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Home My WebLink About13580-zFORM NO, 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southoid, N,Y. Certificate Of Occupancy No ..... Z. ] .~ 5.2.5. ...... Date .............. ~.ay..2. 1. ............ 19.8.6. THIS CERTIFIES that the building ...... o..n .e.-.~ a..m }.l.y...dF.e. ~..1 ~_.n.~: .................. Location o f Property . .q 5 9 ........... .B.ay.b.e. ? ?.y.. L..a.n.e. .................S. o..u .~.h.q ]:..d ..... House No. Street Hamlet County Tax Map No. 1000 Section ........ 5.2...Block ..... 3. ......... Lot .... 1. .9 ........... Subdivision .... ~b 9?.e.q ,p~.s.~. ............... Filed Map No...5.5. 8.~..Lot No ....... 1. .~ ..... conforms substantially to the Application for Building Permit heretofore fried in this office dated ·.. ~9.v.e.m..b.e.p.. 1. ....... 19 .8.6. pursuant to which Building Permit No ..... .1.3.5. g..0.Z .......... dated ........ ~ 9y.e.~b..e ¥..2.~. ....... 19 .8.6., 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 ......... ... 9~e.v ¢gJ~.3y..d.~e..~.J_.J_.n.g.. ..................................................... The certificate is issued to ........ H.R....&.. ~ .R.S.... $ .V.E.R.T..0 .ixl..H. 0..L .D.E.~ .................... (owner, ~ ~( ~'lXe~O~ of the aforesaid building. Suffolk County Department of Health Approval ................. 1. 5.-.S. 0. 7 .2.1.2. .............. -UNDERWRITERS CERTIFICATE NO .......................... .~.7fi. 8..2 7.7 ................ Building Inspector Rev. 1/81 TOWH OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERJ~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No ~.3580 Z Permission is hereby granted..~t°': ~... ~ ~..'. .... ,--,~ tO. . II ...... ~ ............. ~..... ...... ~......t ........... ; ....................... i/i.i iiii iiiii'17'i County Tax Map No. 1000 Section ~....~...~.....~'.. ...... Block ....... ~ ........... Lot No ..... ..(~....k...~ ....... pursuant to application dated ....x]!?...~,..J. .................. , 19.~..q., and approved by the Building Inspector. F, ,...I..~.~.'...L.~. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y, 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions Bo This application must be filled in typewriter OR ink, and submitted m ~ 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. 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 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. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $ I5.00 3. Copy of certificate of occupancy $1.00 5.Updated C.O. $15.00 Date ..... ~ New Building ., .,~, ....... Old or Pre-existing Building ............ Vacant Land ............. Location ofProperty.'' y y...4 .... .............. House No,Street Hamlet Owner or Owners of Property ~.~. ?... '.~..~..~....~..~.?'..~..~..0.~. .... /~..~..~..~..~..& ........... County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision. ~..~.O.~t.~.C..~..e.~. 7' .Filed Map No. ~'~4¢ .Lot No. /7 No /~ ,~. O0~) 7-- Date of Permit/~./~, .~'/~. Applicant J ~' ~...~. 'f :!~ Permit ........ ¢ ........ .. 4.DH .... Health Dept. Approval. ,~. ~..~....?.('il./. ~.~..~..Labor Dept. Approval .................... Underwriters Approval./~..~ y..~...'~./.ff.~.,..Planning Board Approval ...,~ ................ Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ .... d~..~....~...~.~..~...0..~. ..... Construction on above described building and permit meets ail applicable codes and regulations. ~,0. '~-~_]L~Li/,~,~i Applicant..~...~ ....................... Rev, 10-10-78 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 buildings or new use: 1. 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 appticable. 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 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 or land use 3. Copy of certificate of occupancy $1.00 $5,00 Date ...... ~. ~.~..~.-.~( ............ // New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property .. HouSe No. Street Hamlet Owner or Owners of Property ~.~'../~.~.~.. County Tax Map No. 1000 Section ... ,.~. ~ ....... Block ...'.~.. ......... Lot..../.9. ......... Subdivision. ~.~-.. ~..f..,~.~.~?. ¢~ ~.~ ..... Fi~ed Map ~o. ~r.~ .~.W...Lot ~o...:. ¢~ ....... Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate Final Certificate :o.~ ....................................... Fee Submitted .... $ "~'! .......................... Construction on above described bulJdlng and permit meets al~plica~odes and regulations. Applicant ...~ ~ .f ~ :...~. ! .~ ~.~ '. ............ ~I~LD INSFECTION 1. FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING COMMENTS INSULATION FERN. STATE ENERGY ODE FINAL ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION [L/J/FOUNDATION 1ST [ ] ROUGH pLBG. [ ] FOUNDATION ZND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: .INSPECTOR TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O, BOX 728 TOWN HALL SOUTHOLD, N,Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No. Owner ~ /L/O~e~ (please print) (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (p lu~be r '/~s signatur~ Sworn to before me this dayof , 19 ~/. ~ Notary Publi~ County /~ Notary Public FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined /0o-a.0~,,Lu.