HomeMy WebLinkAbout13255-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Sou(hold, N.Y.
Certificate Of Occupancy
No.Z.1.2.5..9.3 ........... Date ...... J.. u..1 y..6. .................... lf~.~.
THIS CERTIFIES that the building. ,O,rt e,. ~.a,~J,. :~y..ck~O :~-,~,qg ........................
Location of Property .... 2.5.7. 5. p.Z. cl. 0 ?.c.l~ ~ ~'.d..I~ 9 ~ ~t ............... ~ a ~.~;..I~a r£Qn ......
House No. Street Hamlet
County Tax Map No. 1000 Section ... 0..3.7 ...... Block ...0.6. .......... Lot . .7 ...............
Subdivision..~.a.v..d 3.n.e.v..s..B.a.y..E.s.~., ........ Filed Map No, 2.7.5. ..... Lot No.. 7 ...........
conforms substantially to the Application for Building Permit heretofore filed in this office dated
July 2 ......................
...................... 19 .8 ~. pursuant to which Building Permit No. q 3 2 5 5 Z
dated ....... J.u..~y..2. .............. 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 .f~ o. r e~o v a t e
in. ~..e.v.i.o.v. ~..e.qc..i.o.s.e.. p.o.qq~...a.n.d...a.d.d..d..e.c~..~.9..e.x.i..~ .~.i.n.g, .o.n.e...~.a.m.i.i. ~..d.w.e..1 .i.i.n.g.
The certificate is issued toT~.e.q. ~. g.d.¢ ~-..K.~p..& .~/O2[f.g~g. ,&. ~ y.e./,~. ~.~Up~2 .........
(owner, ~ ~n~
of the aforesaid building.
Suffolk County Department of Health Approval ....... Nf.A ...............................
UNDERWRITERS CERTIFICATE NO ............... ~-/./~ ...............................
Building Inspector
Rev. 1/81
l~O~,lt~ NO. 0
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? 13255 Z
Permission is hereby granted to:_ /~
::}:~./.:.:.~:.~~:....~.,. ..............
. ~.~...,.~~.....~.,.~..:....~...~.~..~. ...... ~ ,
~o~,:.~~;..~~..~....~....~....~.~...~
~.~'....,.:...~.~....~....~.~... ...................................... :. ..............
at premises located at ....~.....~...~....~'.........~....~......~/~....~...~...~...~ ...........
County Tax Map No. 1000 Section ..... ..~...~...~. ...... Block ..... .~.....~. ......... Lot No .......~. ................
to application doted ..... ~.,~-:~z~........~....~ .................. , 19..~..~..,, and approved by the
pursuant
Building Inspector,
Building Inspector
Rev. 6130/80
F~LD~INSPECTION
FOUNDATION
(1st)
FOUNDATION (2nd)
ROUGH FRAME &
PLUMBING
INSULATION FERN. Y.
STATE ENERGY
QODE
FINAL
COMMENTS
ADDITIONAL COMMENTS:
FORM NO. I
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTFIOLD, N.Y. 11971
TEL.: 765-1803
Disapproved a/c .....................................
..............................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Application No ..................
Date ................... 19,..
INSTRUCTIONS
a. This application must b~ completely filled in by typewriter or in ink and submitted in triplicate 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 dia~am 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 issue 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 Per]nit 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, honsing code, and regulations, and to
admit authorized inspectors on premises and in buildings for necessary inspections,
(Signature of applicant, or name, if a corporation)
141 .K.e.l.b qu .r n.e. ;~V~ ,.No · T~r ry~wn, N~.l 059~
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
owner .......................................................................................
Name of owner of premises .. Kavap/.S.t;upe.1. .... (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 .........................
..... No
Electnmau s License ........................
Other Trade's License No .......... , ............
Location of land on which proposed work will be done.
2575 Old .O.rchqr.d .R. qa.~t,~$¢. ~arioD~ ........
ltouse Number Street Hamlet
'c~)U tyT pN 1000 ti B1
n ax Ma o. Sec on . . 0.37 ........ ock ...q~ ............. Lot.~i..Q07 ...........
Subdivision G.a.r(;liB.etrs. BgtY..w.s.t[s .............. Filed Map No. 2.7.5. ......... Lot ...7. ...........
(Name)
2. State existing use and occupancy of premises and intended use and °ccupancy °f Pr°p°sed c°nstructi°n:
,.,.% .....................
Existing use and occupancy '
b Intended use and occupa~" ' · · .~ ~%. ' .....................................................
REQUIRED -,,i
JRED
,~ROUGH., 'FR~M NG & PLUMBING
, ,/ '
CON'$TRUCTION ,MUST,
FOR
ION ,SHALl. MEET
~E, ~.Y, '
ENERGy'
ESPON~I
tho ~id work and to m~e. and filo ~ .L