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Home My WebLink About13386-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No, Z12764 . Date August B0 8.4. THIS CERTIFIES that the building .......... D. e ¢ I~ .................................. ............ ~.9. O 9..~.e.e..b.c..~.~..~y.s ............... .C.u.~.q ~. ?.g.u.e. ....... Location of Property House No. Street Hamlet County Tax Map No. 1000 Section .1.Q3. ........ Block ...... .3 ........ Lot .... ! .5 ........... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... g ~ g.... 3 .~ ........ 196.4.. pursuant to which Building Permit No... ] 3.3.~ 6 ~ ............ dated ... g.t~g,. 2,7. ................ 19 B.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 ......... ...... ~.c.k .,.d.d.~ ~..5 p.n..~..o. A .e.n.e. f.a..m.~.~.Z..dy.e.z.z..~.n.~... ........................... The certificate is issued to ..... .A.~ v..5.n..{..~.3..5.qe...g.u?. 3:. ~..n.g.~.m. ? ......................... (owner,~ ~t~r~ X of the aforesaid building. Suffolk County Department of Health Approval .......... .~/.& ............................ UNDERWRITERS CERTIFICATE NO .................. .N./.~ ............................ Rev. 1/81 Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT ('rillS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13386 Z Permission is hereby grant t ,., at premises ~o~ted ot ............................................................................................................................ to application doted ....~.....Oa~...~........~....~ ........... , 19..~....~,, and approved by the pursuant Building Inspector, Fee $ ........................ ~ Building Inspector 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 applibation must be filled in typewriter OR ink, and submitted~,![cctc 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 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 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 / Certificate of occupancy on pre-existing dwelling / land use 2. 3. Copy of certificate of occupancy $1.00 / --Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property . .~-?,O.~ .... .~...~.e.~ .~.~....~.~. ~. ~ ¢~ ........... ~ .... ~.~ ................. Ham/et Hou~ No. ~ Street Owner or Owners of Property .... ~.q ........ ~'. ~ ..... ~, · ~,~.~ ..................... County Tax MapNo. 1000 Section .,~?,~, ........ Block .........,..... ~ Lot.,.~,~.....,.... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./.-~..~..~.~.. ?. Date of Permit ....... Applicant. 4~... .~. · .~..~, · ...... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwrit, ers Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $.. Construction on above described building and permit meets all/~3~licable codes and regulations. Applicant .., ........................ Rev, I0-10-78 FIELD INSFECT~ON FOUNDATION (1st) COMMENTS FOUNDATION 2. (2nd) ROUGH FRAME & FLUMBING INSULATION FERN. STATE ENERGY CpDE FINAL ADDITIONAL COMMENTS: ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 :), .,~.. TEL.: 765-1B03 Examin · .~.~. ·., 19~. ~. Approved~. f...~..~.., 19~.~. Permit No. )..~..~.~..[o. L Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,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 s_c~hedul~e. -~. '~6~ ~0-ffi~ ~o~-~i°n--6-f f~-~-d o~ffiI~dings on premises, relationship to adjoining premises or pubhc st'feets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli~ cation. e. The work covered by tlfis 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, ho~ucing code, and regulations, and to admit authorized inspectors on premises and in building for necessary insllections. Y~ / , ~" i~i'g~l~[t~r'e'(}i ~pplica'q-~:' ' ' 'n~i ~e', 'i~ ~ 'c~[~&;a'tidn') .... (Mailing address of applicant'J ~ State whethdr applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~'//f. f~'o '/- d/~ce ~ r-Z ~.~.'~t ~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. P~. .... . .~-..~-.~...~.'. .... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ....................... I. Location of land on which proposed work will be done .................................................. · ........ ...... House Number Street Hamlet County Tax Map No. 1000 Section ~ ............... Block ~ ..... ~. Lot..~... ............... Subdivision ~'~ Filed Map No.~. Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construct/on: a. Existing use and occupancy ~ ?~/&"t~Z~ b. Intended use and occupancy .~.....~.Qt ?..~.~....~..~..a~2~}~~, ~.(fftO..~iTy,:L~. ~ .............. · New Building .......... Addition ......... Alteration 3. Nature of work (check which apl~hcable) ........... Repair .............. RemoVal .............. Demolition .............. Other Work .............. 4. Estimated Cost .--..~.~..., ........................ Fee ............................ ~ *" (to be paid on filing this application) 5. If dwelling, number of dwelling ttnits ............. Number of dwelling units on each floor .............. It' garage, number of cars i ' 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... - 7 Dimensions of existing structured if any: Front Rear Depth Height ............... Number of Stories ....................................................... Dimensions of same structure with alterations or additions: Front ................. Rear ................. Depth .................... !.. Height ...................... Number of Stories ..................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth .............. Height Number of Stories 9. Size of lot: Front ...........i ........... Rear ...................... Depth ...................... Date of Purchase i Name of Former Owner 11. Zone or use district in which pr{mises are situated ..................................................... 12. Does. proposed construction violate any zoning law, ordinance Or regulation: ................................ 13. Will lot beregraded.........~..................' . Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ...i ................. Address ................... Phone No ................ Name of Architect .......... ................. Address ................... Phone No ................ Name of Contractor ! Address Phone No Locate clearly and distinctly all! buildings, whether~lSroposed, and, indicate all set-back dimensions m propel~ty lines. Give street and block r~umber or descnpt:on according to deed, and show street names and indicate whether interior or corner lot. ....... ~~)~..~ ... being he is the applicant c°ntract~ duly sworn, deposes and says that (Name of individual above named. He is the ................. ~~ .......................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is du)y authorized to perfom or have perfomed the said work and to m~e and file this application; that all statements con(ained ~ this application are true to the best of his ~owledge 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 .......... ~ day ........ 19~ *~erm Ex~r~ M~rQh