~..~.~..w."~ .~4. ..... (Si.¢qature of 3pplicant~ '?or name, ifzvkor/~6ration) "" '~'/' ;Ta~ii~i) .......... State whether applicant is owuer, lessee, agent, architect, engineer, general contractor, electrician, plumber or build, ................... ~..~.~ ..................... , ............... ;j ............. ..............:.. .... (as on the tax roll or l~'es[/:Jeeo) 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 ....................... ~ (2/ Other Trade's License No ..................... Loc,~ion of land on v/hich pr, opal_sea work will be done ....... .... ...................... County Tax Map No. 1000 Section ' Filed Map No Lot Subdivision .................................................................. (Nmne) State existing use and occupancy of premises and in~ded use an~ccupaney of proposed constmefiom a. Existing use and occupancy ...... ~.~,~¢~~ ......... ~ ...................... b. Intended use and occupancy .............. A~,..~q. ~ .~ ............... J. Nature of work (check which applicable): l~ew l~uilding .......... Addition .......... A/teration ......... Repair .............. Removal .............. Demolition .............. Other Work .~..q .~. ...... ' L.._~..g~.. .c~. '- ~ (Description) t. Estimated Cost.................... . . · .......... Fee.. .................... ¢ ........... (to be paid on filing this application) L If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage number of cars ' 5. If business, commercial or m/xe~ occupancy, specify nature and extent of each type of use .................. 1. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of stone structure wilh alterations or additions: Front ................. Rear .................. Depth .................... ,.. Height ...................... Number of Stories ...................... L Dimensions of. entire new construction: Front ............... Rear ............... Depth .............. Height ............... Number of Stories ....................................................... 7. Sizeoflot: Front ........... : ........... Rear ...................... Depth ..................... ) Date of Purchase ' Nalno of F.c~rrner O~vner 1, Zone or use district in which premises are situated ........................................... !. Does proposed construction violate any zoning law, ordinance or regulation: ............................... I. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No ~-.Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect ............................ Address ................... Phone No ................ Nmne of Contractor ......... : ........... - ...... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly ail! bui/dings, whether existing or proposed, and. indicate all set-back dlmensions from :operty lines. Give street and block number or description according to deed, and show street names and indicate whether ~terior or corner lot. TATE OF NEW Y43J~.K, ., .~ - OUNTY OF ~_~r~d~.. ~/.~i , , ...... ~-~ ~,~.~..~. . being duly sworn, deposes and says that he is the applicant '"(Name of individual sigfiing contract)/~/~ hove named. ' is the .................. ~ .......................................................... (Contractor, agent, corporate officer, etc.) said owner or owne~, ~d is duly authorized to perform or have performed the ssid work and to m~e and file ~is pplication; that all statements contained ~ this application are true to thb best of his ~mwledge and belief; ~d that the ,ork will be performed in the m~n~r set forth in the application filed therewith. worn to before me this ......... ..... .... ....... ~t~ P?lic, ...... ~ ........ :. ~.. County ...... ...... , ~o~ 52 8125850, Suffolk Cou~ ~ ~ ' ' Te[m ~p~res Match 30, 19 ~ z 0 0 -- ~ ~ disp6ssl axtd water supply- fo,~ili%zo~ f,,r tbJ3 looaulo hgvo been to bo satisfactory. Chief of ~eneral Engineerin~ Services " "'