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Home My WebLink About13518-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No... Z..1.3.2.6..3 ........ Date March 15 19 .8.5. THIS CERTIFIES that the buildh~g .... ,Iq.o?.. p.w.e.1.1..i.n.~. ............................. Goose Creek Lane Location of Property . ¢.9.6.5 ............. ?y~.:. B.d. :..~.l ................. .S.o.u. ~.h.o.l.d. .... House No. Street Hamlet County Tax Map No. ]000 Section .. 9.7.7. ...... Block ... 9.3. ......... Lot....0.2.5. .......... Subdivision ......... .X ..................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... ~.u.g.. ......6 ....... , 19..8.4pursuant to which Building Permit No .... 1.3. .5.1.8.Z. ........... dated ...... ~gY.-. ..... 7. ........... 19.8..4, was issued, and conforms to all of the requirements of the applica, ble provisions of the law. The occupancy for which this certificate is issued is ......... New Private One Family Dwelling The certificate is issued to WINDSWAY BUILDING CORP. ~ ..................... ...................... of the aforesaid building. Suffolk County Department of Health Approval ........ .9~S..O7.8 4 ........ UNDERWRITERS CERTIFICATE NO .................. ?.o.n..d.i.n. cj ....................... Rev. 1/81 Building Inspector l~o~e NO. ~ TOWN O~ SOfT'OLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NB 13518 Z Date .................................................. , 19, Permission is hereby granted to:// ~ /,~ ~, ....... /_~.~.~.~.~...~.,.~..~.....~/~ ....... .zo,.~..a.....~/~....~......:....,./~ ....... .~..~ .~...~4~.......-.....~-.~. ............... ,o ...~.~.~.~...~....~~.~....~~,....~= ..... - ~ - ~ ~ ~ ~..~ ..... ~~..~..,.~ ......... ~,~ ..~ .~ ~ ..... ..................................... County Tax Map No. 1000 Section .~..Z.~.. ......... Block ..~...~'.. ......... Lot No. ~..~',~...'~... ...... pursuant to application dated ........................................................ , 19 ........ , and approved by the Building Inspector. Fee $../~..~ Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD 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 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. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operty 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 prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 $15.00 Date ..... ,~/,,~, .~./~ ..... New Building .. ~ ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property .... ~F~ /~ ~ ~'~%'~ /~/ ,.~.~/,.~..~.f House No. Street Hamlet Owner or Owners of Property . ~.. ~..~..~...~...(~.~.C~: ........................... County Tax Map No. 1000 Section .............. Brock ~ 3' Lot ............................... Subdivision ................................. Filed Map No ........... Lot No .............. PermitNo. /?..~/.~..ZDateofPermit ...t./ ... ,icant ...~.C.~.~..~. ...J~.O."..~.~.. ,. Health Dept. Approval ..~.: .~ ;..~./~ ........ Labor Dept. Approval ........................ Underwriters Approval ~ .......... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $..':~ ......................... Construction on above de scribed building a n~~~ ~,~ i ~,~,)_, ~o,~ pp' Rev. 10-10-78 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building P. ermit No.~ (please tp ~Int ) Plumber /~' '%/- '/' t5 ,'~.. L. (please print) Date I certify %hat the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber's signature) V sworn to before me this 19 5 Notary Public, County Notary Public ELLEN M. URBANSKI NOTARY PUBLIC, State of New Yo~k No, 4688534 Qualified in SuffolkCoun~ ~ C~mm~$$ion F. xp4t'es Ntarch 30,1 ~l~,'~'~ FIELD~ IN~.PECT ION DATE COMMENTS FOUNDATION __ ! J ~ t--J-) __ FOUNDATION (2nd) ___ __----~- PLUmBInG ' INSULATION ~ER N. Y. STATE ENERGY C~ODE 4. ADDITIONAL COMMENTS: TOWN OF ,~OUTI{OLD BUILDING DEPARTMENT TO!,~ CLERK'S OFFICE SOUTI-IOLD, N.Y. NOTICE' OF DISAPPROVAL File No ................................ - - House No. u 0 Street I Hamlet County Tax Map No. lO00 Sectkm ,, . ,0,~..~. .... Block .... {~ ...... Lot ...ITl .~-..~'~..... Subdivision ................. Filed Map No ................. Lot No .................. is returned herewith and disapproved on the following grounds..(~:~...~.4Z.~..~ .... ~ ~. ,-. ~...~.¢ ~., .e, ~.,. ~~...¢~..~.~ .~ ............ Building Inspector RV 1/80 BUILDING DEPT. INSPECTION [ ] FOUNDATION XST ['~/ROUGH pLBG. FOUNDATION 2ND [ ] INSULATION [//]/FRAMING [ ] FINAL REMARKS: ,, DATE INSPECTOR 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y, 11971 TEL,; 765-1803 ^pproved ............ :~ ,, 19... Permit No. ~~ Disapproved a/c . .~..z ~-. J.O 0.; ~{ ............ INSTRUCTIONS R e c e ive d .~.//..~ .... , l& a. Tkis application must be completely filled in by Wpewriter or in ink and submitted to the Building 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 streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- 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 issued a Building Permit to the applicant. Such permit 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 Occupancy 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 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 alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building/code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspgeti~ns; ..... f~/~/~..~.//.d.~/~. ,~...<~...: ..... (Signature .of applicant, or ~ame, if a corp¢/ation) · ....... State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. ........... d~. .,,/~,~. . . .-:. ~ ~... . .a,/. ....................................................... .................................... Name of owner of premises ....... (as ofi the ta~f roll or latest deed ' If applic~,,~ign~,r~ of~ul~thorized officer. .../f.. ....... ~ ~.d~..f.~__~. , (Name and title of corporate officer) Builder's License No ......................... Plumber s License No. Electrician's License No.. Other Trade's License No ...................... 1. Location of land on which proposed work will be done. ~..*..o~.../~../~..~: ...... ;.... House Number Street ~.~-~4/ County Tax Map No. 1000 Section ..... 0.~..'.~. ........ Block . }.~. Hamlet ......... s .. Lot.~ ......... f, ........ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............................. ,~,~. ,;'. ...... ;,.,.., , ........ ,,,.~. j ............ b. Intended use and occupancy ' ' '"" ~ ...... ;~,' .~, -'~-~e~g; ........ 10. Il. 12. 13. 14. Nature of work (check which applicable): New Building ..... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... t~..~ t~ ~ i~ / ff.~:"~ (Des~ript. i~n) Estimated Cost .................................. Fee .............................. ~ *" (to be paid on filing this application) If dwelling, number of dwelling' units ..... 0//.-~...'~.... Number of dwelling units on each floor ................ If garage number of cars If business, commercial or mixdd, occupancy, specify'nature and extent of each type of use ....... ·............. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure ~vith alterations or additions: Front ................. Rear .................. Depth ................... ;... Height ...... ~)i ( ~ .......... Number of Stories ............ ~ .~. ...... Dimensions of entire new construction: Front ............ Rear ...(~. '. ~.. ..... Depth . .~..-? ........ Height ...... ].(~.t ..... ,. Number of Stories .... 0.,9.'%~, ~. ................ ff ................... Sxze of lot: Front .... .~ ,f!,.,,~.. , ', o ...... D~epth .. '. ~.. ~, ~l ........... Date of Purchase ....... .*~.'~ ............. Name of Former Owner . ~/Jit~/~a(.~'.4~/. ~..~,r .~.. .... Zone or use ' ' district ~n which premises are situated ..................................................... Does proposed construction violate any zoning law, ordinance or regulation: .,Q..q ........................... Will lot be regraded ..... Name of Owner of premises ~t~. ,.dr~$~/. (~..~.o,/,ry.. Address 1.o..~o..~,/.e4f~. ~qa~.~p. Phone No.S.~..~.'/Y$o"~.. ..... Name of Architect . . ~ Address .... Phone No. ....... ................. Name of Contractor . . Address . .~.L ./. ...... Phone No...I.~. ......... Locate clearly and distinctly al property lines. Give street and blocl~ t:.,%r or comer lot. PLOT DIAGRAM buildings, whether existing or proposed, anti, indicate all set-back dimensions from number or description according to deed, and show street names and indicate whether STATE OF N~f~'~ ' S.S .......... ~~ ~0~ ~. ,. ~.~ ~.~ [[ ...... being duly sworn, deposes ~d says that he is the applicant (Name of individual sig~ing contract) above named.,. ~ ~?.~. He is the .......... ~ ............................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have perfo~ed the said work and to m~e and file this application; that all statements conth~ed ~ this application are true to the best of his knowledge and belief; and that the work will be perfomed in the m~n~r set forth in the application filed therewith. Sworn to before me this ~ ~ ~.~~ (Signatu of applie~t) oZ ,~ ,?£.. 'q 0 0 0 ..< -~ .-4 < r- ",r