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Home My WebLink About13302-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y, Certificate Of Occupancy No ~.1291,~ Date Oct. 22 19 8.t! Accessory garage THIS CERTIFIES that the building ................................................ L ' of P rty~3~}jo2365 Ackerly ?end Rd. Southold ocatlon rope ......................................................... · Street Hamlet County Tax Map No. ]000 Section ...0. 6. ~ ...... Block .. 5. ........... Lot ...... .2 .......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Pemfit heretofore filed in this office dated ·.. J.u.].y. 2.4 ...... ,19 ~3.4 pursuant to which Building Permit No . 1 3.3.0 2 .Z... dated ....g.u3.Y...2.7 ................. 19 .8.6,, 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 ......... The certificate is issued to ....F?e d (owner, ~q]q~ ~CeEff X X X of the aforesaid building. Suffolk County Department of Health Approval ........... ~../? ............................ UNDERWRITERS CERTIFICATE NO N/A Building Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TO~'N HALL, SOUTHOLD, H. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13302 Z Permission is hereby granted to: ...G.,,,~.~...~..~~ ...................... .....~.~..L.~ ........................... ~ ...................... ~'~'"'~'"~'""'"'"~'~"l'"i~"I ........ ,~ ,.. ~ ,o ..~~....~.~.~....~~...,,. ............... ~~...~ :;;~=';~=':'i~i~i~"i'ii~iii. .......... ~~::::'~::':::~~"...... ...... . .. .. County Tax Map No. 1000 Section~"-~ ~' C~ f~cJ I.~...=...~ ....... Block ....... ~ ......... Lot No ..... . .~... .............. pursuant to application dated ......... ''~....~...~ ....................... , 19.~.~'..,-- and approved by the 1 ' Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Buiiding DeparTment Town Hall Southold, N.Y. 1 ig71 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Buildin9 Inspec- tor with the following; for new buildings or new use: 1. Final su~¢ey of property with accurate location of all buildings, property lines, streets, and unusuai natural or tooograoh[c features. 2. Final approval of Health Dept. of water supply and sewerac~e d sposal--(S-9 form or equal). 3. Appmvat of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar build[ng~ and installa- tions, a certificate of Code compliance from the Architect or Enoineer responsible for the building. 5. Submit Planning Board approval of completed site plan requiremer~ts where appiicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buitdines and land uses: ~ pre-ex~stmg 1, Accurate survey of peoperty showing all prooerty lines, streets, buildings and unusual natural or topograph[c features, ' 2.Sworn statement of owner or previous owner as to use, occuoanc,/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 ce~ificate. ' ,/ C. Fees: 1. Certificate of occupancy $$.00 2. Certificate of occupancy on pre-existing dwelling or lend use $5.00 3. Copy of certificate of occupancy $1.00 New Bui!ding .~.~.~..~,~, .... Old or Pre-ex'sting Buiioing(Z) . ~ -- = ZVacant Land" Hou~ /Vo. .. S~ree~ Namie~ Owner or Owners of Property ~ ~ ~ ) ,o., 00o s o, o, . g.G ...... '. .... ........ .......... Subdiws~on Filed Map'No ~ Lot No Health Dept. Approval ........ ~ ............. Labor Dept. Approval U itc App I ' .- . ndeP,vr rs rove .. ~ ,'.- PI i gB dap I ................... ann n oar prove ............... ~ ,., Request for Temporary Certificate .... . ................ Final Certificate ........ - ......... Fee Submitted S ~' ~ .~. Construction on above described building an~ pfrn~i[ meets all aP~fi~abl~odes and regulations. ...................... FZE~D Y~SPECTZON FOUNDATION (1st) CObIMENTS FOUNDATION 2. ROUGH FRAME & ?LUMBING (2nd) ~r~ ~Az ~C INSULATION FE/H N. Y. STATE ENERGY QODE FINAL ADDITIONAL COMMENTS: 76SA802 BUILDING DEPT. INSPECTIO L DATE /~//~/,~// INSPECTOR* FOUNDATION XST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INsuLATION REMARKS: FRAMING [~/~INAL ~' ~ L~' ~ ' FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL,: 765-1802 Examined i~i '~'" 19~.~. Approved . ~."/.., 19~ ~. Permit No..].