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Home My WebLink About13426-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. ~.1.~695 .......... Date ....S.e.p. ~ ,. 2.4. .................... 19.84. THIS CERTIFIES that the building ...... I~ ¢.c,k ..................................... Lo cation of Property ....3 .5.0.0...S 9.u.n.d...Dy.~. y .e ......... d r e e n p o r t House No. Street Hamlet County Tax Map No. ! 000 Section . .q 3. .3 ....... Bloc]< ...0. ~. .......... Lot . .0.4. ............. SubdMsion .~.~.~. ~..eF.n..~..h.o.~.e.~. .............. Filed Map No. 4.5.~.5.. ....Lot No.. ! .0.~ ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated Sept. 6 . 19 84 pursuanttowhichBuildingPennitNo..1.3.42~.Z dated ·...S.e.p. ~. ~..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 ......... · .. D.ac k...ad di.t.iom. £.o..exl.s. ting..Qne. ~'.amiZ.y .Ow~.].l $~g ....................... Ilie & Sylvia Waes The certificate is issued to ........................................................... (owner, ~.~ ~.IX'~X~~ X X of the aforesaid building, Suffolk County Department of Health Approval ...... ~I/.A. ................................ UNDERWRITERS CERTIFICATE NO .............. [q/.P~ ................................ Building Inspector Rev. 1/81 TOWN OF SGUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CT'HIS PER~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13426 Z Permission is hereby granted to: ~..~...~.!.~.~ ....... ~.~ .............. "~'=~'~'~'~'"'~'~~'-'~ ............ ~ ......... = .... o~..mi~. ~ot~ ot.~a. ............. ~~....~~ ........ ~~ ........ the Building Inspector, Fee $ ........................ Building Inspector Rev. 6/30/80 FORM NO, 6 TOWN OF SOUTHOLD B[~iJding Department Town Hall .~uthold, N.Y~ 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY .. Instructions , A. This application must be filled in typewriter OR ink, and submittm~-o~J~et~to the Building Inspec- tor with the following; for new buildings or new use: 1. Final ~ey of prope~ with accurate location of all buildings, prope~y lines, streets, and unu~al na~ral or topographic fea~res. 2. Final approval of Health Dept· of water supply and sewerage disposal-{S-9 form or equal). 3. Approval of electrical in~aJlation from Board of Fire Underwriters· 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and tions, a ce~ificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming u~s, or buildings and "pre-existing" land u~s: 1. Accurate ~ey of peope~y showing ali property lines, ~reets, buildings and unu~al natural or topographic features. 2.Sworn statement of owner or previous owne~ as to use, occupancy and condition of buJtdJngs~ 3~ Date of any housing code or safe~ inspection of buildings or premiss, or other pe~inent informa- tion required to prepare a ca,if/cate. C. Fees: 1. Ce~ificate of occupancy $5·00 2. Certificateofoccupancyonpre-existingdwelling/landuse--P~e-~x~sb~['~ C.O, $15.00 3. Copy of certificate of occupancy $1~00 Vacan~ land C.0. $ New Building ............. Old or Pre-existing Building . .~ ....... Vacant Land ............. Hou~ No. Street ........ ~ ........ Nam/et Owner or Owners of ProperW .. [ ...... ~ ~ ....... County Tax Map No 1000Secton ~ ~> ~. , ~ ~ Health Dept. Approval ........................ Labor Dept. Approval Unclear/rets A~pr~val Planning Board'Approval Request for Tqmporary Certificate ..................... Final Certificate Fee Submitted.$ Construction on above de~r~bed budding anti, it meets all ap~jcable ~odes and~ulations. FIELD INSPECTION COMMENTS FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & FLUMBING INSULATION FER N. STATE ENERGY QODE FINAL ADDITIONAL COMMENTS: FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 ., 19g. ]. Permit No. 1..~..~.&../*..-~.. Received ........... ,19... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 schedule .... b. Plot plan ~howing 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 ofthis application, the Building Inspector will issued a Building Permit to the applicant. Such pemfit 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 l~l'ain described. The applicant agrees to comply with ali applicable laws, ordinances, building code, housing code, an~t~/~tions/f~d to admit author/zed inspectors on premises and in building for necessary inspe~tiota& /-, x,, I/#, t t [/.~7, ...... ...................... (Signature of applicant, or name, iq ~o;~;rat' ) ....... 2.?/ .... /I//~Z6/(Maili. ng address of applicant) , . ~ State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, elect~ician,/~lumber or builder. ................... ................................................................... ame of owner of premises ..... ..... ............................. (as on thd tax roll or latest deed) If applicant is a corporation, signature of duly author/zed officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Ttade's License No ....................... I. Location of land on which proposed work will be done- - .~.-(/~/~-~-.~).-...~-?-.~/?..-..~-.~/.--~. ................. House Number Street .......... Hamlef County Tax Map No. 1000 Section O 5 3 Block O ] Lot O ~ Subdivision ...... ~4er~ ~0~ff~... Filed Map No..~ ~ ....... Lot.../.Q~7 ...... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... E ........ Z~ ..... ~a ' ~ b. Intended use and occupancy ...... ~ ..................... : .... '..: ......................... 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... Alterati~ ...... .~. :. Repair .............. Removal .............. Demolition .............. Other Work...~.~-_-_~. (Description) 4. Est/mated Cost ............ 77. ...................... Fee ...................................... "- (to be paid 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 occupa/tcy, specify nature and extent of eaclx type of use ...... 7. Dimensions of existing structures, if any: Front ..... .~ ......... 'Rear .. ~ ......... 'l~;~t'h' i i Height ............... Number of Stories ...................................... Dimensions of same structure with alterations or additions: Front .... ?~.0[ i .~i i i i iii 't~;~r' .... ~. f. Depth ...................... Height .............. t ......... Numb.er offitories ...................... 8. Dimensions of entire new construction: Front ..... .~.0. ...... Rear ....~.O. ........ Depth . ~.'~. t. ......... Height ............... Number of Stories ......................................................... 9. S~ze of lot: Front ....... ]~....' ....... Rear ..... /~.~ ............. Devth . .6/,~. ......... 10. DateofPurchase ,B-Iq-(~o Na,ne, of E~ormer Ow, ner ~.~T.~q. ~.~t~. 11. Zone or use districi ]~ 5l~i~t~'l~r;~n'i~e's'/r~'s]t'u'ai;~ ]]i]..~.....~. C.~/..t~.g.~'!~ ;][ i[ ii[. i[[. [ [i.. ][]. 12. Does proposed construction violate~a~ny zoning law, ordinance or regulation: ....j~/.~? ....... .................. 13. Will lot be regraded ............................ ~J~' Will excess fill be removed fr6m premises:' Yes 14. Name of Owner of premises . l~/.~.../g/.~..~. ....... Address ................... Phone No ................ 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 property fines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. 765-1802 ~ ~b~qoECTIONS: 1. FOU~ .~ coNCRETE ~. /Nql)~ h,. Cqb~sTRijr- FIoN 4. FI~*~t ' -"~ FOR c,O. ,,,, R~s?ONStBL¢ FOR sTA~'~ t. .... - STATE OF NEW. YORK, ./ COUNTY OF..A/.~?I/...~.6/~. ?. ~'~ ....... ./x,: .~....~..4r~...~. ?....s,x...,,-.e,'2. ~..~. ..... ~eing duly swo,-n, ,oses and says that he is the a,p~icant (Name of individual signing contract) _ ' above named. ......... · ............................................ the ................................ (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 ~e this application; that all statements contained 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 ........ ; ................ . / -'-0;~,.~,..0.~o..~, ~ . ' ............... }s/g;~i~;;i;pplic:t) 0