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Home My WebLink About12888-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z. l a 29.6. ......... Date .... F.. F.,, .B ,R.U.g. ~..Y. THIS CERTIFIES that the building )t.D.I)~.TJ.O.N. ...................................... Location of Property .2~9.5.0. ~IbI.~. [?.C).~I~ ................... .O.R.Y..E~? .................. House No. Street Hamlet County Tax Map No. ]000 Section . . ~).1.8. ...... Block . .. ~' ........... ]Lot ..... 1.0. .......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated · F.E,~BU~,~.'~...1.q ....... 198. zt. pursuant to which Building Per'nit No.. 1 28~Z dated . F.E~.I~ U/t ~.Y.. ~ 0 .............. 198.6. ., was issued, and conforms to all of tho requirements of the applicable provisions of the Jaw. The occupancy for which this certificate is issued is ......... ...~:Q~{.JL,12$~(..g,I)p~Y.T.~01q. TO AN E~ISTI.N,G ONE F. AMILY DWELLING /e~ee The certificate is issued to . ~ ,~ ~.D. . T ,q ~3.0.~. , ~, ~ ~. F. E~owner'- or tenant) of the aforesaid building. Suffolk Couttty Department of Health Approval .i~ ./.~ ...................................... UNDERWRITERS CERTIFICATE NO ......... N../.g ...................................... Building Inspector 1/81 FORM NO. 2 TOV~N O~ $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) ~T? 1~888 Z Permission is hereby granted to: ................ ..,~.~.~......~L~.........~.... .......................... ,o ...................... ...~....~.~......~.~~.~ .... :~,. ~. .~....-~ at premises ocated o, .....~..~......~....~.~. ........ ~-)~. .................. d .............. Q.~..~... ........................... County Tax Map No. 1000 Section ..... ..~....(...~. ........ Block ........ ..~. ........ Lot No ......L...~.. ............ Building Inspector. and approved by the Rev. 6/30/80 FORM NO. § TOWN OF $OUTHOLD I~uilding Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CEJlTIFICATE OF OCCUPANCY Instructions This a,]phcatioq must be filled ir, typewriter OR ink, and submit[ed in (luptica[e to the B~dlding Inmec- tot with the following; for n,~w buildings or new use: 1. F~nal survey of property w~[h accurate location of 8H buildings, property Hnes, ~,t~eets, ~d natural or topographic fast, ires. ~.: inet approval of J-iee~tb Dept. ot w~er supply and ~e~versge disposal-(S-g form or equet}. 3. Approval of electrical i~ls~a;lation from Board of Fire Unde~riters. 4. Commercial buildings, industrial bui d ngs, Multiple Res;dences end similar buildings end tiDeS, a certificate ot Code cnmpJiance from the Architect or Engineer responsible for th~ building, 5~ Submi~ Planning Br~ard aprJreval of ~.ompleted site plan req[Hrements where applicable. I:or existicO ~-~u;idings (prior to Aprlt 1~57). Non-conforming u~s, or buildings and "pre-existing" 1. Ac.mlrate s~J~ey of peopurty showh~g ali property line~, s~rcets, buildings and uraJ~el rJa~ur~,J or top,~graphic features. 2 ~vzo~ n statement of ow~or or previoJis owner as to u~, occup8ncv and condition of bL dings. ,]. :)ate of any ho~Jsing code or safety ~nspection of buildir~gs or premims, or other pertinerlt informa- t[('~q i equired to prepa~ a ce~'tHicato. ~.'~ Fees: 1 ¢.!ert fica[e of occu ~ancv $5.00 / 2. Certific~t3ofeccup~:ncyonpr~:-exis[;ngdwelling! laud u~ - -Pr','~-].:>; i.u~.i.n~ C. ~.~ 3. C~,y ~f~:ertific~te ut occupaocy $1.00 ~lac~nt~ l~nd C. 0. ~, 5.00 Date ......................... ~'~,~A, ~',~,h.n~tl ............. Old m' Pre-existin~ Bu ~d~ng . . ~ ...... V;Jcan[ Land ., ~'ou~ ~Vo.__ ~. ~ Street Hamlet Own(: or Owners of,"ro,~rty .. ~.~.~'~'' '~' ~~ .................. C,~,Jrqy 73x Map ~o. 1000 So~ion . . . .~.~ ..... Block ............. Lot St~bdivision ................................. Filed Map No ........ P,.~rmit No ........... Date of Permit .......... Applicant ........... H~alth Oept, Approval ........................ Labor Dept. Approval Underwriters Approval ........................ Planning Board Approval Request for Temporary Certificate ..................... Final Certificate .......... Construction on above described boi ding and perm~ meets a app cable~es~egula~. ~ Applicant ......... ~; .......... ~. ........................ MAI h,J GO' TABOr). 0 WA L?.~_ ~CAL.,E'. 40': l" VAN TUYL~ SON FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved .'~'..~...~. %ctt~ .4 .~., 197~. Permit No ............ Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 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 building for necessary inspections. (Signatu/~ of applicant, or name, if a corporation) .... (Mailing address of applicant) / / ~/~/"7 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . Name of owner of premises .....~....C~..~:/.~... i .~...c~...~. C ....... .~....L~...~. ............................... (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 ............................... .~ .................. ........ ............... d.. ................ ............. House Number Street Hamlet County Tax Map No. 1000 Section ..... !.~.q ........ Block .... .~.'~. ........... Lot ........ I...~. ....... Subdivision C'~ ~ Filed Map No. Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................................ ~..,. ..... b. Intended use and occupancy ...... 3. Nature of work (check which applicable): New Building .......... Addition .... Alteration .......... Repair .............. Removhl .............. Demolition .............. Other Work ............... ~. ~. .0. 0' ~ (Description) 4. Estimated Cost .... :...~. ................... Fee ...................................... ~ (to be paid on filing this application) 5. If dwelling,, number of dwelling u~nits ......... . .. .. Number of dwelling units on each floor ................ If garage number of cars ' 6. If business, commercial or mixed ,occupancy, specify nature and extent of each type of use .................... 7 D' ' f ' 'ngstru turesi if any F Rea D pth · lmenslons o eXlStl c : rent ............... r .............. e .............. Height Number of Stories' Dimensions of same structure with alterations or additions: Front ................. Rear ................. Depth ..................... !. Height ...................... Number of Stories ..................... 8, Dimensions of entire new construction: Front .... .o~..Q ....... Rear ..... .A...O. ..... Depth ... ~-..q~. ...... Height ............... Number of Stories ....................................................... 9 Size of lot: Front ' Rear Depth 10 Date of Purchase . Name of Former Owner 11. Zone or use district in which premises 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 Name of Architect .......... i ........... Address ................... Phone No ................ Name of Contractor ......... : ................. Address ................... Phone No ................ I' PLOT DIAGRAM Locate clearly and distinctly all Ibuildings, whether existing or proposed, and. indicate all set-back dimensions from property fines. Give street and block: mmber or description according to deed, and show street names and indicate whether interior or comer lot. STATIE OF NE$!tYO~RK, i o o CO~TY OF~. . ~'~ ........ ;.V ' w '~V 2; [ ..... ..... .................... being duly sworn, deposes and says that he is the applicant (Name of ~n&v~dual s~gmng contract) above named. , He is the ............ ~~~r~;~--~ ............................. ~ ........... of said owner or owners, ~d is d~ly authorized to perform or have perfomed the said work ~d to m~e ~d file ~is application; that all statements centred ~ this application are true to the best of his knowledge and belief; and that the work will be perfomed in the m~n~er set forth in the application filed therewith. Sworn to before me this ............... ' ·