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Home My WebLink About13442-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z12904 Date October 18 198.4.. THIS CERTIFIES that the building .... A..c.c,e.s.s.o..ry. ................................. Location of Property ... ).8.5. ............ .R.a..r~.l..e.r..R.d.: ............S9.u.t.h. 9.1.d' .......... House No. Street Hamlet County Tax Map No. 1000 Section ., .0 .8.8 ....... Block .. 0..5 ........... Lot ,.. 9.2.9. .......... Subdivision ....... X. ....................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·..S.e.p.t.: ......1.7 ......,19.8. 4. pursuant to which Building Permit No....1.3.4. 4..2 .Z ............ dated ........... S.e.p¢.. ..... .1.7. ....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 ......... ·. ~.c.q~p. zz~f, SkeW. in .~he..~e~;c..¥~r.d.. ........................................ The certificate is issued to JULIUS DOWNS ..................... ...................... of the aforesaid building. Suffolk County Department of Health Approval ............ ..N./.A. .......................... UNDERWRITERS CERTIFICATE NO .................... N./.A .......................... Rev. 1/81 Building Inspector 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) Permission is hereby granted to~j /~ ~ ~ ..... ~_~/~.......!'e.~..: .......... ...G.~....~..:~........:u...~...v.!. ..... ~ at promi~e,~ r~ated ot ............................................................................................................................ County Tax Map No. I000 Section ..... .~..~....~. ....... Block ........ .~.~. ........ Lot No ........~....~ ............ pursuant to application doted ...... ~ ...... 1...~ ........ , 19.~.~.., and opproved by the Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall ~outhold, N.Y, 11971 BLDG, DEPT. TOWN OF SOUTHOLD APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted-~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. B. 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. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling/ land use --Pre-Exis ting C. 0. $15.00 3. Copy of certificate of occupancy $1.00 ~ ............. Old or Pre-existing Building ............ Vacant Land ........ Location of Property ............... . ....... . . ?. ..... .. . HOUSe No. Street Ham/et OwnerorOwnersofProperty ...,~...,.~......~.. ............................... County Tax Map No. 1000 Section .... .(~..~..~ ......Block ...... ~.. · · ..... Lot ...... .o~.c) ....... Subd{vision ........................... ~,../...Filed Map No ........... Lot No .............. Underwriters Approval ........................ Planning Board Approval .................... . . Request for Temporarg Cartificate ..................... Final Certificate ....................... Fee Submitted $... ~/.....~..~, ................ Construction on above described building and~permit ~eets all ~plic~le codes and regulations. ~ \~'~J~- , · ..~f~.~. ....... ~.~..-y.~_~.. .................. ....... FIELD INSFECTION FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & FLUMBING INSULATION PER N. STATE ENERGY qODE COMMENTS FINAL ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1803 Disapproved a/c ..................................... ' (Building Inspector) APPLICATION FOR BUILDING PERM IT 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 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 tlie 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 Btdlding Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New Y6rk, 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 ail applicable laws, ordinances, building code, housing code, and regulations, and to admit author/zed inspectors on premises and in building for necessary ins. pe, ctions., ...... .... ..... .... (Signature of applicant, or name, if a.r~qrporat' ) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .......................................................................... (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 ...................... I. Location of land on which proposed work will be done .................................................. ........................ House Number Street Hamlet County Tax Map No. 1000 Section .~..~ ~ Block ~- Lot .... .~..~. i. Subdivision ..................................... Filed Map No ............... Lot ............. (Name) 2. State existing use and occupancy of premises and jlLt&_nded use and occupancy of proposed constructi°n: a. Existing use and occupancy ...~'~. · ........ ;~, ................. '/1 ' ' '; ....... 10. I1. 12. 13. 14. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) Estimated Cost Fee "" (to be paid on filing this application) If dwelling, number of dwelling ;units ............... Number of dwelling units on each floor ................ If garage, number of cars .... ; ................................................................... If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... tteight ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ................... ;.. Height ...................... Number of Stories ...................... Dimensions of entire new construction: Front ............... Rear ............... Depth ............... [/eight ............... Number of Stories ........................................................ Size of lot: Front .......... i ........... Rear ...................... Depth ...................... Date of Purchase .......... ; .................. Name of Former Owner ............................. Zone or use district in which prgmises are situated: .................................................... Does proposed construction violate any zoning law, ordinance or regulation: ................................ Will lot be regraded ........................... Will excess fill be removed from premises: Yes _.~ No Name of Owner of premises '~.. Address .............. Phone No.r~.. .. 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 froTM property fines. Give street and block!number or description according to deed, and show street names and indicate whether interior or coruer lot. STATE OF NEW YORK, COUNTY OF ................. APPRO¥:D AS NOTED DATE: B.P. --~ FEE: BY: NOTIFY BUll_DING DEPARTMENT AT 765.-180,2 9 AM TO 4 P/V~ FOR THF FOLLOWING IHSPECTIONS: 1, FOUN~A] ION ~ TWO REO[JIRED FOR P~URFD CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. IN~ULA-r]ON 4. FIN~t - CqFyRTr~[w"~'~N M~ST BE C '¢,4m ALL CONqI"P~ICT~ON SHALL ~4r~T THE RFO~'mrM17NTS OF THr N, V STATE CONqTRUCTION & CODES. DESIGN OR CONSTRUCTION ERgO being duly sworn, deposes and says that he is the applicant (Name of individual sigfiing contract) ~,. above named lie is 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 cont:alned 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 ............ /..7..~. ....... day o~.. · Notary Public,. ......... ~./~ .4~.~..f~.~, . . . · County ~ . . . .. ,,. ' ,..(~i~nature of applicant)