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Home My WebLink About13500-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z13652 Date July 19 1985 THIS CERTIFIES that the building porch addition. Location of Property 400 Smith Drive North Southold I~s~ h/o: ....................... 's'~/~i ....................... /~iel County Tax Map No. 1000 Section ...... 7. 6. .... Block ... 2 .Lot 17 Subdivision....GP.°.s.e...N.e.c.k. ................ Filed Map No. 1663 .LotNo. p/o 89,90,p/o 91 conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... .S.ep.~e..m.b.e.~...2.7.., 19.8..4pursuant to which Building Permit No. 13500 z dated ...... .O.c.~.qb..eT..2. 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 ......... .... ~l.d.i~$.o.n..~.9..e.x.~.s~.i.n.q screened porch. The certificate is issued to ............ BRIAN T. & DEBORAH O' BRIEN SMITH ..... ...................... 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 gronted~ · .~z~.e..Z......~.~ ...................... .... ~.~....~%...:z~.....~.-.....~~ ...... ..... ~..e.~.~.q.~:..:.::...xZ.....:~..- ............... ....~ ~ /~ to o, prem ses ~ated at ...:.~.q ........ :....~....: ................................ ....................................................................................................................... ~.~....-~ ~ · ..~~...~A......~~ .................. co..w T~ ~ no. ~0oo Se~,,o...~.7~ ........ ,,~ ..D.~. ........ ~o, no..~ZZ .......... ~..uo., ,o ~,,~,,o. ao,~ ...&~.....~g. ......................... . ,,~. ~n, o,,ro.~ ~ ,~e Building Inspector. u d ng nspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted ia ~ 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 wa~e,r 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 P~anning Board approval of comp~ted site plan requirements where applicable. For existing buildings (prior to April 1957), Noo-conformin~ uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~Coperty 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 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacan% Land C.O. $5.00 New Building ............. Old or Pre-existing Building $15.00 Date ................... · ~..' ........ Vacant Land ............. House No. Street Hamlet Owner or Owners of Property ...~.~i/~, ./'~..'.-~...//~.~ .... ~.~¢z~-~... ~.. ~'~. ~..~, County Tax Map No. 1000 Section ...O~.& ..... Block .. ~:~. ........ Lot....~Z.~ ....... Subdivision. ~q >~..~L~'. ............... Filed Map No. /.~;~ .... Lot No.~.~.~,. ~, :~/ Permit No. J ~:D~- 0/ ~ · ~rj~.'~`~ .. ¢. ...... uate of Permit .~. ~. pphcant ......................... Health Dept. Approval ........................ Labor Dept. Approval ........................ Unde~riters Approval ,..~ f~ .................. Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee ........ Construction on above described building and permit meets all apl~licable codes and regulations. qOt, App icant . . .: ....... /'. ~'~,~.4 .~ .~.. ~ .......................... Rev. 10-10-78 ~F IELD INSPECTION DATE COMMENTS FOUND ION (1st) ROUGH FRAME FL uM~BI NG 3. INSULATION FERN. Y. FINAL ADDITIONAL COMMENTS: ~°OUTHOLD, N,Y. 11971 TEL.: 765-1802 Examined .... ,1 .............. ..... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a, This application must be completely filled in by Wpewriter 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_Logs, ...... '. .c.:.. .......... (Signature of applicant, or name, if a corporation) ........... i~l'aili~ ~;e's~ of applicant)' State whether applicant is owner, lessee, agent, architect, engineer, general' contractor, electrician, plumber or builder. ................... ~...~.. ~ .¢~..~. .............................................................. Name of owner of premises ...$.~.';?.~./~ ..l. ['~.r'. ! .~....T'... ~e~,d.. b.*/0o r~'4 . .~.~¢~ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate of,fic,~ Builder'~ License No ..... c~.~ ............ Plumber s License No ........ ~.. ........... Electrician's,License No... T ................ Other Trade s License No../ .................... 1. Location of land on which proposed work will be done .................................................. ...... .......... ...... House Number Street Hamlet County Tax Map No. 1000 Section ...... .7...~? ....... Block ..... ~ .......... Lot .... 1.7. ........... Subdivision. ~'.q~X'~. J~.~:¢':./~ Filed Map No. .]. .~.~. .~. ....... Lot ?..a.?l~..~.d..'~.0..~-" ........ (Nmne) .............. Ya *~ e~ I 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~'~OD . ~Q~ .............. ,..~..4 .%~ ..... - ............... .......... ~ ..... ;- ~ _ ~:~,~ ~,~ ~'.~.~..;:' ~. , ~: b. Intended use and occupancy V~¢~Do~ /~t~. ~L ~:~72~q .'~.~:~-v;:~:(..~. ......... 10. 11. 12. 13. 14. 3. ~']~~~i~t~ applicable): New Building .......... Addition., ~ .... Alteration .: ....... · Repair MMI['[ ~ ~' .~i~R~m~val .......... Demolition .... Other Work ........... ~... :-~ ~~~, ~ ~/j~; ~ ~ ~ ~ ~ (Description) ' · '" ..... .' ....· ..... ........ ~..~,~.',, ~, .,,.~ ..... ~ , " {to be prod on fihng tins apphcation) o~ Number of dwelling units on each floor 5. If dwelling, number of dwelling~units ............................ If garage number of cars J 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use 7. Dimensmns of existing structures, if any: Front .... ~.. Rear .... ~ ~. Depth ~.~.~... Height .../~ ~ .... Number of Stories .... ~N.~. ............................................... D~ensions Df same s~cture ~ith alterations or additions: Front . .~.~ ..... Rear .. ~. ~ ..... I)epth'... ~.~ ...... ~.. He~t ... ~. ff~ ........ Number of Stories .... ~ ............ 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... tleight ............... Number of Stories ....................... ~ ....... Size of lot: Front ...... ].~ .~ ....... Rear ..... (~. ~ ......... Depth . .~.~..~: ........ Date of Purchase .. ~../.~... ] ~. ~ ........ Name of Foyer Owner .......................... Zone or use district in which premises are situated.. ~k~]~. ~4~/~. ~.q~ ......................... Does proposed construction violate any zoning law, ordinance or regulation: . .~ ........................... Will lot be regraded .... ~. ~ .................. ~ill excess fill be removed from premises: Yes No N~e of Owner of premises ~r,~. ~.~ae3~.~'d~q~ ~'fi~ress MI ~ ~9..~ Phone No ~. P.~ ~ ~... Nme of Architect .... ~. ~ ................. Address ............ ' [ ~ ~ Phone No' . ............. N~e of Contractor...~]~. ~ ................. Address ............ ~ ...... Phone No~ ......... [ ..... . ~ _~. PLOT DIAG~ , ~d dist~ctly ~ bufld~gs, whe[her existing or proposed, ~d. indicate ~1 set-back d~ensions from ye street and block number or description accord~g to deed, ~d show stree ~ nines and indicate whether lot. / Locate clear] property lines. C interior or cornel ........ .... (Naiae of individual sig! above named. S.S .ing contract) (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duiy authorized to perform or have performed the said work and to make and file 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 mann6r set forth in the application filed therewith. Sworn to before m~ this i Notary .o. 62.0,~448~ ~ ~.~,~..~ (Signature of applicant) Comm~ F. xIdrM MM4h ao, 1~.~' being duly sworn, deposes and says that he is the applicant