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Home My WebLink About13391-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z16261 Date February 24 1986 THIS CERTIFIES that the building ... Q ~ .e..f.a..m .5.5.7. . .d .up.1.1..~ pg... ..................... Location of Property ...... 1.7.!.5..H.a. ¥.w.a.~.e..p.s..R..o.a.d ..................C.u.~..c .~.o.g.u..e ....... House No. Street Ham/et County Tax Map No. 1000 Section . 1. .1 .1 ........ Block .... .0.4 .........Lot .. 1. .5 ............. Subdivision .... lq,~.~glJ..EQ~Ei~.T. ............ Filed Map No. 8.0..6 ..... Lot No...3.5. .0 ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated .... A. u. g....2. 7 .......... 19.8.4. pursuant to which Building Permit No. 1 3 3 9 1 Z dated . g.u.g,. ~7 ................... 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 ......... .... ~e~..q~ .e. ?.~m. $ !y..d..~?.Z.~.~..rig.. ................................................ The certificate is issued to ...... WzLL.Z.P,~. ~..P,$~.E.R7i~,..J.A.C.O..B.S ......................... (owner, legffl~'X~l~) of the aforesaid building. Suffolk County Department of Health Approval ....... ] 4..-~S.q ~ .I 5.4 ......................... UNDERWRITERS CERTIFICATE NO ......... P E ~ D ~i~ G PLUMBERS CERTIFICATE 3/16/85 Building Inspector Rev. 1/81 FO]SM bO. :B 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? 13391 Z Permission is hereby granted to: ...... s ......... ...~....~........u.~%: ....... ~o ....~ ...........c~......~ ................... ...~~.....I..~.L....~ .............. Vv /)-~,,/ at premises located at .......... (....~.~..~......ZT(.~'.'.~..~.......~.... ......... ~..~L ................. County Tax Map No. 1000 Section ........ l.[.]. ........ Block ..... ..~...~. ........ Lot No ........ J..~. .......... to application dated ...~..tA~..~..........~...~. ............. , 19.~...~.., and approved by the pursuant / Building Inspector. Building Inspector Rev. 6/30/80 : · ~. 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 wpewriter 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 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 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 bu ildings. 3. Date of any housing code or safety inspection of buildings or premi'ses, 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 q/r land use $/5'/ $5.00 3. Copy of certificate of occupancy $1.00 °ate./.: .: ...... New Building ... ¢... ~,.... Old or Pre-existing Building ............ Vacant Land ............ Location of Property .i./.l~ ..... lff.~.~.~ ,~.,..~..'~ ...~..' .... C(''/T~'~-~' HouseNo. .. .......... Street ........... Y' .... Owner or Owners of Property ..................................... CountyTax Map No. 1000Section .../.~l ......... Block O .~. Lot ~.~.~. Subdivision ................................. Filed Map No ........... Lot No .............. PermitNo ~ "SCJJ ~ Date of Permit ..~. ~??.~.~/~pplicant ...~.'~:' ~''' ~'~>* "" ~,~,, ........ ..................... · ,,' .................... Labor Dept, Approval ........................ Health Dept, Approval Underwriters Approval I ~'=~ ...... Planning Board Approval , t~ Request for Temporary Certificate Final Certificate - Fee Submitted $. -~..~.' ...................... Construction on above described building and i~er~n,~;t meets ~ll. applic, ab. le codes~nd regulations. Rev. 10-10-78 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Permit NO. Owner W////~ ~ ~'1 ~T~ (please print) Plumber ~,~Z Z~/[ ~, (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber's ~ignature) ~/ Sworn to before me this Notary Public, ~q3~,~P~[ ~ County Notary Public FIELD INSi~ECTION 1. FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N. STATE ENERGY Q,ODE FINAL COMMENTS ADDITIONAL COMMENTS: BUILDING DEPT. INSPECTION FOUNDATION '~ST [ ] ROUGH PLBG. FOUNDATION 2ND [~/INSULATION [ ] FRAMING [ ] FINAL REMARKS: INSPECTOR FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved ~r~ .......... 19~.~. Permit No. ?. '.~: .~.~. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT I , mw~'b~aoum, 0m 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 inspec~i~n, aV.~/? ~ ~ F3 /~ ............... "' "' i~i'g~ture of applicant,~r l~dne, if a co po;a!idd) .... .......... ih'ah;i,~ ~i~iliis~'o'?a'p'pii'c'd~i)' " t'~'¢ '~' '~' State whether applicant is owner, lessee, agent, architect, enCneer, general contractor, electrician, plumber or builder. .............................. .(5. ' ................................................... Nameofownerofpremises .(/~)l.lll.'.~.k...~. ./~.~.'-(~.~.-~..'~.... · ~ ~ ~''~ c' · .7~.~t. .................. (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 .... .Z.t..~. ¢... .............. Electrician's License No. ~ °t~ Other Trade's License No ...................... 1. Location of land on which proposed work will be done...~....~...&J~ ~...~....~ ............... ' co . . ?.7 ......... House Nmnber Street [[ ( Hamlet County Tax Map No. 1000 Section ... md¢. ck .................. Lot ................... Subdivision ....... ~.~.2O/f~V ......... FiIed Map No. ~.~. ....... Lot .~>~. ........ (Name) 2. State existing use and occupancy of premises~d intended use and occupancy of proposed construction: a. Existing use and occupancy ff ~ [~7~ ~ ~/~ b. Intended 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... '~~ : (Description) 4. i I ~l ........... [ .- j :' (to be paid on filing this application) 5. ~'~'Ve~ d~/l{ilg,units .... f. ......... Number of dwelling units on each floor ................ 61 :f bus~[~0~~ mi~ed occupancy, specify nature and extent of each type of use ..................... 7. !~rrrc,~ res, 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. I)i.mensio.n&?f entire new construction: Front .... .~.6,., ,,. .... Rear . .~.(~ .......... Depth ,,~....~. .......... 10~ !)ate o'f Purchase ?~y,~... [~...~'. .............. Njtme of l~o~Owner ............................. 1 1. Zone or use districf~n ~,hich pr~mises are situated .... ,-/t~. (...~.&,.~/. ~.%tv ................................. 121 I)o~s proposed construction violate any zoning law, ordinance or regulation: . .. ~¢~..q..' ................ lot be regraded · · · , ................. Will excess fill be renmved from premises:~ Yes Name of Architect ......... ~ ........... Address ....... ............. Phone No ...... PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether exi~sting or proposed, and. indicate 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 NEW-I~gRK,t d, i~, ,, COUNTY. OF .~. _. Ia'a · .F~,'~~/k/t~7. ............ being duly sworn, deposes and says that he is the applicant ~ "~ - -(Na~'e t~f in~aS, idtfft,l"signing contract) above named. ~.~Ytr I (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application i that all statements conthined 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 G