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Home My WebLink About12870-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THXS CERTIFIES that the building --New Dwelling Location of Property 1650 Truman's Path East M.arion County Tax Map No, 1000 Section 031 .Block 13 .Lot 05 X Fil d Map N X L X Subdivision ............................... e o ......... et No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... Feb. 7 ,19 8..4pursuant to which Building Permit No. 128701 dated ........... ~.¢.b.... ~..5 ......... 19.8./3, 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 certificate is issued to ......... F.U. CC ILLQ, JOAN&~IC~OL~fi ........................ (owner, lessee or tenanO of the aforesaid building. Health Approval 1.3-$O-227. Suffolk County Department of ........................................ UNDERWRITERS CERTIFICATE NO N-652068 Building Inspector Rev, 1/81 FO~I~[ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CT'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 128 0 Z Permission is hereby granted to: to. ::~ ~...~..~ .~'~. at premises located at ..... !.~.~.~.?........~..2.~..~.+..~:.~.~.%~.:~?.....~..~.~.,~..~.~......~...r4~......!~.~/~::~ ........... County Tax Map No 1000 Secton ,,~c~...~. ........ Bock .......~...~ ......... Lot No...~. ................ pursuant to application dated .~Z'~;!'.~¥.~, ~,~ 19..~..~t., and approved by the Building Inspector. Rev. 6/30/80 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION lSTr~ ROUGH PLBG. FOUNDATION 2ND ~, INSULATION FRAMING [ ] FINAL 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST ?~] ROUGH PLBG. FOUNDATION 2ND [~ INSULATION /~] FRAMING [ ] FINAL REMARKS: 765-1802 BUILDING DEPT. INSPECTION [~ FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION FRAMING [ ] FINAL REMARKS: N E~ ~0 ~K THE ' ' · ' ~UREAU OF EI~ECTR C .,' .... , . e5 JOHN S"~REET NEW YORK, NEW 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 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-iS-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and simqlar 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 applicabler B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peopertv 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 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/ land use 3. Copy of certificate of occupancy $1.00 --Pre-Existing C.O. $15.00 Vacant la~d C.O. $ 5.00 .... Date ...... -.~.. New Building ........ · .... Old or Pre-existing Building ............ Vacant Land ............ Location of Property/Yeu~e No. .. Street .............. Hamlet Owner or Owners of Property . /~.,. ~ ; ..................... County Tax Map No. 1000 Section . , 0 ~ / Block . ./..-~ Lot ~o Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. ~ Date of Permit . .Applicant ................................ [~T.~ ~ ~% Labor Dept Approval Health Dept. Approval ................................. Unde~riters Approval, · ,~ ............... Planning Board Approval ............... Request for Temporary Certificate Final Certificate ,~ · ........... Fee Submitted $ .... ~. ~' ~ .................... Construction on above described building and per, nit meets all applicable codes and regulations. c~ q~oq~ FORNI NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971, TEL.: 765~1803 ."f ~ .~ } .~.., 19~.I. Permit No./.~. ?.~ .~ .'~... Approved. Disapproved a/c ..................................... Application No .................. (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 tlEREBY 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_inst, c~ons. .. ~/x, vazr. ~./~- ~- .~~.o.,~ (Signature of applicant, or name, if a corporation) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. Name of owner of premises.. J;t~f~ .... ~,~7~... ~ .............................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. Builder's License No .... ./~/t .................. 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 co.~ty ~x ~ap Xo. lO00 S~tio~ ....... O. ~Z ...... mo~k ..... ZS ......... ~ot...-~ ............. Subdivisiou ..................................... ~il~d Map ~o ............... Lot ............... (Name) Stat~ ~xisting us~ and occupan:y of pr~mis~s aha intended us~ and occupancy of proposed construction: ~. ~,= u~ ~,~ oo~,~an~, ...... ~a.4~.W..,Z~ ~..~ ~ ............................. b. Intended use and occupancy ... / 3. Nature of work (check which ap.pi/cable): New Building ...... Addition .......... Alteration .......... Repair . ............. Removal .............. Demolition .............. Other Work ............... ~ (Description) 4. Estimated Cost ....'~..&../. ~.i ......................... Fee ...................................... ! (to be paid on filing this application) 5. If dwelling, number of dwelling ~nits ............... Number of dwelling units on each floor ................ If garage number of cars i 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use si f ~ if a D pth 7. r)imen OhS o existing stmctur s, ny: Front .............. Rear .............. e ............... Height ............... Number of Stories .............. i .................................... Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... i.. Height ........... ./ .......... Number of, Stories ........... ..~. ,q. ...... 8. Dimensions of e~ire new constrUction Front ~ ~ . . Rear . ~ .... Depth ....... ~.~.! ........... Rear ....... ~...~.. ' '. ' ' ' ' ' ' 'Depth' '. ' '~..~.~'. ': ' ' ' ' ' ' ' ' ' ' ' 9. Size of lot: Front 10. Date of Purchase ........... ,.. Name of Former Owner 11. Zone or use district in which pr~mises are situated ........................ ; t~ .......................... 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 Name of Architect .......... ................. Address, .... Phone No. . Name of Contractor ~,~.~.,f~.. ,~,~ ~V~.. ~c~.. Address Phone No. PLOT DIAGRAM Locate clearly and distinctly alli buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. G~ve street and block inumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORICo~ ~ /~ jS.S COUNTY OF .... ~'-(.J.~(~. · .~. · · · · I .......... · ~.~ ~...~.~ ................. being duly sworn, deposes and says that he is the applicant (Name of individual signling contract) above named. ~ He is (:he....~,~ ./.~ .... ; ................................................................... I (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 conthined in this application are true to the best of his knowledge and belief; and that the work will be performed in the mann{r set forth in the application filed therewith. Sworn to before me this ....................... day o. ..... ~, .., 19 Notary Public, . ............ ~-,~c-I...~.~.. Term Ex~r~ (Signature of applicant) T Z i.u T 0 ,>- 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION ::'ND [ ] INSULATION [ ] ROUGH pI-BG. FRAMING ~ FINAL REMARKS: 2-- ' , DATE ~, / Il) ~ dl" INsPECToR