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Home My WebLink About13050-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate O[ Occupancy No. Z13000 Date November 21 ., 19 ~.4. THIS CERTIFIES that the building ... $ 9.c.c.s..s 97.Y.. ~ .h.eA ............................ Location of Property ..... 1.5.9.5. Am.a.r.. ........................... L.a..u.p.ql. .... House/Vo. Street Ham/et County Tax Map No. 1000 Section 1 2 ? .Block 4 .Lot ~ 0 Subdivision .n.a..u?.e. 1...Cg.u.n..try..E.s..t.a.t.e..s .... Filed Map No. 5..4.8.6 .... Lot No .... ~..1 ........ conforms substantially to the Application for Building Permit heretofore fried in this office dated A p r i 1 1 $ 198. 4.. pursuant to which Building Permit No. 1 3 0 5 0 .Z dated .... ~. p..p .i.1.. 1. 8. ............... 198fi,,, 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 ......... Accessory shed, in rear yard. The certificate is issued to .B. ~ r ;q.a.~..cl..F.... 9 r..D. 9.1 9.p.e.s...M.... N...i.e.c~k. 9 ..................... (owner, 5~( OZ/~yri~t2~}X X X X of the aforesaid building. Suffolk County Department of Health Approval .................. N./. ~ ..................... UNDERWRITERS CERTIFICATE NO ..... N / A Rev. 1/81 Building Inspector ~'OwM' NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13050 Z Permission is hereby granted to: '~.~...~, ....... ~..~.~..~.~ ............ ..z ~...~...~.~.....~.~ ............ ..~.~,..~...~. ........ k...~..~ ............... ,o..~.~.....~..~. . ~ .......................... ~..~....~ ....... ~ ~ ........ at premises located at ..,/...~?...~....~.......~..?,,~....c~....,.~ ........... ~..~ ......... County Tax Map No. I000 Section ..... Z..=~.....~. ....... Block......................'~c-}L Lot No...../.....(-~.. ............ to application doted ...~...,../..~..~. ................ , 19.~..L/.., and approved by the pursuant Building Inspector. Building Insl~ctor Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ,~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in wpewriter OR ink, and submitted--ia=cPjpHcc*,c 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. C. Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancv on pre-existing dwelling/ land 3. Copy of certificate of occupancy $1.00 use --Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 wB ¥ ..... Old gB ............. Ne uilding .., ~,. , , or Pre-existin uilding ........... Vacant Land . Location of Property .................................. HouseNo. Street )~./..l~..j~. Ham/et Owner or Owners of Property ....... O.~.. . ; ............. County Tax Map No. 1000 Section ..../?..7...... Block .......~.. ..... Lot.../.~.. .... ... .. PermitNo Date of Permit Applicant ..... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $: .~.~ ..................... Construction on above described building and permit mee, ts all al~cable codes and regulations. FIELD L~SFE6TION COMMENTS ~_~__ FOU~IDATION (1st) FOUNDATIOn! (2nd) ROUGH FRAME & PLUMBING 3. INSULATION PER N. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined...C~ Approved ...(~. {~a~Q...~.~...., lg~fi.. Permit No. I. Disapproved a/c ..................................... Received ........... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date 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 c~.~, and regulations, and to admit authorizes inspectors on premises and in building for necessary i~pections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......... ~A.e;~ .............................................................................. Name of owner of premises . .~..z~4~.fl-.g ~....~.....0~...~.o.k. q .g./r.~..]~......~./.'~..C~.o. ............................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corpm'ate officer) Builder's License No ...... 0~. O. ·~4. ............ Plumber's License No ......................... Electrician's License No ....................... Other ~rade's License No ...................... 1. Location of land on which proposed work will be done..].~f..~...~..~.]~?..,~.~..~..]~ t(..~/.~.'.~..~/4./~4'A ~/..~.~..~..~.~.'.. House Number Street Hamlet County Tax Map No. 1000 Section ..... ]..~..~. ........ Block ........ q... Lot .... ~.0 ............. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed 'construction: b. Intended use and occupancy .................... ,., ................ ; ................ 10. 12. 1:3. Nature of work (check which acplicable): New Building ..... .x~.... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............ ~ ! (Description) Estimated Co ........................... Fee ...................................... *" (to be paid on filing this application) If dwelling, number of dwellin~ units ............... Number of dwelling units on each floor ................ If garage, number of cars .... j .................................................................... If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories', ....................................................... Dimensions of same structure With alterations or additions: Front ................. Rear .................. Depth ................... !... Height ...................... Number of Stories ...................... Dimensions of entire new const~ction: Front ............... Rear ................ Depth ............... Height ............... Number of Stories ........................................................ Size of lot: Front .......... i ............ Rear ...................... Depth ...................... Date of Purchase .......... ' ................... Name of Former Owner ............................. Zone or use district in which piemises are situated ..................................................... Does proposed construct, ion 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 ................ Name of Architect ........................... Address ................... Phone No ................ Name.of Contractor ........ i .................. Address ................... Phone No ................ ~-'"'k. .. PLOT DIAGRAM Locate clea}ly and distinctly al1 buildings, whether existing or proposed, and. indicate all set-back dimensions from prop.e.,rl~y lines.Dive street and bloc; number or description according to deed, and show stree[names and indicate whether interi°rXprc°rn~rl°t' ~Yo,~h ~'q~ ,o 4 STATE OF w osg¢ S s '.'(l, rame of individual sigrl{ngContract~ above named. [ ~ being duly sworn, deposes and says that he is the applicanf~, He is the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is du!y authorized to perform or have performed the said work and to make and file this appli0ation; that all statements conthined 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 ........... or ........... 19 No~.tary Public, . ........... ~---.-~1,--~-). ounty NEVIllE · · ~ ~7 .......... (/' NpTARY PUBLIC, ~te o~ New Ygll ........... (Signature of applicant) No. 52.8125850, $1lflolk Coqll~ Term Expires March ~0, 19 ~o~r- .... O_~oM > d~m'-I rn~O00',-.~--I rn o.~-~ ] .- , ~P.':~.,~o~>O! 1'~ , ~:.-~'o~>0 ) -om .. --I-.1~0 _.