~. 21 .¢ 19 .~'[ Approved ~....~oDA-?...~...~ .¢.., 198.}1. Permit No.j. .~..&.-~..Q ?.. Disapproved a/c .......................... ' ........... .......... ...o.'..:...L. ...... (Building Inspector) APPLICATION FOR BUILDING PERMIT BLDG OEPT TOWN OF SOUTHOLq Application No .................. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate 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 issue 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 Occupahcy 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 buildings for necessary inspections. ........ ; .... i'd .... ~ignature'of applicant, or name, ifa co porat'o ) , .c?.d..~.c. ~ .~... ~.~c..~x .r:. 5. ~.o..t,/.7~ .t..4.,/.../.~, (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· · i.t...A.a., ........................................ Name of owner of premises .... ~./,//~: ~E-. ~..Q ./M'..,(ff. ~./.~. 12./-, 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 ............... ........... Plumber's License No... ~-..~...~...?. ........... Electrician's License No.. ~. · ~..& · .~. ........ Other Trade's License No ..................... Location of land on which proposed work will be do/~;,j ~ .~. ~/~,Y...~.~./~/~.../'. i~. ~..~ ........ ,~ .......... House Number Street Hamlet ' c~i~nty Tax Map Nol 1000 Section . , ~..~.~. ...... - ..... Block .... ~)..~..-- ........ Lot..- .... ~ ! .~.~ ...... Subdivision. ~ .~. · .~. · .~..~''~)~ .............. Filed Map No.'".~..ff..~..~. ...... Lot..t .~. .......... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........ .fi(. P..&,5. ~c. .... .~..(~. ~ .~.'77.,~/..../-:..o.'f....,) ..................... b. Intended use and occupancy .... ~. ~. ~.t'..~ .~-.t',r ~,a~'- ............................................. Repmr' ....... Rem val .............. Demolition ........... Other Work ............... .._ (Description) 4. Estimated Cost....?.~.~ .~..~. ~ ........................ Fee ...................................... I (to be paid on filing this application) ' ~ ~ Number of dwelling units on each floor 5. If dwelling, number of dwelling iun~ts ......................... If garage,.number of ears ..... i .7. W. O. ....................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .................... 7. D~ensions of existing structures, if any: Front ............... Rear .............. Depth .............. Height ............... Number of Stories '. ...................................................... Ihmensmns of same structure w~th alteratmns or addmons. Front ................. Rear ................. Depth . ................ ;.. He~t .......... ~ 6. ....... Number o~ Storms ................. 8. D~enslons of entire new constmctton: Front ........... Rear ... ~ .......... Depth ........... t~eight ............... Number of Stories ..... ~ .............................................. 9. Size of lot: Front ..... 4~.~ ........... Rear .... ~ ............. nepm ...l.~ ............. 10. Date of Purchase ......... ~C~.q5 F..../. ~.. Name of Foyer Owner ...~. ~. ~ K. ~.~.~. [~ ~.~.. 11. Zone or use district in which prSmises are situated ..................................................... 12, Does proposed eonstrucrion violate any zoning law, ordinance or regulation: . . ~ .......................... 13. Will lot be regraded ....W.~. ~ .................. Will excess fill be removed from premises: ~_~ No 14. Nme of Owner of premi~s ~7gr~.~.g&~ddress,.~~.~l~ePhoneNo.~..~.~.~.,. Nme of Architect ..... ; ................. Address ................... Phone No .............. N~e of Contractor d O ~e.12~. ~.~.~ t ~.~ · · · Address ~8 ko.~. (~ ~ ~. ~r~one No, ~.~r.~ Z~.. . PLOT DIAG~ Locate .cleariy ~d distinctl~ ~ buildings, whe~er existing or proposed, ~d~ indicate ~l set-back d~ensions from prope~y ~nes. Give street ~d block~number or desc~prion according to deed, ~d show street n~es and indicate wheffier inie~or or Corner lot. STATE OF NEW YORK, ,S.S COUNTY OF ................. ' being duly deposes and says that he is the applicant ............................ ~ ..................... swor~ (Name of individual signing contract) above named. He is the ..................... ~ .................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have perfumed the said work and to m~e and ~e ~is application; that all statements contained ~ this application are true to the best of his ~owledge and belief; and that the work will be perfumed in the m~n~r set fo~h ~ the application filed therewith. Swum to before me this ~ - I HF. LEN NO)ARY PUBLICj State ~I New Yorb ................... N0. 4'/0'1818~ Suildk Oom~tv (Si~atu~ of app~c~t) Term Exp.es:March 30, 19~