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Home My WebLink About12925-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEDARTMENT Office of the Buildin§ Inspector Town Hall $outhold, N,Y. Certificate Of Occupancy No..Z.1.2.~97 .......... Date November 1 9 8.4. THIS CERTIFIES that the building .... ~. d..d.i.t.~ .o.n..~.o...e.x.~.~..~ .~.n.g.. ?.n.e.. f..a.m.i.!y..' .d.w.e. 3:.1 ±ng Location of Property .... 3.Z6 0..C.&n3 p. ~i.~ ~ 93-A. $ .d.. ................. .M.a. C..~.~.t.q c..k ...... House No. Street Ham/et County Tax Map No. 1000 Section ... ~..2.3 ...... Block ..... .0.~ ........Lot .... .0.~ .7 .......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·...F.e.b. :..1.5. ......... ,19 .8.4. pursuant to which Building Permit No.. 1 ~ 92.5. ~ ............. dated ....M.a?. c..h..1.2. ............... 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 ......... Addition to existing one family dwelling. The certificate is issued to ........ H ~ ¢ j:t.& E. I~. J3.E.I.R..iq.E ................................... (owner, IF.~.~ Rr.~t~/~Rt~ X of the aforesaid building. Suffolk County Department of Health Approval ......... ~ ./~ .............................. UNDERWRITERS CERTIFICATE NO ...... # N 656266 Rev. 1/81 Building Inspecto~ FOR~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: .~..~?.~ ...~3..~.~.,..~.~ ............................................ ......:..:..:......?...~...~: ....................... ,,...~~a.:~.~, ~..~.~ ...... :~:~m....~....~.~~ ........ ~~ ~ ~~~. .................................. co~, ,~ ~,p ~o. ~o0o sec,o~ ....L.~.g ........ ,~k.....................,~ to~ Uo ..... ~J.~ ........... Building Inspector. Fee $.~ ................ approved by the Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ~)uthold, N.Y. 11971 DN FOR CERTIFICATE OF OCCUPANCY Instructions ~ypewriter OR ink, and submitted-J~=~to the Building Inspec- ildings or new use: ~ccurate location of all buildings, property lines, streets, and unusual water supply and sewerage disposal-(S-9 form or equal). from Board of Fire Underwriters. ........................ u ........... 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 site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: I. 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, use--Fre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling / land 3. Copy of certificate of occupancy $1.00 New Building ............. Old or Pre-existing Building I Vacant Land Location of Property ............ ~..~....~....~.., ........ ~~.~. .... ~/~/~ House No. ~ ~ . Street Owner or Owners of Property ~..~ ....................................... County Tax Map No. 1000 Section .~ ~.~ ........ Block . .~.~ ........ Lot...~./.~ :r]'; .... Subdivision .......................... p N ....... Filed Ma o ........... Lot No .............. Permit No/~ ~-. ]~. Date of Permit ~ ~.Applicant .~.. ~.. Health Dept. Approval ........................ Labor Dept. Approval ........................ Unde~riters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate Final Certificate ~ Fee Submitted $ ............................. FIELD INSFECTION FOUNDATION (1st) FOUNDATION ( 2nd ) 2. ROUGH FRAME & ?LUMBING INSULATION FER N. Y. STATE ENERGY C,ODE o FINAL COMMENTS ADDITIONAL COMMENTS: Application No ................................. (Building Inspect.or) APPLICATION FOR BUILDING PERMIT ........... t£ ................ INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and submitted in du_j~,lj_c_a.te to the Building ~spector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or 'eas, and giving a detailed description of layout ofproper[y must be drawn on the diagram which is part of this application. 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 issue a Building Permit to the applicant. Such perrnit ~all be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy ~all 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 ~ilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws Ordinances or egulations for the construction of buildings, additions or alterations, or for removal , rmdemolition, as herein described. !,)e applicant agrees to comply with all applicable laws, ordinances, building code, hou: ~g code, and regulations. ................ ........................... (Signa ure at app/cal or nome, if a corporation) [ ' (Address of applicant) ate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................. ..................................................................................................................................................... ' ame of owner of premises ...t/.~,J:::.JJ.a$;L.....~.5~-:'..,lZ,~J./~: .................................................................................................... applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No......~..!.7. ............. Street Number ~wumc~p~n~ 2, Store existing use ond occuponcy of premises ond intended use ond occuponcy of proposed construction: 3. Nature of work (cheek which appl'cable) New Building .................. Addition ......... ~....... Alterotian Repair .................. Removal i Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ..... a~.J~4.'~,,.?.~.';: ............................. Fee .......................................................................................... (to be paid on firing this application) 5. If dwelling, number of dwelling units ........... [ ............... Number of dwelling units on each floor ............................ If garage, number of ¢~rs ...... .. ...................................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ Rear ...r...¥. ........................ Depth ::~, ............ 7. Dimensions of existing structu!es, if any: Front ............ , ............... ' ' ' Height ..~0'..(~'.~ ....... Numb:er of Stories ............... t.~-~ ....................................................... : .................................. Dimensions of same structural with alterations or additions: Front .......... ~..7] ...................... Rear ....~'.~ ................... Depth ...... ~, ..................... Height ....... r~¢l'''~''~''i ......... Number of Stories 8. Dimensions of entire new conbtruction Front ...... ,,>~.4...0. ................. Rear .......~.,~ De~th ,:.~ Height .................... Numberl of Stories ...................... ,,~.,3; ........................................................................................ 9. Size of lot: Front ........ ,:.:¥,.'~:~.~;! ........ Rear ........... ~'X. Depth 10. Date of Purchase .................. ! ...................................... Name of Former Owner ........................................................ 11. Zone or use district in which premmes are situated ..................................................................................................... 12, Does proposed construction violate any zoning law, ordinance or regulation? ............................................................ .:,~.~C.(~ · C .,~-s.~?..~ ,~ ~ O, ~'- f~,..~:'~Phone No ..................... 13. Name of Owner of premises .l:.~.~,.I~.l.~, .:b,...i~,t:,i~'.N.L:~...Address .... > ~ Name of Architect .,. ,.,.., ,, .,.~....:..,,. ...... ~...~ ..... Address ..?\.~v,\~..~,,~,[-, ............ I.....,,.';~ PJ~ona No. Name of Contractor ..............' ...................................... Address ............................................ Phone No ..................... PLOT DIAGP Locate clearly and distinctly all buildings, whether existing ~roperty lines Give street and blo~k number or description ¢ vhether mtenor or corner lot. , ,TATE OF NEW ,Y, QP~,,,,, / b c :OUNTY OF .... /.~..'0,4~. ............ ~'f'~ ). .................. fi.~..)~t~f~'/~.~.....,.~.;,/~t/,,//.~,d]4,,l.! ......................... being duly sworn, deposes and says that he is the applicant (Nb~n'eJ'o( ifidiv'[dual [i'gnidg'~pplication) ~bove named. He is the ....... /.]¥,?~,¢.?~./.7.-~,a..T_~'"~ ........................................................ ..................................... ' ~ r ~Contractor, agent, corporate officer, etc.) f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file qJs application; that all statement~ contained in this application are true to the best of his knowledge and belief; and qar the work will be performed in tBe manner set forth in the application filed therev 'h. wornlt~before me this .................... day of .................... ,,, _ · Z; .......................................................... ~otary Public, ........................................................... C t)'r,, .J 0 FTO L~' V,¢,,"',. "FLI'.,/t... ,,. SON