The URL can be used to link to this page

Home My WebLink About11169-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildin8 Inspector Town Hall Southold, N.Y. Certificate O~ Occupancy THIS CERTIFIES that the building Accessa.~, Location of Pro 6800 Alvahs Lane · Cutchog~..e ...... Hou~ No. Str~t h/~/d County Tax Map No. 1000 Section ....q.0.q. ..... Block . ..0.~ ........... Lot...0.'1.~. ....... . ..: Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore Fried in this office dated ....lV~.y. ~.2. ........... ,198.'J. pursuant to which Building Permit No.. ?~.~6.9.Z ............. dated ........ .~. ~r. 2.6. ............ 19.8.2, 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 ......... ........ · o~. a~. i~g~:om~,d .poP~. ~.d..f. ~.e.e. ................................... ~o',;,~, ¥~/,'d/t~;~}j ...................... of the aforesaid building. N/A ': Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO. N 522t[~8 Building Inspector eUlLD,Ni~ TOWN HALL SOUTHO~D, H~Y. BUILDING P,E~!T~ (THIS PERMIT MUST BE KEPT ON THE PRE~ISi'!SUNTIL ~ULL COMPLETION OF THE WORK AUTHORIzEDi N°. lllG9 'Z r~ote,.....! ..... } ................. , ~ormission is horoby ~rontod to: : ...... ~X~ ...... Z ..~ .................. ~..o.~......z ............. ~. to...~a~.~z~.~.~: ........ z~~....~~.~....~ ...... / ..,, ............. ~..~ .................. ~~......~.~ ................. ~. ...................................... ........................................ , .................................................... ~' ~ / .... :... ~ .... am~o.9~.~.~..~. ...... co~ ,o~ ~op ~o. moo so~t~o~ .Z.~.~ ........... ~o,~ r....~.~ ........ cot ~o ..... ~.t~.~ ........ 'pursuant to ,ppl,c,t,on~ d~ted ......... ~-~,:..-,..X...-,-'~-'" ~.'"", 19 ., ~nd ~pprovsd bg the 8~ildln0 Inspector. Rev. 6/30/80 ' . ~ ~ FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A, This application must be filled in typewriter OR Ink, and submitt~e~ duplicate. - V .:co she 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 disposel-(S-9 form or equal). 3, Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, lndustr a bu dings, Multiple R, esidences and similar bu.!l,din, gsa. nd, in.s,t.a, lla- tions, a certificate of Code compliance from the Architect or Engineer responslole tor 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 p]coperty 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- tion required to preoare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2, Certificate of occupancy on pre-existing dwelling $15.0 0 3. Copy of certificate of occupancy $1.00 Date '~ · ..... New Building .~. Old or Pre-existing Building ............ Vacant Land . .~ ......... Location of Prope/rty..g~, · · ........ //,~-~./)~. · .~, ~t~r~;t' ............... d'~/' '~' '~'~"~/~f' I'lou~e No. Owner or Owners of Property ............................................................ County Tax Map No. 1000 Section ..... .//~/. ...... Block .... ~.~-. ....... Lot .... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. ///~/~.~. ,~,. Date of Permit .~/t/~/,Applicant ,~,.,~,,/~,,~,~,~,~1~.~.,~.~'~, ..... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval. ~//..~). ~..~. ........ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $...¢.~,.. ,~, ,(2, .................. Construction on above described building and permit meet 's~plicabl~odes and regulations. Applicant...~' .-~, .~,~-~. 4 .......................... Rev, 10-10-78 FORM NO, 6 TOWN OF SOUTNOLD r3uildJng Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions A Thru apphcauon must be hlled in typewriter OR ink, and submitted in duplicate to the Building tor w~th the folJowmg; for new buddings or new use: 1. Final survey of properW w~th accurat~ location of all buildings, property lines, streets, and unu~al natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of e~ectrical mst~llat~on from Board of Fire Unde~riters, 4, Commercial buCdmgs, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a cer~dma[e of Code comphance from the Architect or Engineer responsible for tho ~uilding. 5. Submit Phmmng Boa~d approval of completed site plan requirements where applicable. B For exmtmg buddings (prior to April 1957), Nomconformmg u~s, or buddings and "pre-existing" land uses: 1. Accurate ~y of peope~ty showH~g all property tines, streets, buildings and unusual natural or topograpt~ c features. ' 2.Sworn statemem of owner or previous owner as to use, occupancy and condition of buildings. 3.Date of any hou~mfl code or ,safety inspection of buildings or premises, or other pertinent informa- tion requued to prepare a certificate. C. Fees. 1 Certificate of occupancy $5.00 ~. C~rt~fmate of occupancy on pre-ex~sting dwelhng or land use $5.00 . Copy of cert.f,cate of occupanc~ $1.00 New Bu,ld,ng ~¢~ ~.. ~¢ Pr6-ex,stmg gu,Ming .... Vacant Land ' /~/ ~ ~ , IHam/et County Tax Map No. 1000 Sect,on .~ ........ Block .~ ....... ~ot ..... ~ Subdiwsion ............................ Filed Map No ........... Lot No .............. Permit No ...... Date mit ....... Applicant ..... ' ..................... Health Dept. Approval .................... Labor Dept, Approval ........................ Underwritors A~p~oval ....... ~lann~n~ Board A~proval ........... > ........... ~equest for TemooraW Certificate ..................... F~nal Cerdficate ................... .... ¢ ...... 