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Home My WebLink About12891-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z12658. Date July 31 198.6 THIS CERTIFIES that the building..D.e.c..k..a.d. O. ~, .g.~.q n...~.o., e. ¥ ~.s.g. ~ ¢ g..b. U ¢ ~.d.~, ~ g ...... Location of Property 430 West Shore Drive ..... Southold ..... .............................. Street ....................... Hamlet House No. County Tax Map No. 1000 Section .0.8..0 ........ Block . .q ~ ........... Lot ...(~ 0 ~ ........... Subdivision .... ~ .e.y.~ o..n..S.h., o. ~ ?.s ............ Filed Map No ......... Lot No. 2. J .-.2.~ ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated 2/23 .., 19 84 pursuant to which Building Permit No. fi. 2..8~.1.Z. ............. dated .... .2./.2. .7 ................... 19.8.~., 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 ......... Deck addition to existing dwelling.. ................................. D. ANNINOS The certificate is issued to ..................... ?o~,n.o.r,~y~t.d~.~.x.,~ ................... of the aforesaid building. Suffolk County Department of Health Approval .......................................... N/g UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 FOF,~ NO, ~ TOWN OF $OUTI'IOI-D BUILDING DEPARTMEhIT TOWN HALI. SOUTHOLD, N. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12891 Z Permission is hereby granted to: ........... ..~....~.....~~/~ .............. ......... ~....,.:~.~_m~..~..~_~~. ..... ....... ................... ~/. ~. ~. ~z~. ~/... ~.. ,~ ...... ~z~ ~ ,o ..,~.~.~ ....... ~...~..~.~.~...~~..~~ ........ .... '~ZZ~ ............................................................................................................................... at premises I~ate~at ...~ ......... ~..~~...,~ ....... ~~Z;~'~ .. ~. ~ ~ ..~ h'~.~ .................................................... ~ ................................. F ............. co..~ ~.x M.~ N.. ,,00 s.~,,o..~.~ ......... ,,~ ...~.~ ......... ~, N,....~ ........ pursuant to application dot~ ...~~....~ ........ , 1~ and approv~ by the Building Inspector. Fee ,../..~.~ ...... '"v Building Inspecto~~'~''['''''j'' 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 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 disposel-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4, Commercial buildings, Industr|al 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 aite plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land usos: 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 occupancy 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 Date .......... .?./. ~1,~, ....... New Building ............. Old or Pre-existing Building ............ Vacant Lend ............. Location of Property ............... Hou~ No, Street Hamlet Owner or Owners of Property ....~.,.. ~t~. h~. li~. ·O. .J ......................................... County Tax Map No 1000 Section. .~..~. Block .', .~. Lot .......... Subdivision.. (.~.D.~ .~. .... SJ~ ........ Filed Map No ........... Lot No. ~.~., .v~. .... Permit No. ate of Permit .-. cant.., i .................. ~lth Dept. Approval .............. Labor Dept ......................... Underwriters Approval ..... ~,,~ ......... Planning Board Approval ............ ~ ....... Request for Temporary Certificate .................... ~Final Certificate ....................... Fee ~ubmitted Si Construction oni~bovelt described buildint] and permit meets all applicable codes and regulations, Applicant~.'~.~%~ .~... Re*/, 10-10-78 FIELD INSFEC'rION~ COMMENTS FOUNDATION ( 1 st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY FINAL ADDITIONAL COMMENT~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765~1802 .,, X.. Pe it No × 2£ ?/ Approved. ~.-.~..~..~,--~,~..., n ............ Disapproved a/c ........ -~ ......... ~/ ..... ~. (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 shah 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 remova[ or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances/.'~auilding code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessarg~.__~ '~¢nnOn'~,~. ~ ~ignature of apl}licant, or name, if a cotporation) · )..q. .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (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 ............................................... House Number Street Hamlet County Tax Map No. 1000 Secti~ ...... ~, ,-'.':...Z;". .... Block .................. Lot ................... 2. State existing use and occupancy of premises and intefided ~lse and occupancy of proposed construction: b. Intended 3. Nature of work (check which applicable): New Building .......... Addition .......... Alterati~,t2t;j~ .... P, epair .............. Rem6val .............. Demolition .............. Other Work... t~r~.,-,-~ ..... ' (Description) 4. Estimated Cost .... Fee ............................. (to be paid on filing this application) 5. If dwelling, number of dwelling~units ............... Number of dwelling units on each floor ................ If garage, nmn bet o f cars .... ~ ................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing stmctur+s, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ D~efisions of same structure with alterations or additions: Front ................. Rear .................. Depth ................... ?.. Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ......... , ..... Rear ............... Depth ............... Height ......... ~ ..... Number of Stories... 2 ................................................... 10. Date of Purchase ..... [ ~ ~ ~ ................. Name of Fomer Owner ....................... 11. Zone or use 6istrict in which p~emises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will i0t be regraded ........ .................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .. ~ .................. Address ................... Phone No ................ Nme of Architect ............................ Address ................... Phone No ................ Nme of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly al} 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 YOlk, COUN~TY OF ..... /~.t.d.~ .~.~..' a'a ........ ~ .~."3'?:.~> ..../~./x).{~Q .~. ,~3.~_~3 · being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d¢ly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the mantlet set forth in the application fil~d therewith. Sworn~to. before Ine this ......... /.~..*",4 ...... day ~f. ~..~'.~ .~..4~ . .:'...., , 90~..~ / N~k;, Y:~?t,~4'~f New Y~k ........... ature of applicant)