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Home My WebLink About13504-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z13008 Date Nov. 21 19 8..4 THIS CERTIFIES that the building ....~.c..c.e.s.s.o..fy .................................. Location of Property .~7 O... Park Way Southold ~Youse No. ' ..................................................... Street Hamlet County Tax Map No. 1000 Section . .0. 7..0 ....... Block .... $ .0 ......... Lot .... 0..4.1 .......... Subdivision ...Squ~cb, xgq>O¢. .................. Filed Map No. , .2..1.4.1..Lot No...4 ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated Oct, 1 19 8.4. pursuant to which Building Permit No. 135067. dated ....... O..c.t,. .... .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 ......... ..... %c..c.e.s.s.o..ry..s.t. 9.r.a.g¢..~.u.i .Z .d.~.n.g ............................................ The certificate is issued to .................... .M._.~. $.~.A.~$.R.R.Q ~ .~.P,A.~..K...~..~.I. ¥.E ............ (owner, of the aforesaid building. Suffolk County Department of Health Approval ........... .Iq././[. ........................... UNDERWRITERS CERTIFICATE NO ................... .N./.A. ........................... Building Inspector R~. 1/81 ltORM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT {THIS PEP, MIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLEI~,ION OF THE WORK AUTHORIZED) N-° 13504 Z Permission is hereby granted to: ........ ~.~...~...~.~..~::~ ...~...W_./.......,~.~....~o..~.~.. ...... ..~.~,~ ..... ~.~,~..~..~. ....... /z.~ 7~ , ,o ........... .~O~.~cz......~.~ ~.~~ ........ ...... ~~...= ............................... ~/.~ ................................. .~ .......... ~ ............ co,,~ T.~ ~p No. ~ooo s.~,io.....~Z~ ...... e,~k .... Z.~ .......... ~ No. ~.~Z .......... Building Inspector. Fee $..~....(~... ............. 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 application must be filled in typewriter OR ink, and submitted-J~=d~pHc=t= 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 featu res. 2. Sworn statement of owner or previous owner as to use, occupancy end 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. 1. Certificate of occupancy $5.00 ! 2. Certificate of occupancy on pre-existing dwelling/ land use --?re-E×±st~ing C o0. $15 · 00 3. Copy of certificate of occupancy $1.00 Vacant~ la~d C.0. $ 5.00 Date .... /.?. ?..~.?..~. · .~..~. ...... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property..~..?~.. ........ ~ ?~" -/~t ............... .~...o.~. ~ .o./. ~..., , ....... House No. Street Ham/et Owner or Owners of Property ....~J./.~. ,-~. ?.--./? ?., .~-, .~..~.o., .,.../~./?~..~./.~./~.,..~. ¢, .~?. (.~.. ¢ .......... County Tax Map No. 1000 Section .... .~..~-~ ...... Block . (..O. .......... Lot, .~/,~ Subdivision.~'.'.'.~. ~.~'..~(-U~.~, .~..~. .............. Filed Map No.O~..~.'.~./...Lot No.. ~ ......... Permit No. /.~.~.~-. ~.. Date of Permit/.~7.~.~.~, .~.~.Applicant..~.A~../.~... ~ (~..~...~..~7 ?..~..~.~ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $..~...~.. ..................... Construction on above described buiiding and permit meets all applicable codes and regulations. ~---0 'g~ ~"z'~O0'~ Applicant ................ Rev, 10-10-78 FIELD I~SPEC-TION DATE COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ~ ROUGH FRAME & - INSULATION PER N. Y. STATE ENERGY FINAL ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLO BUILDING DEPARTMENT TOWN HALL ,, $OUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined /'d/'~' '3~'F/ ...... ' 19~' ~~' ~ Approved /. ~./..~.~. ....... , l:~.c . Permit ............ ]Disapproved a[c ........... ~ ........ .~../ ..... APP.LI-~TI'ON 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 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 i~nspectiqns. __ . ................. (Signature/ff applicb/t~,/~/r name, ifn ,~ .a corporation) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. ...... /f~.~ ........... (~'s ;~' t'~egax'roll or la~est deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Plumber's License No. Electrician's License No ....................... Other Trade s License No ...................... 1. Location of land on which proposed work will be done...~.~.:..~ ..-.~ .... ....................... .............. .................... House Nmnber Street 'x~ Hamlet County Tax Map_No. 1000 Section ...... '~.O. ........ Block . ./.O ............. Lot..%/../. .............. Subdivision. ~'. ...................... Filed Map No. (9. O.~,. lht]. .... Lot ...~. ........... (Name) 2. Stateexistingusea~d~ccupancy~f ~emisesa~ i~ n~ d. ed;~and~ccup~hcy~f pr~p~se~c~nstruc~n: a. Existing use and occupancy...[.~~..(~q,~.~,~it~,~,oZ/,~121/ ............. ... ?,,.. .......... b. Intended use and occupancy . .~-. ~,-:h~. _~--~:~"z~[ ......... ..... ~ ......... ................. .... 3. Nature of work (check which applicable): New n .......... Addition. ~ ........ Alteration .......... Repair .............. Removal .............. Demolition .......... ~... Other Work ............... 4.' Estimated Cost .~ ~..~. °g~ ~. f ~ ~ (Description) ~'~ (to b~ paid on filing this application) 5. If dwelling, number of dwelling units ............ Number of dwelling units on each floor ................ If garage, numlJer of cars .......... 7. Dimensions of existing structures, if any: Front ............... Rear ...... i ....... Depth .............. Height ............... Number of Stories ........................... ~ ........................... Dimensions of same structure with alterations or additions: Front ........... ~ ..... Rear ................. Depth ...................... Height .......... , ........... Number o (~S?ries ..................... '- 8. Dimensions olde, tire new construction Front .. f.O.~-~..; Rear . ./..a..~-t~- .... Depth . Height ..¢.~.K~.. ....... Number of Stories ....t/ .... i'" ....... . . ' .i...~.~i'. .... '...ff~i'. ....... ..... 9. Sizeoflot F~ont /.~. Rear [ .~.' [B~h II.10' Date of Purchase ..... [.~.~..~r .................... Name of Former Owner .[' . .~....~t..o-~..~t~ ...... . ."'" .... Zone or use district in which premises are situated ........................ . ............................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ..~.0 ............................ 13. Will lot be regraded ....~..~: ..... , ......:..., .... ~Will excess~filljlg.~moved from premisesi ~es 14. Name of Owner of premises/,0~.-~..,, .~..t~ress ,,,.ng~~. [ .... Phone No..'~ ~,-~': '.~7-~:..~"~'-.... Name of Architect ........................... Address .............. i ....Phone No ............... Name of Contractor ...... '. .................. Address .............. i ....Phone No ............... - PLOT DIAGRAM Locate clearly and distinctly all bhildings, whether existing or proposed, an& indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and showy street names and indicate whether interior or comer lot. STATE OF NEW YORK, COUNTY OF ................. S.S (Name of individual signing contract) above named. He is the ............................................................. i ............................ (Contractor, agent, corporate officer, etc.! of said owner or owners, and is duly authorized to perform or have performed the laid work and to make and file this application; that all statements contained in this application are true to the best of hi~ 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 ................... day of ...... ~. .... ,19.. N01ARY PUl ~ppltcant) being duly sworn, deposes and says that he is the applicant I