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Home My WebLink About13556-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildin§ Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.$9 ~.&.5? .......... Date ........... .~.~2r. .~.tt:. ..............19 THIS CERTIFIES that the building-..-gB,~a ge..acld;i-.~.5, Qr~ ............................ Location of Property . .~.3~5 ................... . .~.gg.n.e. ~..8..R..q~..d .......... O..~.~.c.h.o. ~.u.e.. House No. Street Ham/et County Tax Map No. ]000 Section .... 0. c)~ ..... Block ..... 0..2 ........ Lot .... 0..2.0 .......... Subdivision ........ ~ ..................... Filed Map No...~... ~..Lot No .... .~, ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... .~.q¥ .e.m.~.e.:r?. J ~..., 19 .~.g. pursuant to which Building Permit No .... ~J 35.~ · g .......... dated ....... ~ovem3~ e~. 20 ....... 19 ~.zl-., 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 ......... ROBERT STRIMBAN The certificate is issued to ........................................................... (o wn of the aforesaid building. Suffolk County Department of Health Approval ..... ~9.~..~TOq~.5~l ....................... ~/r UNDERWRITERS CERTIFICATE NO .................................................. Rev. 1/81 Building Inspector · 0~ NO. 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N-° 13556 Z Permission is hereby granted to:v~O~ .......... ~.,.~=.~~..,.~.... ......... ...... ~.~¥.....~/L~.~.....,.,.:.~..:... ...... , ...... ~~..~.,.'..~....~....~.~..~ ............. ,o.....~z.~.~.........~/~.~....~....~.~:~,~.~.....,~..~ ...... ~ .... ...~......~~.....~~ ......................... ~ ........... ~ .......................................... o,,r.m,,. ,~o,.a ~,-~.~ .......... Z~Z~..[~ ........................................ ........................................................................................................... Coun~ Tax Map No. 1000 Section ..~ ....... Bilk .~.~ ........ Lot No. ~.~ ........... 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- tot 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 buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of pZ"operty showing all property lines, streets, buildings and unusual natural or topograph ic 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. 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 New Building ~ ......... Old or Pre-existing Building $15.00 Date..Zgt',/,~ ~./.~-/ ............. '--- Vacant Land Location of Property ./...~..~.~. .......... . .......... House No, Street Hamlet Owner or Owners of Property .Z~..~../~.~1~..//C/'~¢z~,... ~.,"r'~C/,~?~).~.. .................. CountyTax Map No. 1000 Section (~ c~. ~... Block .(~...'~. ...... Lot ................................ Lot No .............. Subdivision ........... Filed Map No. -'"'--- Permit No./.~..~.~O~. .~.... Date of Permit~.~'. '.~.~..Applicant .... ~.~' ~. ~..~./. ~-~. ~., J ........ Health Dept. Approval ~ ..... Labor Dept. Approval "-"-'-- Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate... ~----'-~ .Final Certificate .~.~ Fee Submitted $ ...... .7:.~..T. · .~. · .............. Construction on above described building and perm~ets 911_applicable codes and regulations. Applicant .~.~...~. ;:; ......................... Rev. 10-10-7S FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. Y. BTATE ENERGY FINAL COMMENTS ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined../~.~....b:.q.., t9~.~. Disapproved a/c ....... -... ;~ .......(/f//) f~ ........ ..................... ::~ ....... ~ ' ' ' ' ' '~'~i.~:. ~....---f~ (Building Inspector) Received ........... ,19... A,,',CAr,O..o...,.o,...E.M rr .......... INSTRUCTIONS a. Ttds 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 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 ins ,p_~tions. ..... . . . . . ............. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premiseS:../~O.~?.F./..~..-.