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Home My WebLink About11161-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate OJ: Occupancy No ..... .255.6.! .& ..... Date April '13 19(33 THIS CERTIFIES that the building ...Adcl£'l;ion .................................... LocaticmofPronarfv 4035 Calves I~eok Road Southold House No. Street Ham/et County Tax Map No. 1000 Section 063 .Block 07 .... Lot 032 Subdivisio- Calves Neck n .............................. Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... /~.a. 7' .q.3. .... , 19.8.? pursuant to which Building Permit No... fl.q16.qT, ........... dated ... ~a. 7. ?.0. ............... 19.87., 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 ......... for altered Porch & full bathroom The certificate is issued to Basil ~ilardi ..................... ?o~;n'e'r, 'l~sde'dr't3~a'n't) ...................... of the aforesaid bmld, ing. Suffolk County Department of Health Approval . .~./.A. .................................... UNDERWRITERS CERTIFICATE NO ...... ?./..A ....................................... Building Inspector Rev. 1/81 11161 Permission is hereby granted ~o~t~ ~o. TOW. BUILDING DE?ARTME~? TOWN HALL (THIS PERM)T MUST BP KEPT 0N'~H,E P'REM, IS]S UNTIL FpLL COMPLETIOi~I OF THE WORK AUTH~RIZED)~ ~'0 ......................... ' '~'"'~'"t ....... at premises located at ......... .................................................................................. ~ ................... C~n~ Tax Map No. 1~00 Section ....... ~., Block .~ ...... ot No..~; ........ pUrsuont to opphcehon deted ................... .,.....,,., ~9 end ~pproved by the Building Inspector. Fee , ..................... Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. 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 ali 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 ~nstallation 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. B. 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 buddings or premises, or other pertinent informa- tion required to prepare a certificate. Co 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 N.~ Build,rig ............ ~ld ~.,.-.~t~ ~.i~n~(Z~. ~.~.. _ ~ 'W~.t L..~ ............ ...... ....... ..... .................... County Tax Map No ,000Secton ~ Bock ~ 7 Lot DZ~ ~ ~1 .............. : ................... .... ........... .... . ....... Health Dept. Approval ........................ Labor Dept. ~pproval ......................... Underwriters Approval ........................ Planning Board Approval .................. ~. o~ Request for Temporary Certificate ..................... Final Certificate .,..~..- ......... - Fee Submitted $ ............................. Construction on above described building and per,mit'meets all/app~cabl, e,~o_des and regulations. Appl,cant.; .... ~.~... ',.~.~.~_.~ .................... Rev. 10-10-78 FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS FOR~/NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c ..................................... ~ / (Building Insnector) APPLICATION FOR BUILDING PERMITDate ~. . . .[..?., 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 of plans, accurate plot plan to scale. Fee accozdlng to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stre~ or areas, and g~ving a detailed description of layout of property must be drawn on the 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 pern shall 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 pu~ose whatever until a Certificate of Occupan shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building 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 buddings, addztions or alterations, or for removal or demolition, as herein describt The applicant agrees to comply w~th all applicable Iawso, ordinances, building code, hpusing co~l~, and regulations, and admit auJ~orized inspectors on premises and in building° for necessary inspections. //// (Sig.natt~t, or name, ~f.,a corporation) CMaili~¥g address of appli~(nt) State wJ~ther appli.~ant is owner, lessee, agent, a.rchitect, engineer, general contractor, electrician, plumber or butt& Name of owner of premises ..... ~.t . . ~ (as on the tax roll or latest deed) If applicant is a co~poration, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ...... Plumber's License No.. IN...~'7.r."¥.V.¥L'~'. ......... Electrician's License No.--. ~.~.. ~. ~.l ~. ~/.'.~..~/ Other Trade's Liceuse No ...... 1. Location ofland on which proposed work will be done .... ~ff~.. ~~" ..... 1o7 - o ........... ........ ............. .... ...... z .............. County Tax Map No. 1000Sec¢on .~¢/~ .......... Block...O.Z .......... Lot....~Z?....'U.. Subdivision .................. '. Filed Map No ............... Lot ............. (Nmne) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... ~ ~ ~ ........................................... b. Intended use and occupancy ............................................ . . 3. Nature of work (check which applicable): New Building .......... Addition ..... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... ~,. Estimated Cost ................................................ ¢ ........... (to be paid on filing this application) /. Number of dwelliug units on each floor L If dwelling, number of dwelling units .............................. If garage, number of cars ..... ! .....~ .......................................................... 5. If business, commercial or mixed occupancy, specify nature and extent of each type of use .................. ?. Dimensions of existing structures, ifany: Front....~..... Rear ..... .~..O ..... Depth.. ~ ........ Height .... ~ .~. ~f. ..... Numl~er of Stories ............................................ .,. · · ·... Dimensions of same structure with alterations or additions: Front ................. Rear ................. Depth .................... ,...Height ...................... Number of Stories, 3. Dimensions of. entire new constmctton: Front .... ~ ~.0.t. Rear .... ,,l~./d.t. 'l~e';t~' i ~(~.' .J'~. ~t' Height ............... Number of Stories ...... ~. ........................... ). Date of Purchase ....... '.... ! .................. Nm'ne of Former Owner ........................ r ...... I Zone or use district in which pre'raises are situated ~. Does proposed construction violate any zoning law, ordinance or regulation: ................................ PLOT DIAGRAM Locate clearly and distinctly all i buildings, whether existing or proposed, anti, indicate all set-back,dimens'ons from :operty lines. Give street and block ~umber or description according to deed, and show street names and'indicate whether · :terior or corner lot. TATLOF NEW~ORK, ' -- 'S.S OUNTY OF...~t./..~..(9.A.. ~..... i ...~..~/.L.~ ./~.,~. ..../~,.....~.t'.~..~.~, ................ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) '~ove named. e is the ...................... i ................................................................... ~ (Contractor, agent, corporate officer, etc.) f said owner or owners, ahd is dufy 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 ka~owledge and belief; and that the ,ork will be performed in the manner set forth in the application filed therewith. worn to before me this i ....................... day of .............. , rotary Public,t./~/'/"/'J""//'14'ird~"t'~'F74~'''"c'c/"""""'/~"k~'~ [tNt)A.; r. ~OWALs~{!~ ..... County .... 0TAR¥ PUBLIC, Stato at ~ew Yo~ * ................ No 52'4524771 (Signature of applicant) Qualtfi~.d ia SUffolk Counly Cumm~ss~oi Expires March 30,