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Home My WebLink About12884-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. zl. 3185 Date Feb. 5 19.8.5. THIS CERTIFIES that the building Accessory Location of Property .... ,4.4.5, ................. S..m.~.t.h..~.d.. .......... Peconic .ou~e ~vo. .~'treet .............. I:l~ie~' County Tax Map No. 1000 Section 098 .Block 04 ..... Lot 005 Subdivision .......... X ................. Filed Map No ....... Lot No ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated Feb. 2 19 8.4. pursuant to which Building Permit No. ;. 12884Z dated Feb. 2 3 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 ......... . Accessory Two Car Garage .............................................. The certificate is issued to ........... .~...K..~.N.~.E.? .H..~..N..~.qY...B....S. ~.I?.H. ................ (owner,=~ess~e=or=~) of the aforesaid building. N/A Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO ..................... ~./..~ .......................... Building Inspector Rev. 1/81 FO~M NO. 2 TO~N O~ $OUT~OLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PE:RMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF TIlE WORK AUTHORIZED) N? 1~88~ Z Permission is hereby granted t~,~ ~.. ~'~._.~.~ ~ ...... ....... ./.~.'.........~.~:..,~..7., ................................ ...... ~_~ ..~..~ .~.... ~ ~, ....~o.L~<,~cz...~~~....~..... ~d~....~<~y.~t.. ............. .............................................................................................................. ~..;.....~ ........... ~ ~.~~ .............. at premises ~oteo ~t ........ ~..~ ....... ~<L.~....T.~......~ .............. ~.~...~ .............. County Tax Mop No. lO00 Section ...~..~..~... ....... Block ......0.....~... ....... Lot No.....~.....(~....~- ..... pursuant to application dated .~~...~.;.~.~.. ....... ~.. ...... , 1 , and approved by the Building Inspector. Fee ,,../.Z. ................ Building In,~ector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLO Building Department Town Hall ,qouthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY BLDG. DEP¥ TOWN OF $OUTHOLD Instructions A.This application must be filled in typewriter OR ink, and submitted in dupltothe 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 featu res. 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. B.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 p~operty 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 occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 " 4.Vacant New Building ~ ,. Old or Pre-existing Build ng .......... Vacant Land ........ ~ ..... House No. i ~ I , Street ,,,, .~ I, '/ Harmer Coun Map 000 Section . .g7 ......... ..... q ......... Lot ............... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No .................................. Health Dept. Approval ............ : ........... Labor Dept. Approval .......................... .~. ?.~.'??.~C Planning Board Approval Underwriters Approval ...... ~ ........................... Request for Temporary Certificate ..................... Final Certificate .... .~. ................. Fee Submitted $ ..... .~7.~. ....... .......... Construction on above described building and per~i~eets~all applic,,a~e~and regulations. ~, ~),_/~'[0 \ '~ Apphcant ...................................... Rev. 10-10-78 FIELD I$!SPE~TION ~ · DATE COMMENTS FOUNDATION ~ (lst) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY QODE FINAL ADDITIONAL COMMENTS: h FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1802 Examined..VS .. .... 19 Approved. . .~..~ ...., 19~.'~. Permit NO./'. .. Disapproved a/c ........ . ..~....~ ........ ,.~ .... /' , ...................................... (Bu Hding Inspector) APPLICATION FOR BUILDING PERMIT I FEB 1 198 I 'ill BLDG, DEPT· TOWN OF: SOUTHOLD Received .......... ,19... 