3O'lStruct,ononabovedes bedbu,ld,ngand r gulations. lev, 10-10-78 ~THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ Q~ BUREAU OF ELECTRICITY CERTIFIES THAT ~ ~ ~,Y~- ~, ~, 'J '2 o~ectrical equ ip~e~t as described below and introduced by t~ applicant na~d o~ ~he above appl~catio~ nu~ber in ~he pre~nises of *vas examined on ~]~IJ~O ~,~ J.' ~c~j~* ~ and found to be ~n compliance with the requirements of this Board. ~IXtU~ RX~OESS EANG~S OWNS 01SM W~SHSES EXH~US~ F~NS DRYERS APPLIANCE FEEDERS TIME CLOCKS MULTI-OUTLET SYSTEMS NO OF FEET DIMMERS SERVICE DISCONNECT OTHER APPARATUS, S E R V I C E A W G NO OF NEUTRALS OF HI LEG lic.~i227 in an the office may be the~ IN ANY MANNER, must COPY FOR THIS COPY APPLICANT: TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 DATE: TEl.. 765-1802 July /~, 1986 Dear: While reviewing our files I find that your expired pool permit ///~ has never been finalized. Kindly return the enclosed application with a check for $5.00. Also, please call and arrange for a final inspection so that we may issue a Certificate of Occupancy on the above pool and complete this outstanding file. Yours Truly, victor Lessard Executive Adminstrator OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTiFiCATE OF OCCUPANCY FOUNDATION (1st) FOUNDATION (2nd) 2 o ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: ~0~9 \ %. \ \ \ k \ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1B02: Examined ............... ,19... Application No ................ Approved ............... , 19 . . . Permit No ............ Disapproved a/c ....... ; ............................. (Building Inspector) * APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tins application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi Inspector, w~th 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan she',ring locatmn of lot and of buildings on premises, relationship to adjoining premises or public stre~ or areas, and gwmg a detadcd description of layout of property must be drawn on the diagram which is part o~this ap[ cation. c. The work covered by tlns application may not be commenced before issuance of Building Permit. d. Upon apprc, al of ttus apphcation, the Building Inspector will issue a Building Permit to the applicant. Such pern shall be kept ou tile premises available for inspection throughout the work. e. No braiding 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 Boildmg Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to t Buitdmg Zone Ordinance of the Town 'of Soutbold, Suffolk County, New York, a~pther applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or fof/f~ova') or derjttilition,~herein describt' The applicant agrees t~ comply with all applicable laws, ordinances, buildfff~ co~, l)/ousing/cffde, a:~regnlations, and admit authorized inspectors on plemiscs and in buildings for necessary ills~ecti.~, r'~~ ...: .... ...... (SiggqJ0lre ? applica.nt, or ~ame, i~ gakpo~ttioj0 ..., (Mailing address of' applicant) - State whether apphcant is owner, lessee,(~/~gen/architect, engineer, general contractor, electrician, plumber or build Nallc: of o.~r ell rumlSes . . / ! / ~ .- ~ (aS on t',¢ tax roll or latest deed) If ap~o~ authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's Licens~. N .......................... County Tax lvlap No 1000 Section Block Lot ' Subd,v~mon ..................................... Filed Slap No .............. Lot ............ (Name) State existing use and occupancy of pfs/nises and intended ust~ and occupancy of proposed construction: a. Existing use and occupancy .................................................... ,b Intended use and occupancy ~. L~.I~../.. ~. ~~. ' Nature of work (check whicl,:apphcable): New BuL!ding Addition Alteration Reinm al Demolition Other Work Repair ' ; (Description) Estimated Cost ...................................... Fee I (to be paid on filing this application) If dwelling, number of dwellifig un ts ............. Number of dwelling units on each floor ............... If garage, number of cars ...: .................................................................... If business, commercial or mixed occupancy, specify fiotnre and extent of each type of use ............. Dimensions of existing stmctsres, if any: Front ............... Rear .............. Depth ....... Height " ' ............... Nt~ber et Stories ................................................ Dimensions of same structure?ith alterations or additions: Front ................. Rear .......... Depth ' Height Number of Stories Dimensions el'entire new construction: Front ............... Rear ............... Depth ....... Height ............... Ntlm:ber of Stories ................................................ Size of lot: Front .'. '. · Rear Depth Date df Purchase ......... . .................... Name of Former Owner ..................... Zone or use district in which premises are situated ' Does proposed construction violate any zoning law ordi mnce regulation: Will lot be regraded ....... ~ ..................... Will excess fill be removed from premises: Yes Name of Owner of premises . i ................... Address ................... Phone No ............... Name of Arclmect ........ ! ................... Address ................... Phone No ............... Name of Contractor .......................... Address ................... Phone No ............... PLOT DIAGRAM "'" Locate clearly and distinctly ~11 bt ihhngs, whether existing or proposed, and. indicate all set-back dimensions iron ,operty/ines. Gne street and block number or da~nmm,~n accord~ ~g to deed, and show street names and indicate whethe: te~5or or cornerlot. ~ i ~ ' ~ ' · rATE OF NEW YORK, OUNTY OF ................ , S.S (Nanie of indMdual signing contract) ~ov? named. ~ ·.. being duly sworn, deposes and says that he is the applicant e is the ..................... . ................. (Contractor, agent, corporate officer, otc.) F said bwner or owners, and is dti~ly authorized to perform or have performed the said work and to m~e and file this )plication; timt all statements contained in this application are true to the best oftlis knowledge and belief; and ti~at the ork will be performed in the mann;er sot forth h~ the application filed therewith. worn to before me this ....................... day Of ..................... ,19... otary Pul~lic /. · Countl, FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y, 11971 TEL.: 765-1809 Examined . . ----..., 19 Approved ~:~.~..~.. ?~.. .... 1 2. Permit Disapproved a/c ..... ................................... (Building IrYspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in 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 stre~ or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this apt' cation. 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 peru 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 purpose 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 buildings, additions or alterations, or for r~oval or demolition, as herein describ~ The applicant agrees to comply with all applicable laws, ordinances, buildi ~. coc~e, housij~g cod/~ and regulations, and admit authorized inspectors on premises and in buildings for necessary ins~c~ .~7~/~.~ _ . ~. (Signature of applicant, or name, ~t a ~orporation) (Mailing address of applicant) g State whether applicant is owner, lessee, agent, architect, engineer, general~electrician, plumber or build~ Name of owner of premises ........ .~. .............................................. (as on the tax roll or latest deed) Builder i License No ........ ~ ............. Plumber's License No ......................... .... Electncmn s License No../-':q , - Other Trade s License No... ~.~.' .............. I. Location of land on which proposed work will be done ....................... House Nmnber Street Hamlet County Tax Map No. 1000 Section .................. Block ............... Lot ........... Subdivision ..................................... Filed Map No ............... Lot .............. (Name) 2. State existing use and occupancy of p~ises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... ~/~/~ ............................................. .... ................ 3. Nature of work (check wh~ct~ apphcable): New Building .......... Add~tmn..; ........ Al oration, . .~[~,__ ........ Repair ......... ~ ..... Removal ......... Demolition ........... i... Other Work ff~,.o[.~..!:..~..?..c.~ .~ /J~ ~. ! (DesCription) $. estimated Cost . .~ .............................. -' (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Nmnber of dwelling units on each floor. ............... If garage, number of cars ...... ~.. .................................... ' .......................... 5. If business, commercial or mixed occupancy, specify ngure and extent of each ty~e of use ................... 7. Dimensions of existing structures, if any: Front ..... .~.~.. ...... Rear . .~..ws.s.s.s.s.s.s.s.~.. ........ Depth ~:~..Z ...... Height Number of Stories ! Dimensions of same structure with alterations or additions: Front ' ' Rear Depth ...................... Height ...................... ~ Number o~ Stories .................... 3. Dimensions of entire new construction: Front ............... Rear ................ Depth .............. Height ............. N~mber of Stories ........... '/'2 ........................................... ). Date of Purchase ............................. Name of Former Owner .[-?/../~...c~.,jq../.~ ............... 1. Zone or use district in which premises are situated ..................................................... 2. Does proposed construction, viojate_~any zoning law, ordinance or regulation: ............................. ./~-,-~<. · /WrJ · (Ye.~) Will lot be regraded ...... ~ ..................... Will excess fill be removeld from premises:~ No Nmne of Architect ........................ Address ............... ; ....Phone No ................ Nmne of Contractor ,.,v,)v~-.,. .f) .......... Address .~ ~. C/. :~.T..ocy.%.:, ....Phone No. ~7..~. ~.O..'-77.. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and~ ifidicate 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. being duly sworn, dep'oses and says that he is the applicant ( ~ (C°ntract°r,~,~nt, c°rp°rate°fficer, etci) f said owner or owners, and is d~.y. au.t.~.orm or liave performed the said work and to make and file this pplication; that all statements contaDn.ed in this application are true to the best of his knowledge and belief; and that the ,ork will be performed, in the manner set forth in worn to before me this the application filed therewith~,~ ......... ........ ........ ' / · County ..... f~i~ . ................ ~ stat0 of Ite~ ¥~ .~ (Signature of aplflicant) B~N~Y, AT CUTCHOGUE TOWN OF SOUT~D eUARANT~D TO ' SUffOlK COUNTY~ N. ~ , AMERICAN TITL[ INSURA~ COMPANY SCALE' BA~EY, JR. ~ DOROTHY ~TES