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Home My WebLink About13520-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No, z13107 Date .d,,a., n. 3 ................................................ 19,,.85 THIS CERTIFIES that the building ...... ,g-,d.d.~.~. ~-9.n. ................................ Location of Property ... ~ 3 ~.0. ............. .G.r,e.a.t...P.e. q9 .n.~.c' .B..ay..B.I,. y.d.,,...H.a.~.t..i .t:.u. qk.. House No. Street Hamlet County Tax Map No. 1000 Section .... ,1.2.6 ..... Block ....:[..1 ......... Lot .... 0..2.0 .......... Subdivision X ,Filed Map No ....... Lot No. conforms substantially to the Application for Building Permit heretofore Fried in this office dated Oct. 10 ...... ,19 84 pursuant to which Building Permit No. 13520Z dated ...... ~qy: ..... .8 ........... 19 .8.4., 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 ......... .... A44~.t~-.o.~..t.o..A..c.c.e.s.s. 9.ry..~..a.~.a. qe. .......................................... The certificate is issued to ................. ~p.w.~p..~.. q.~.~.?..~.~.q~..~.&q ............... (owner, of the aforesaid building. Suffolk County Department of Health Approval ......... i't/. ~ .............................. UNDERWRITERS CERTIFICATE NO ................. ~I/,~ .............................. Building Inspector Rev. 1/81 FOBS[ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING FERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO- ~3520 Z Pe~nission is hereby granted to: ......~...o..~...~.~. .................................................... ....... ~.~..,.~:~.,......m~..~.~ ....... ,o ...~.....~..~......~~.....~.~...-..'~ ....... ~ ......... ....... at premises located at.. County Tax Mop No. 1000 Section ..... .~.....~......~. ...... Block, ........ ~L.~ .......... Lot No ...... .(~.....~...?. ...... pursuant to application dated ...~J~...~...~...~.. .................... , 19.~...~., and approved by the Building Inspector. Fee $...L ................... Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD 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 submitte~pHcctc to the Building Inspec- tor with the following; for new buildings or new use: I. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic featu res. 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 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 buildings or premises, or other pertinent informa- tior~ required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling/ land use 3. Copy of certificate of occupancy $1.00 --Pre-Existing C.O. $15.00 Vacant land C.O. Date' ' ' '/'9'7J~ '0~/?' ~''' '...$. 5.00..... New Building ............. Old or Pre-existing Building V/' Vacant Land Location of Property r~Y -~,~ c~ ,. Owner or Owners of Property ...~J~... 4~..,'? .~.~ .¢-....~:.../~.~..~.~L.~..~.~. ........................... County Tax Map No. 1000 Section ../. ~ Block ?/ ... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./~(.~,,°. ~ Date of Permit/,/l .~.~?.~...Applicant..~/~.~ ,~".~,~.~/. ~..~..~/..~.~.~, .......... 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 permit meets all applicable codes and regulations. ~ ~-C,J ~ Applicant ......... ~'...~...~.: .............. , .................... Coz Rev. 10-10-78 FORE/I NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold~ N.Y. Cerli~icate OJ: Occupancy No... Zg~J.8 ...... Date ....0'..a~..g.l~.~. 2/4 , 19 80 THIS CERTIFIES t ~L~ building ................................................ of Pro~O ~Ve~ ~eO0~O B~ ~Vd. Street ~~'~ ~cation -- - ~s~ ~o: ................................................. County 2'ax Map No, 1000 S~ction .. ~g~ ...... Block .... ~.'..' ...... Lot ....... 2~ ........ Filed Map No~ ' ~. .... Lot No Subdivision ................................................ confo~s substantially to the Application for Building Pe~it heretofore ~ed in this office dated .., ~9~PE .g7 ..... ,19 7~ pursuant to w~ch Building Pe~it No ..... ~.' ......... dated..... · · · · · · · · · ·. ·..NOv~ebP ~8 ~ 19 ~8..,, was issued, and conforms to,all of the requirements of ~he applicable provisions of the law. ~e o~upancy for which t~s certificate is issued is ......... ~e Femily ~elltng w/Addition & Ne~ Fomd~ton The c~ificate is issued to ~Wa~d B, Re~~ .................... ..................... ioW~;;,~~ " of thc aforesaid building, Suffolk County Department of Health Approval ...... ~,.. ~ ............................. ~E~W~TE~S CE~T~F~CAT2 NO .... N Building Inspector Rev 4/79 E1ELD INSI~ECTION FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY qODE FINAL COMMENTS ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined19 . 1 Approved ................ 19... Permit No.. ! .~..~..~. ?..~2 Rece±ved ........... ,19... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Dat ......... 19... INSTRUCTIONS a. This application must be completely filled in by typewriter 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 properW 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 Y6rk, 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 aut ho rized in spec to rs on premises and in building for ne ce s~n~ spec tions. .... ......................... (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. Nameofownerofpremises ....... ~'/6 ¢ ~ /.?~..~f. (as on the tax roll or latest deed) 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 ...................... Other Traue s License Not .' ........ 2~ .......... 1. Location of land on which 13roposed work will be done'~' '~' ?' · ' ' ' '~'~'~'~' ¥'~' ' ' '~' '~' '~' ' ' '~" '(:'~'~' '~ C.~ce~ ............ '~~/, ~' .~ ~.~.~ ' ' '- '" ' '-' ' ' ' ' ' 't~ .... -'-'' "' House Number Street Hamlet County Tax Map No. 1000 Section ... l ...~..~. ......... Block ............ Lot ...... ' ..... 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 .... .~.~..~-. · ·; ..................................................... Nature of work (check which applicable): New Building ' Addition ~ Alteration Repair ' Removal~ Demolition ' Other Work (Description) 4 Estimated Cost Fee *" (to beI paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling un,ts on each floor ................ If garage number of cars 6. If business, commercial or mixed occupancy, specify n~ature and extent of each. type of use ......... ~./ ........ 7. Dimensions,of~existingstructures, ifany:Front...~..~ .......... Rear .d6/.f..i ....... 'Depth ../.~. ......... Height .../.~ ........... Number of Stories .... d~.~.e,- ...... i .......... Dimensions pf same structure with alterations or additions: Front . ~Z~.~ . e r Depth ~ Height .. ~.. ................ Numbe~' of Stories /-P.~z e~. ....... 8. Dimensions of entire new construction: Front .... <~ .......... Rear ...~...; ....... Depth . ~. ........... Height .~. ! ........... Number of Stories .... ~ .~ .er,. ................. ~ ......................... 10. Date o Purchase ... ?'fl. ..................... ~.. Name of Former Owner ~:~-.~.e~./.. 7~..~/J~.~ ~. ...... 11. Zone or use district in wh. ich premises are situated .U2'~ .................... ~ ......................... 12. Does proposed construction ~vi~late any zoning law, ordinance or regulation' ~.~i ' · ........ 13. Will lot be regraded ..... ~. ~.q~ ~ ...... .~..~., ..... Will excess Iill be remov~d from premises: ~ 1~ Name of Architect . .. Address PLOT DIAGRAM, Locat~ clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from >roperty lines. Give street and block number or description according to deed, and shqw street names and indicate whether interior or comer lot. STATE OF NEW YORK, S.S COUNTY OF ................. (Name of individual signing contract) above named. 0ses and says that he is the applicant tie is the ........................................................... ~ ............................ (Contractor, agent, corporate officer, etc..') of said owner or owners, and is duly. authorized to perform or have performed the ~aid work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this · .' ........./.~. · .~. · ....... day of..~.~ ......... , 19 I~OIARY PU[3LI(;, State of No,,~ York , t,)o, 4707878, Suil01[~ C0tmty ]e~m £xp~ros ~a~ch 30, 19~~5 ~_ ........ being duly sworn, del: (Signature of applicant)