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 Peimit 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, bull,ding, . code, housing_.....code and regulations,_ and to admit authorized inspectors on premises and m building for necessa~I}~p~,~tlons.~L __CT' '"/'fi-x, ~ . i/v.. )--.-..-r-..-: _: .7 ........ ;,~. · 1 .......... : ...... (Signature o f applicant,i ~r. ~h~x~,. ifla cgrporatlo, n) .... .......... iMailing address of applicant~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on thte tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ( ,N_ame and title of corporate officer) Builders License No~./f~'.I;. .~.:.&/~./.i.U.9 .... Plumber's License No ......................... Electrician's License No: ,<. ..................... Other Trade's License No ...................... 1.,/L°cati°n.~..~..~.°f land .... on which proposed .~.../--'f-~. · ¢c/~.w°rk wil.~l, be done~.~., .................................................. . .~..~q~.z~4.~. ~../.../~. '..~...... House Number Street Hamlet County Tax Map No. 1000 Section~....~).?.~. ......... Block ./....~f ............ Lot.V~....~-.. ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy..Q~.&/.~.. F.~.,/~/./(-. ~....~.././/..~..C/~ .... ~.:.1'7:.~./.~..~.~./..,~.... a, b. Intended use and occupancy ...~.-~t,(7,~5~...2~...Z~.t~...z,~7~. ~-.~...~/~,f'~.~./ .............. / 3. Natm:e 6[~J~hecl~i~'b applicable): New Building ... ~, .... Addition .......... Alteration ........ Repair .............. Removal .............. Demolmon .............. Other Work .............. 4. Est*mated Cost ........ 0 ....................... Fee . .~ ........................... ~ifl~(¢"':"c'?" ;c,q(~,, , } , (to be paid on filing this application) 5. ~;'~ '~er of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars ... ~ .................................... ; .............................. 6. If business, commercial or mixdd occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing stmctur~es, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stohes ........................................................ D~ensions of same structure w~th alteratmns or additions: Front ................. Rear .................. Depth ......... ;... HeiSt ............. ~/.. . Num}elof Stocks .......... o · · ,. · · ,/ .... 8. Dimensions ofen~r~new constmctmn: Front ~ --O, Rear . ~.. ~ ..... Depth ~.~. 7.~. . / r a ~ ..... ~'~' ' Height . . . ~....~ .... Number of Stohes . . . ~ .............................. ;. ~.~ · .~ ....:,~ .... 9. Size oflot: Front ....... /~.~.~ ..... Rear .~'O~// ...... 2 ..... Depth /[}'.~?, I ]. Zone o~ use district ~ w~ic~ ~temis~s ~ situated.. ~%~.~ ....................................... 13. Will lot be regraded ..... A JUly., .~ .... ,,. ~...~ .......... Will excess fi~ be removed from premises: Yes 14. Name of Owner of premises~q~¢~. ~: ..... Address ~'*~..~QNT:~' ....... Phone No ................ Nme of Architect ......... ~...t ............... Address Phone No Nmne of Contractor ~[¢ ~Cq ~ Address ..................... ~; ;. C,~:~ ...... Phone No.7.~'~7~ ....... ¢', PLOT DIAG~M Locate cle~ly ~d distinctly ~1 bufld~gs, whether existing or proposed, ~d, indicate all set-back d~ensions from prope~y Hnes. Give street ~d bloc~ number or description accor~ ~}e~, ~d show street names and indicate whether interior or corner lot. .-~ ~,~ _. ................... - .... COUNTY :0: ................ (Name o~ ~ndividuM si~:~ co~t~ct) above n~med. ~ is t~e ..................................................................................... (Contractor, ~e~t, co~pomt~ office~, ~tc.) o: s~d o~no~ o~ o~:e~s, ~d is dgly ~ut~o~ed to ~effo~m or h~ve peffo~ed th~ smd ~o~ ~d to m~ ~nd ap~]kafion; that ~ st~tem~nt~ co~ta~ed ~ t~s ap~c~do~ a~e tree to th~ b~st o~s ~o~edge and b~]~e~; ~nd t~t ~o~ ~1 b~ ~ffo~d i~ th~ m~e~ s~t ~o~th i~ t~ ~]k~do~ ~l~d therewith. Sworn to b~fo~e m~ this Nora, Public, , ~,..~~~ County / ]/ i / ~ /guali~,M h, Na~,,,,u Co,.*v .~/~ . ~nature of apphcant)