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Home My WebLink About13611-zFORM TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate O[ Occupancy No..Z.1.3..0.4.1. ......... Date ..... December 6. ., 198..4 THIS CERTIFIES that the building Acld±t±on Location of Property ....8.5.5. ................ B.~..i~t.a.n.~..i.n.e..D..~.. ...... Southold ~ House No. Street Hamlet County Tax Map No. 1000 Section ...0 .7.9 ....... Block ....0.,i .......... Lot 0 5 0 Subdivision..H..a.r.b.q~.. ,L,i,q,h, .fi,s.,.S.e..c:..3. ..... Filed Map No....5.1.4.7..Lot No. 37 conforms substantially to the Application for Building Permit heretofore filed in this office dated .... D.c..c.e.m.b.~..r ..... .3.. , 19.8..~ pursuant to which Building Permit No. 1 3 611 Z dated ........ p.e. qe..r~..e.r.....5. ..... 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 ......... .... ~¢~k .~00£.~io~..~o. ~xi~ing. 9~.e..F..a.m.i.%y..D.w.e..~.~.in~ ...................... The certificate is issued to MYRA AVEDON ..................... ?oYn'e'r, ~;dd~ ~) ...................... of the aforesaid building. Suffolk County Department of Health Approval .......... .N./.~. ............................ N/A UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 lrOll,l~ NO. ~' TOWN OF $OUTHOLD BUILDING DEPARTJ~ENT TOWN HAt. L $OUTHOLD, N. Y. BUILDING PERMIT (THIS PEP. MIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 13611 Z pu~uont ,o opp,,cot,on dot,d ~~.....~ ................ . ,,.~..~.. ond op~ro~e~ by ,h, Building Inspector. Building Insgector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ,~.;outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filted in typewriter OR ink, and submitted~ccdaf~to the BuiJding 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 tmusuaJ natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal-tS-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 featu res. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of bu tidings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. Fees: I. Certificate of occupancy $5.00 2. Certificate of occupanc.y, on pre-existing dwelling/ land 3. Copy of certificate of occupancy $1.00 use--Pre-Existing C.O. $15.00 Vacant land C.OI. $. 5.00 Date ..... ,/~ .... ~ ...... New Building ............. Old or Pre-existing Building ......... ... ~.Vacant ynd.~. ·h ......... Location of Property ....................................................... flou~ No, Street Nam/et Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Dat;~f~ermit .......... Applicant..~. ~ ...)~k~. · . .~. ·I ......... Health Dept. Approval ,.'.~y4/., .Labor Dept. Approval ...................... . .Planning Board Approval ...................... Request for Temporary Certificate ............. Final Certificate ...... Fee Submitted $ ..~. .......................... Construction on above described building and perr~it me,~ts all appl~able codes and regulations. Examin~ .~ .... 19~.. ~. . Approved~. ~. ?...e--~...~ 'FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 ., 19 ~.~.. Permit No. ).~..q.lJ..?~.. Disapproved a/c ..................................... Received ........... , (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tkis 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 inspect,ions. ~ / / ~ ''' '~g~;d' r'e';~ ~licant, or'~'' - ~e} ]; ~ 'c;;~;ia'ti~) .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. Name of owner o f premises .' .'.'.'-~. · .~ I' ........... ' ........ (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. i~ ~.. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ........... ................ House Number Street Han~let County Tax Map No. 1000 Section .... .~..~..C~. ........ Block ...(~..~. ............ Lot...C~..~..C) ......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) property lines. Give street and block number or description according to deed, and sho~ interior or corner lot. 3. Nature of work (check which applicable): New Building ..... ~.. 'Addition ¥... Alteration pair ~" (D ripti ) Re ........... Removal ............... Demolition ......... ~... Other Work ..... ~. ......... 4. Estimated Cost ........................... Fee ........ ~ ................... ~. ........ '~ (to be ~aid on filing this application) 5. If dwelling, number of dwelling units ............. Number of dwelling units on each floor ................ 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...L9 ........... Rear .... ~.C~ ....... Depth . ~ ......... Heig' ht . .. ~.'~ ......... Number of Stones' .. ~ ....................... ~ .................. Dimensions of same structure with alterations or additions: Front .................. Rear ................ Depth ...................... Height ...................... Number ofiStories .................... 8. Dimensions of entire new construction: Front ............... Rear ........ i ....... Depth ............. Height ............... Number of Stories ............................ i .......................... 9. Size of lot: Front ...................... Rear ...................... iDepth .................... 10. Date of Purchase ............................. Name of Former Owner .! ........................... I 1. Zone or use district in which premises are situated ......................... ! ........................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... i ........................... 13. Will lot be regraded . ........................ Will excess fill'be removed from premises: Yes No 14. Name of Owner of premises ~i~.~... Address ............... i ....Phone -. . Name of Architect ........................... Address ............... , .... Phone No ................ Name of Contractor Address ' Phone No PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from , street names and indicate whether STATE OF NEW YORK, S.S ~ ' COU~,~ OF ................. .................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the sgid work and to make and file this application; that all statements contained in this application are true to the best of hi~ 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 ............. County NOTARY PUBdC grate 0l I~ew York ~ (Signature of appli :ant) NO, 4707878, ,g.'uffolk OI)u.I.~,