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Home My WebLink About12862-zFORM NO, 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate O{ Occupancy No...~.12248 Date .......... .F.e. lg$'.u.a.r, 7..8 .......... ,1984. THIS CERTIFIES that the building, rrP. Orck .es¢l.osura .......................... 190 North Drive Location of Property 1545 ay. vJ_ew Avenue House No. Street Hamlet County Tax Map No. 1000 Section 106 .Block 06 .Lot 033 - Subdivision ..... X. Filed Map No. X .Lot No. X conforms substantially to the Application for Building Permit heretofore fried in this office dated .... ,F.e.b.r.u..a.r¥..8. ...... 19 .8 .4. pursuant to wlfich Building Permit No ..... J-2.8,6 ~. 7, ......... ' dated ..... F..e.b.r.u.a..ry...8 ........... 198..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 ......... the porch enclosure. LAURIE McDERMOTT The certificate is issued to ........................................................... (owner, lessee o~' ~narrt) of the aforesaid building. Suffolk County Department of Health Approval ...... N./..A ................................. N/A UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 FOyer NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12562 Z Permission is hereby granted to~ , County Tax Map No. 1000 Section ..... L.~,...,~,, ....... Block .......... ~ ........ Lot No ....... :,~..,~ ........ pursuant Building Inspector. Fee $..~.: ............ Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOU3'HOLD Building Department Town Hail Southold, 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 suwey of property with accurate ~ocation of al~ 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 appiicable. 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 landuse--Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Date...~. / .~. l~'.z~ ............ New Building ............. Old or Pre-existing Building . .~-~. ........ Vacant Land ............. Location of Property /(~O .)(,~. ~C~t~D ' '~1.~ ..... /,~,~/3..~/~l.~.~;e~ ~. Owner or Owners of Property ,. ~ .C~,. ~. ;~: ~ ~ ........................ County Tax Map No. 1000 Section ..... /~ ..... Block ...... ~ ....... Lot,. ~5 ......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./~.~ ~ Date of P~rmit ~r.~.. ,Applicant. ~J :~ .~ ~.~,~ ~ ~ ..... Health Dept. Approval ........................ Labor Dept. Approval ........................ Unde~riters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and permit meets all applicable codes and regulations. Applicant...-~.~..~,~_~0_,,.~,,/-~..~'.~,~.. ............... Rev. lO-lO.7e FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL.: 765-1802 Examined ................ , 19... Approved ................ , 19... Permit No ............ Disapproved a/c ..................................... Received ........... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date 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 t9 comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. ..... ........ (Signature of applicant, or name, if a corporation) · '(Mailing address o~' ~(pplicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contract~_elec~.r, ician, plumber or builder. ..... ~~ .............................................. t~T.E:...,,/.~]~ :,.,: .~. /~ ~ g ~ .... . C~ FE ~ Nameofownerofpremises ..~J~ ~ XA I'~mmm~ ~, BY. t ~,~-, the tax roll or~%~[~lkolNG DEPARTMENT AT (as on /6b- - '-1802 9 AM TO 4 PM FOR T~q~ If applicant is a corporation, signature of duly authorized officer. FOLkOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE (Name and title of co~orate officer) 2. ROUGH -FRAMING & PLUMBIN6 3. INSULATION Builder's License No .......................... 4. FINAL - CON'STR[JCT ON MUST BE CO~4PL[T[ FOR C.O. Plumber's LicenseNo ......................... AkL CONSTRUCTION SHAkk MEET THE REQUIREMENTS OF THE N. Y, Biectfician'sLice~seNo ....................... ~STATE CONSTRUCTION & ENERGY Othe~ T~ade s ~[ce~se No ...................... __.1~ OR C~NS~RUCTIO~ ERRORS ,. =o~in~ o~,~.~ o. w,,~ ~o~o~ =o~, w~,, ~ ~o.~/.~.?.b. ~.~ ~. L~...~ ....... . , .- .:~ , .... ..... J. ?. ~. ...... :0: ~... D r.m~.. ~. ~ .~. ~.c~. ~..~. ~ ........................ House Number Street Hamlet :o..~*~o.,000~ec~,o~ ...... 1~ ....... ,,o~ ...~ ............ ~o~ .... 35 .......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ~ ~J: V'~t~tl~... J':~.O/~ ~ C .d.&G~)'[xq* ........................ b. Intended use and occupancy.. ~ .... /./.c~ ~..~...~..~. ..................... 3. Nature ofwork(check which applicable): New Building .......... Addition ...~,~ ..... Alteration .......... Repair .............. Rem9val .............. Demolition .............. Other Work ............... ~ c~, (Description) 4. Estimated Cost.. ~0.(~ ....................../.z 0~ Fee ........... (to be paid on filing this application) $. If dwelling, number of dwellinglunits .............. Number o f dwelling units on each floor ................ If garage, number of cars ........................................................................ 6. If business, commercial or mixe~ occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Numbgr of Stories.. ....................................................... Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ................... i · · Height ...................... Number of Stories ...................... 8. Dimensions of entire new c?nst~uction: Front ............... Rear ............... Depth ............... I-Ieight ............... Number of Stories ........................................................ 9. Sizeoflot: Front .......... ; ........... Rear ...................... Depth ...................... 10. ~ate of Purchase ...q./.'~... i .................. Name of Former Owner ~/~..~..F~t.l/f~?-~ ......... 11. Zone or use district in ~vh~ich pr~mises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: . . ~i~. .......................... 13. Will lot be regraded ... ~ ~ ........ . ........... Will bxc~ss fill 1)e r, emoy~d,~rom premises: ,Yes 14. Name of Owner of premises j~ ~)~qqo/~7. ........ Address~ L~_.CC~.~)£d.t,t/~).~7.. Phone No. Name of Architect ...... ~ ........... Address~. ~.r2 .~./~.~. .... Phone No ........... Name of Contractor ..... ~ ........... Address.../'~e~.~/~f~l~..Phone No. ' '. i . .' ' PLOT DIAGRAM Locate clearly and distincfly"ali~ 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. STATE OF NEW YORK ..... COUNTY OF..~ ~ .~.~..LJ? ..... (Name of individual sign:lng contract) above named. He is the ...................... ....... being duly sworn, deposes and says that he is the applicant (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dull authorized to perform or have performed the said work and to make and file this application; that all statements cont dried 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 ........................ day of..~.~.~).f..t~...t~ ....... , 19 . Notary Public ~.' HOTAR¥ PUBLI~, State of N'ow Yorl( ............ i rqo. 52.452477! (Signature of applicant) I ~Uaiiti~d in Su/t01k Coun~