~..~..Q..~..~ Disapproved a/c ..................................... Received ........... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 1S 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, ~¥ilding code, housing code, and regulations, and to admit authorized inspectom on premises and in building for necessary ' s~ctions.. ~ ~ · ..Iq .... .... (Signature of applicant, or name, ~t.~ co porat' ) ....... (Mailing address of applicant) I State whether applicant is owner, lessee, agent, architect, en~neer, general' contractor, electrician, plumber or builder. (as on the tax rollhfr 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. t.,... . .~' 1. Location of land on which proposed work will be done .................................................. House Number 'Street Hamlet ' County Tax Map No. 1000 Section . .~..~-,~ ........... Block ... ~ ........... Lot....~.. ............. Subdivision ~ Filed Map No. ~ Lot ........... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed constructi°n: a. Existing use and occupancy ..... 2.'~- ............................................... b. Intended use and occupancy . .~.o~ .~.~C~'~- ................................................... 3. Natureofwork(checkwhichapplicable . .~ .......... Alteration .......... Repair .............. RemOval .............. Demolition .............. Other Work ............... 4. Estimated Cost.. ,~.~,~. ~7..O.. O?. ~ ~ ............... 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 .nature and extent of each ty, pe of use ...' ......... ~ ....... 7. Dimensions of e~isting structures, if any: Front..'.~.~. t ......... Rear . ~ .~ ......... Depth . ,,~.~-~ ........ Height . ./. ~ ......... Number of Stories .... ~-~ ................................................ Dime~sinns of same structure with alterations or additio~ Front ..... '..'~-. ....... Rear .. "- ...... Depth. ~ ............ :... Height ...2f~. .... ~ .......... Number of Stones ...... :: ............. 8. Dimensions of ~ntire new construction Front .. ~2.~..'. .... Rear ,,2, ~ t . Depth ,~ .3 ' . .. Height /.~ ..... ,.. Number,of Stories I a/.~.. ". ..' .... i i ....i .......... 9. ~izeoflot Front 1~..~*.~..~ ...... 'h;~; ~,~,i-.'~'~'~i.t. 10. Date of Purchase .......... ...."~':.. ........... ,,. Name of Former Owner .O~..g.cC.. ~ ..~. ............... 11. Zone or use district in which premises are situated .I.~.w l ..... 12: Does proposed construction wolate any zoning law, ordinance or regulation: . ~ ............................ 13. Will lot be regraded . I~J. O... .................... Will excess fill be removed from premises: Yes 14. Name of Owner of premises .. ................ Address ................... Phone No. '~6'~ 7. I .q. I~,~...'~". Name of Architect ........ '-w-.. , ................ Address ~.., .--r~. .............. .,.Phone No, Name of Contractor .~ .~-,~..~ t~ ,~o ~/~tt.~o~ *. 't~/. · '~'. ~ ..... Address~oae,,Ir/-/o.~. q~/~/.t~.. Phone No. ~.'~i~ ~ ~- Locate clearly and distinctly all property lines. Give street and blockl number or description according interior or corner lot. Ir.9 ~/ PLOT DIAGRAM buildings, whether existing or proposed, and. indicate all set-back dimensions from to deed, and show street names and indicate whether STATE OF NEWYORK, COMITY OF..'-24. .L/.C ....!S.S · · ~~ .%..~ .~,~..,~-. .............. being duly sworn, deposes and says that he is the applicant (IV',fme of individual signing hbntract) above named. He is the.. ~ .................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is du!y authorized to perform or have performed the said work and to make and file this application l that all statements conthined in this application are true to the best of his knowledge and belief; and that the work will be performed in the mann6r set forth in the application filed therewith. Sworn to before me this ........ ~ .......... day oi .... . .~...ct...L..~ ........ 19 .~.~/ Notary Public~..~.. ~.~. LINDA F, KOWALSKI IqOTARY!PUBL C, State of New Yore ' 1' ............ ; .... i No, 52-452477! (JtSSignature of applicant) @ualified in Sulfolk County Commission Expires March 30~