£:e.lS.t~. ~../~J ............................................ (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 .......................... , /v//~ ..... Plumber s License No .................... Electrician's License No. ~//'~ Other Trade s License No ...................... 1. Location of land on which proposed work will be done..~?. ,~7-- '~ ....... t ..................... ,q .~, ~ .~, ~. . ',3. . ,~. q ,~.~, ............ q .'~.~. ~. .o. ®, q ~. ~. ,/~, : : .......... Hous~~ .... Street Hamlet County Tax Map No. 1000 Section ...... .~. ~ ........ Block ....... ~ ........ 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 ...... ._~..././]7 ....................................................... . _ b. Intended use and occupancy ..... .~.~. ~. ......~....~...~.'f.q .~-.c?~j .~../~-~: ./.~.~....~. .... ..~ . 3.Nature ofwork (check which applieable): New Building ..... 'Addition , Alteration i ...... Repair .............. Removal ............. Demolition ........... !... Other Work ............... 4. Estimated Cost ~2~, C/d~PC) ~C). Fee , [to belpmd on flhng this apphc 5. If dwelling, number of dwelling units .......... .~f./.~. · Number of dwelling uniis on each floor .... .A~./.~ ....... If garage, number of cars ........ ,.. ~ ............................. ~ .............. ' ............ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ....... 7. Dimensions of existing structures, if any: Front ..... o~.~/~. ...... Rear .... ~.t/~. ...... Depth. Height ~ oq.~t Number of Stories .~ Dimensions of same structure with alterations or additions: Front..........., .....J Rear ....... ......... Depth ...................... Height ...................... Number of Stories .................... Dimensions of entire new construction: Front ...... ~;2..~..'. .... Rear .... ~ ~ .~ ...... Depth . .,~..~5./ ....... Height ........... Number of Stories ...... ~ ......................... Sizeoflot Front -- ~.~.~ ~A,~ . - Rear .,~.e..~.~qV~.?.~c/ iDenth .................. "" .............. ~: ....., ~ . .~.ee..~.~.e.~. ....... Date of Purchase ...~.~ ./9.,..~.t_~,. [.c2. ~..~. ........ Name of Former Owner 1C~ OF.. :.~..L...~¢.~.e/.o/~. me~..~. I 1. Zone or use distriqt in which premises are situated ..................... . , r . DOeS proposed con'struct~on vmla'te any zoning law, ordinance or regulation: ........ .~.o .......... ' ......... 13. Will lot be regraded ........ ~...,'~..o .............. Will excess fill be removed from premises: Yes (~ 14. Name of Owner of premises ~.o~*~'g- 5'/r '~k~ ~q . Address ~.o..~e~¢~'~(~.¢~ Phone No..~T..~..q/.~.7.~?.~.~,... Name of Architect ~/~ ~,. ~ i~;~ .~.i¢~.' .~r4.. i. Address .... ~ E/~ .... ! ....Phone No...'~..~. 7.~. .~.~...~.~-.Q Name of Contractor ~./. f?.~q/. ~/C_~.~/2.~4~.. Address .~/e.~'/. ~.0 ~ ~ .! .... Phone No...~..2:~..~..c~.~/.. PLOT DIAGRAM i Locate clearly and distinctly all buildings, whether existing or proposed, and, i~dicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NE~ YORK, ,~ ,, CpUNTY O~. m,~..~..o.W.~... ~'~ go ~ .¢...ST8 t ~ ~ t5 U ..................... ~ing d~y ~wo~, d~p,~ ~ ~ that ~ i~ th* ~pp~i~ant (Name of individual signing contract) , above named. ~ He is the ............................................................. :~. ........................... (Contractor, agent, corporate officer, etc.) of said owner or ownem, ~d is duly authorized to perform or have perfomed the ~aid work and to m~e and file ~is application; that all statements contained ~ this application are true to the best of hi ~ ~owledge and belief; and that the work will be perfo~ed in the m~ner set forth in the application filed therewith. Sworn to before me this ~ . ..~ ...... , ~9.. . ................... day of ~ Notaw Publ~ ...~.~ ~O ~.~ . . Coun y ..................... ~ ~.~,;o~ a~*,~ ~*~ ~0. ~ ..... (Signature of applicant) ~ow or fo~me.,'/y / ~oseph t~ Zabd$#i ¥OGU£ · $OUTHO£D now or FOrmerly Hart7 Pum~71~ /!'/-/ now or forme~"/y Harry \ %