The URL can be used to link to this page

Home My WebLink About11151-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...Z1060.~ ........ Date ...... Jul~r. .24, ................. , 19.8 ~ THIS CERTIFIES that the building ................................................ Location of Property .... .5.7.5...~.o.q~..e..C.~.e..e.k..~a..n.e., ........... .S.o.u..~.h.o.I.d. ~../q.e.¥..Y.o.~. House IVo. Street Hamlet Connty Tax Map No. 1000 Section ... 07.9. ..... Block ... 0 ~1 .......... Lot ..... J0.0.3 ........ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... l'~ay..1.% ......... ,19...~irsuant to which Building Permit No... ].1.1.5 ], Z ........... dated ... I~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 ......... ................... De.ok. Ad.d i t ion · %o..Dwe ll.ing ............................... The certificate is issued to .... E.l.sxlop..T.~- lm6s¢o ..................................... [owner, I~:~ Fxt~t~Xx of the aforesaid building. Suffolk County Department of Health Approval ...... e%/. R ................................ UNDERWRITERS CERTIFICATE NO ....... t%/.8 ....................................... Building Inspector Rev. 1/81 Building Inspector. ~, ,.L~...--... ...... (THIS PER~IT MUST BE KEPT ON ~HE PEEMI$iS UNTIL F JLL COMPLETION OF THE WORK AUTHORIZED~ ~ O. 111 ~ ~[ Z [;)ate ..... ! ~'"'"'"'/'i' Permission ~s hereby grant d to~ ~ ..........~.~i~z'""C~"~-~, ,,.....~.'.~o.o.z:..~..~.....~..,:~.~ ................. ?..~....O.. .... ~ /.< ~ , ,~'.( .~.: .,~...~.~ .~.~/.,~.~.Z~, .................. ..... ~./../...,.~.:.....~.~.~:~..::r .......... ,~~~...../,~'::-~. ~..~.?... .................... at premises located at '"~""'~'~'""~'"'"~"~"~'~"'"~ '~'~'~:7 '' .................................. ...... ·'~.~.,?....-.~a.,......,.~ ........... County Tax Map No. 1000 Sechon .. ;.~,,,. Block; ~ ............LotNo ........... p~rsuant to apphcahon~dated ........ .....~.v(. ......... ~.._!~..,.., 19 ., and approved by the 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. 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 buddings (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 unusua~ natural or topographic featu res. 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. Fees: 1. Cert[ficate 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.. :Z~ .2'.~'././. ' ............. New Building ............. Old or Pre-existing Building ... ~ ....... Vacant Land ............. Location of Property .,,~. House No, Street Hamlet Owner or Owners of Property County Tax Map No. 1000 Section . . .O, .7.<,/ ........ Block , ,O, ,/ ........... Lot, ?, ,~:.:~ .......... Subdivision ................................ Fded Map No ........... Lot No .............. Permit No../. ! ,/.?~(..~. Date of Permit .O. .... /..Applicant . .,~.Zq ?~.~. ~.?..-..~.~,~.~.~,c.~.,~ .~.... Health Dept. Approval ........................ Labor Dept. Approval ..................... Underwriters Approval ........................ Planning Board Approval ...... _ .~,-~ ..... Request for Temporary Certificate ..................... Final Certificate ............ Fee Submitted $~. ,~: ......................... Construction on above described building and pbr~m~eets all applicable codes and regulations. App,,cant .... ".: .' ................ FOUNDATION (1st) FOUNDATION ~(2nd[_ 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY G~DE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ..... ,i9. )~sapproved a/c ................................. .~.. (Building Inspector) P,PPLiCATION FOR BUILDING PERMIT Application No../'././, .~( .......... Date .... .'5~.~././. ........ , 19 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 ~ving 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 permit ,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 nntil 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, build, ja~code, housing code, and regulations, a.nd to ~dmit attthorized inspectors on premises and in buildings for necessary ins~ect~ns. / (Signature of applicant, or n~a~tle,j~ a corporation) ....fk. x-...&)./. .... ~ ?.?/...be~......x/..~..,..~:??. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... ~..~.~/9~ .c. d~ ,~'/?z-~,,c ,lame of owner of premises ....zf(2/(,~.,ff.,: (q... '~ '- (as on the tax roll or latest deed) If applicant is a corporation, signature of duty authorized officer. (Name and title of corporate officer) Builder's License No ...... c~..?ff. ............... '' / Plumber s L~cense No ........................ Electncmn s L~cense No ....... ~. ............. Other Trade's License No ...... ~ ................ 1. Location of land on which proposed work will be done. ....................................................... ~.o :.:~.~.~?.,,, d~. ................... House Number Street Hamlet County Tax Map No. I000 Section . ........... Block..e.4 ............ Lot ............. 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 ...... fl.. './~.~5..~..~-.-~.q ¢;.'... ~.~, ................................ b Intended use and occupancy ..... ~.~.:"zZr/~'~-"c~ .... z~'_ .~ .~.... ~.j,'.. ~ .~: .......... ). /, 2. 3. 1, Nature of work (check which applicable): New Building .......... Addition .......... Alteration ..... Repair- -- ........... Rembval ............ Demolition .............. Other Work ..... ,~-.~'~... (Description) Estimated Cost /./~...' Fee (to be paid on f'fling this application) 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 .~.~ ......... ; ....... Ihmens~ons of existing structures, if any: Front .... .o..~. .......Rear .... ~...'~. ...... Deptla' ~' ' ' ' ' '~ - .......... Height ..../.g'~ ........ Nmober of Stories .... 4 ............................................... Dimensions of same structure with alterations or additions: Front .-F'-(/ Rear.. '~Z '~,~./ Hight ./~. fSt ri Depth ................ ~.. e ................... Numbero o es ................... Dimensions of entire new construction: Front .... (.~.' ........ Rear. /.~' Depth /2, Height ...... ' .........Number of Stories ...................................................... Size of lot: Front ... 2..o~.(.. i ........... Rear ) ~Tf ........... Z~-o '~ ......... D, epth ...................... Date of Purchase .... ~Z .................. Nmne of Foyer Owner ~C~.~R · .~..~fff~ ..... Zone 0r use district in w~ch premises are situated... ..... A~(~c d~ ~Aqb: ................................ Does proposed construction vioiate any zoning law, ordinance or regulation:...............~° ............... . . Will lot be regraded ....... ~ ................. Will excess fill be remo?d from premises: ' Yes No N~e of Owner of premises ~ .~ ~(g~' ~... Address~/~ .~~one No. ~(~. ~ K~. N~e of Architect ......... ~ .............. :~.. Address ..... , ............. Phone No ................ N~e of Contractor . ~.~-.z ......... ; ....... Address PLOT DIAG RAM' Locate clearly and distinctly ali buildings, whether existing or proposed, and, indicate all set-back dimensions from -operty lines. Give street and blocklnumber or description according to deed, and show street names and indicate whether terior or corner lot. ___.---':~~n~:~... being duly sworn, deposes and says that he is the applicant oovenamefl~ ~ e is the ' (Con.actor, agent, corporate officer, etc.) f said owner or ownem, ~d is duly authored to perform or have performed the said work and to m~e and file ~is pplication; that all statements contained ~ this application are true to the best of his knowledge and belief; ~d that ~e ,ork wHl be perfo~ed in the mannbr set forth in the application filed therewith. worn to before me this ...... ....... ..... ' '~o.82-g12~am~.m,u o.,,.~.Y BLIO, State of ~ew York