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Home My WebLink About12950-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No .... ~3.Z84 ........ Date ........ ~gggg.%.$? .............. 19~. THIS CERTIFIES that the building ..... p. qr..c.h..a.d..c.l.i.Lj:.q .n: ......................... Location of Property ..... 3, 8 ~.0 .......... ?.b.a...Lg.n.c,[..W.ay. ............. g..a.s.c..~.a.r.~.qn.... House No. Street Hamlet County Tax Map No. 1000 Section ..... 3. 0 ..... Block ........ .2 ...... Lot ..... ]..2. 9. ......... Subdivision .... P.~bbl.e..B~,.c.h. ~,g,r.m.~ ..... Filed Map No....6.2:6. 6. .Lot No ........ 4.5. .... conforms substantially to the Application for Building Permit heretofore filed in this office dated March 19 8~p 12950Z ...................... 19. ursuant to which Building Permit No ...................... dated...........March ....29.. .. . .. .. ....191~4. ,wasissued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which ttfis certificate is issued is ......... Porch addition to existing one-family dwelling. DOROTHY & EDWARD ALBER The certificate is issued to ........................................................... (owner, ~'1~Xo~~) of the aforesaid building. Suffolk County Department of Health Approval .................... bl/A' .................. N/A UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1181 TOWH O~ $O~THOLD BIJILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 12950 Z Dateoil c~ ....... .~.~ ................. ~ ................. ~_~..~...o...~..,..~ .:~:: ........ !.!..7,.~.~...., ........... .......... at premises I~ated at ..../..a..~.a......~.....~.~ ............ .~.,....~. .............. ~.~ .. ~~ .~ ~,. ~ ~ .~..~.2~ .~ Coun~ Tax Map No. 1000 Section ...~.~.0. ........ Bilk ....... 0..~ ...... Lot No ...... /..~.~ ........ Building Inspector. Building Inspector 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 subm~tted=i~c~--',' ' '-':-"*" ...... 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--(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. 5o 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 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 Use 3. Copy of certificate of occupancy $1.00 --Pre-Existing C.O. $15.00 Vacant land/C.O. .$ 5.00 Date ... ........ New Building ............. Old or Pre-existing Building ............ Vacant Land / Loca, on of Property ~?.~ ~ ~¢~/4~/~ ~,--~ .,~,~P~C-'~ ~ :.~ Hou~ No. ~ //'Street ............ ' ............ ' ~ Ham/et Owner or Owners of ProoerW ~~ ~ ~j ~ ~ ~_;~o ~ ................ 7~ ~ ...... County Tax MapNo. 1000 Secton '~ Bock ~ O - _ ~ ,~ - ~ ....................... LO~.. ~>, ~ ,~ ;q .q,, , Subdivision ................................. Filed Map No ........... Lot No .............. ~ ~ No.. (A .Y~.~ ~D.~ o~ .~r~ ..~..~ ....... ~ ................ Health Dept. Approval ........................ Labor Dept. Approval ........................ Unde~riters Approval ........................ Planning Board Approval ..................... Bequest for Tempora~ Certificate ..................... Final Certificate ~ . , Fee Submitted $ ........ ~ ........ ( ~ ...... Construction on above.described bu ilding aS ~rmit meets all ~PPl~ble~ c~Jes and regulations. C,O.,? Z.l~'l%q~ ~ ~'~ ' ' ~,~, c~ 7~- ',-~' Applicant ~. , ~~: ................. Rev, 10-10.78 FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING 3. INSULATION PER N. Y. STATE ENERGY qO E 4. FINAL 76S-t802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH'PLBG. FOUNDATION ZND [ ] INSULATION FRAMING [ ~/fFINAL DATE INSPECTOR FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined ^pproved Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets o! 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 issue 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 Occupartcy shall have been granted by the Building Inspector. .~PPL!CAT!ON IS HEREBY MADE to i:he Building Department foi' the issuaffce 6f a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o~ 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 cod~, and regulations, a~d tc admit authorized inspectors on premises and in buildings for necess~ ~~ (Signature of applicant, or name, if a corporatior0 ' (Mailing address of applicant) ///7o~°~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or b~xilder. Name of owner of premises. ~...~. ~.....~..."~..~( ............ i ......................... //(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 ...... ~..~. l .~ ............. Plumber's License No ......................... Electrician's License No ...... '~. ................ Other Trade's License No ...................... 1. Location of'land on which proposed work will be done ...... ./..~..~9..0... //~,...~ .~...~ .............. ..... ....... ........ House Number Hamlet ( County Tax Map No. 1000 Section ..... O..~..~ ....... Block ...... .~....~ ...... Lot....~. '.~ ........ Subdivision...~.~.O.... ~¥.~.. Filed Map No..(_D..~(0.9. ' Lot...../'J~... ....... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... ~~'~' '" ',:' '~" ~: ~"51 ..................... -b. Intended uso and occup~cy ... ~4~,~ 3. Nature of work (check which pplicable): New Building ......... Addition .......... Alteration .......... Repair Ren oval Demolition Other Work 4 Estimatea 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 number of cars 6.If business, commercial or mixed occupancy, specify n~u~re and extent of each t~p,e of use ............. z ...... 7.Dimensions of existing structures, if any: Front .... O".~. ........ Rear .. ?..d~ ........ Depth . ..,~..~. ........ Hei llt . . Nu bet of Stories .. g ............. ~n ..................... x ...................... ./ ........ Dimensions of same/structure with alterations or additions: Front .... .~.f. .......... Rear ..... ~..4P. ........ Depth ..... ~.?. .......... i. · · Height ............. ~ ........ Number of Stories ..... .~ ....... ? ....... 8. Dimensions of entire new cons[ruction: Front ..... ~..~ ....... Rear .... ~'7.a.../. .... Depth .. ~ .......... Height ............... Number of Stories ....... .,,~ ............................................... 9. Size oflot: Front ' ...... IleDth .....a..... 10. Date of Purchase .... ~.~'. ~. ................. Name of Former Owner . .-.-....... ,x:n~rfC~,~' ..... . .... 11. Zone ~)r use district in which p~emises are situated ..................................................... 12. Does proposed construction v~la. te any zoning law, ordinance or regulation: ..... ~ ........................ 13. 'Will lot be regraded ....... &.t.Og .......~ ...... ~, .. 2. Will excess filk be. removed from premises: , Yes ~-~', ~No Name of Architect ......... i ............ (/ ..... 'Address ................... Phone No ................ Name of Contractor ........ i .................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly ail buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and bloci: number or description according to deed, and show street names and indicate whether interior or corner lot. ~ ~ .....- "f'~~~~;a'c~j~~ .......... being duly sworn, deposes and says that he is the applicant above named. He is the" (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perfornt 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 manner set forth in the application filed therewith. Sworn to before me~t~hi~f i '