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Home My WebLink About13025-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z1~.533 ......... Date J.une 8 198..4 THIS CERTIFIES that tile building..,..........Access°v.Y...... ........................... Location of Property 1 .1 .8.0..F..i.n.e..N. ?.c.k..?..o.a.d ..... Southold fl~uso No. ' ..... Street Ham/et ,County Tax Map No. 1000 Section .Q7 [3 ........ Block ..... .8 ......... Lot .... .2.1 ........... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... ~. p?.t.:[. J .2 .......198.6.. pursuant to which Building Permit No. 1..3 9.2.5. Z. .............. Apt.il 12 19 84. was iss ed and conforms to all of the requi dated ............................. u , rements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... for an accessory, buildin.~. Richard M. & Doris M. Sherman The certificate is issued to ..................... io~,n'o'r,'t~q~t~t~) ...................... of the aforesaid building. Suffolk County Department of Health Approval ~/. a UNDERWRITERS CERTIFICATE NO ..................... ri./..a .......................... Building Inspector Rev. 1/81 i~'nM' NO. 0 TOWN OF SOU'I3'IOLD 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? 13025 Z Permission is hereby granted to: ........... ~ .~ -~,.~;,~ ~o...~...&...4. ....... ~...,~~~ ~...~ !~..~ ........... ,o .... o, premises located at ..J..]...~..D..~.,~..~......~...~C...~....~.,......~.~.~ ............... County Tax Map No. 1000 Section ......0.,,~,...?.. ....... Block ........ .~. .......... Lot No ....... ..~.....~ .......... pursuant ,o application dated ....... .~.....~, ..................... , 19.~..~.., and approved by the Building Inspector. Fee $...L...: .............. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall ,~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate 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 features. 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. Co Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling/ land 3. Copy of certificate of occupancy $1.00 use --Fre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Date .......................... New Building ...~ ........ Old or Pre-existing Building ............ Vacant Land ............. Location of Property ./,/.~.O. .......................................... House No. , ~ .~. Street Ham/et Owner or Owners of Property .~J.C-.J~.~.~...~. .~.'.~....~...~.../2z~...../~..Z~../~ ............... County Tax Map No. 1000 Section ..... ~.7.~. ..... Block ..... ~. ........ Lot ..... .c~)[ ........ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. z/.-,~ .o.~.-~. Date of Permit z~//.~./~.~...Applicant .~.~C¥;c~f~2.. ~.~o...~.~('~./~...~J. .... Dept. Approval ..... . .-~.~../)~. · ........... Labor Dept. Approval ........................ Health Underwriters Approval ...... ! .~ \ ~- ........... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $..~-',,~0....J ?..?.~.~ ........ Construction on above described building and permit meets all applicable codes and regulations. Applicant . . .~ .~..~//~' ....... FI~E LD ~%NSPECTION FOUNDATION (1st) FOUNDATIO~ (2n~) ROUGH FRAME & PLUMBING COMMENTS INSULATION PER N. STATE ENERGY C,ODE FINAL ADDITIONAL C~MMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 . . .~. '..~ .., . .. Permit No I ~ ~ S :?c Approved · . [ ?... 19gq ...... '..~.. · . Disapproved a/c ..................................... Application No .................. (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................... 19... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted.~,.&5£!i;-~l~- to the Building Inspector, with 3 sets o( 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 issue 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 buildings for necessary inspections. .... ........ (Signature of applicant, or name, if a corporation) (Mailing address of applicant) i~X~owner lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. State whether applicant ~.~ 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 ...................... 1. Location of land on which proposed work will be done .................................................. .... ..... ................. .... ' .............. House Number Street Hamlet ' 1 County Tax Map No. 1000 Section .... q.~.~ .9 ........ Block ..... .~'. ......... Lot....'~. ............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed constructi°n: a. Existing use and occupancy ..... ~. ~ ~.., , .......................... b. Intended use and occupancy. [..~ .°<~. '..~ .~..~..LxP~.. ~.~...~. · .~.~4..~. · ~C-~~r~.. · 3. Nature ofwork(checkwhichapplicable): New Building .......... Addition .......... Alteration .......... Repair .............. Rem6val .............. Demolition .............. Other Work ............... (Description) 4. Estimated Cost ....................................... Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling ~ ~nits ............... Number of dwelling units on each fioor ................ If garage, number of cars ......................................................................... 6. If business, commercial or mixed occupancy, specffy nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Nun~ber of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... ~.. Height ...................... Number of Stories ...................... 8. DimenSions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...........~ ........... Rear ...................... Depth ...................... 10. Date of Purchase ........... i .................. Name of Former Owner ............................. 11. Zone or use district in which promises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ........ ~ ................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .. ~ ................. Address ................... Phone No ................ Nam6 of Architect ......... ~ ................. Address ................... Phone No ................ Name of Contractor ........ : ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly ail buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block!number or description according to deed, and show street names and indicate whether interior or corner lot. FEE:~h. ~_'~_ DY: ~.6.~ NOTIFY~ B~ Ill..DING DEPARTMENT 765-1802 9 AM TO 4 PM FOR FOLLOW hG ~NSPECTIONS: ]. FOUNmATION - TWO REQUIRE FO~ P~URED CONCRETE 2. ROUGH - FRAMING & 3. INcU~ AT[ON 4. FIhMt .- C~NSTRUCTION BF ~"'~nl ~TE FOR C.o. ALI_ COk~q rm ICTION SHALL THE RF~'"2vMENTS OF THE STATK C~NRTRUCTION & EN[ CODES. NQT RESPONS[BkE DESIGN OR CONSTRUCTION STATE OF:NEW YORK, COUNTY OF ................. ......... ' ........................................ being duly sworn, deposes and says that he is the applicant (Name of individual sighing contract) above named. He 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 file this application; that all statements con(ained in this application are true to the best of his knowledge and belief; and that the work will be performed in the marmot set forth in the application filed therewith. Sworn to b~fore me this "N'~';iR¥ [i~b[~,,K~t~e V{~Ne~ Vorl '" X (Signature ........ of apphcant)[ .... NQ, 470'1878, ,~uIfl~lk i Ternt Expires March 30, I9~"