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Home My WebLink About13108-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Cerfificafe Of Occupancy No..Z. ~. ~ .2.7.5. ......... Date March 20 1985 THIS CERTIFIES that the building Deck and fence Location of Property ....3.2.-~9~ Main Road Orient County Tax Map No. 1000 Section ....0.1.~ ..... Block ......... .~ ..... Lot .... 1.3. ........... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... ~-a. I/. fi. ............ 198.4.. pursuant to which Building Permit No..~ .3fi. 0. 8. .Z .............. dated ....... .Iyi.a.y...8 ............... 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 ......... .... C on.s.~u¢.k .deck .,~u~..C~ u.c.e..a, rp.u.r~q..e.x,i..s ~.i.n.g..a.b. qv..e..,~.r., o..u.n.d..pgp.~.: ..... The certificate is issued to ..... E.U.g.E.N.E. H MOISA ...... k'x'i ................ of the aforesaid building. Suffolk County Department of Health Approval N / A UNDERWRITERS CERTIFICATE NO. i~ / A Building Inspector Rev. 1/81 i~0~ NO. ~ TOWN OF SOUTHOLD BUILDIHG DEI~ARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING I~EI~MIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13108 Z Dote ~. County Tax Map No. 1000 Section ..... ~.~....~...~.~ ....... Block ......... ~ ........... Lot No....)...'.~ .............. pursuant to application doted ............. ..~.~...~..~.~" ' ............... , ,9.k.'l..,~)L( Building Inspector. and approved by the Building InSl:~ctor Rev. 6/30/80 'row N · BUILDING L~ERMI~ : (THIS PERMIT MUST BE KEPT ON TBE P~EM[S~ UNTIk F L~L OMPLETIO OF THE RK,AU ORI ) :~ ~. 0900 Z ~o...,.~..?.~....: ...... : ............. ,; ......... , ~ : Pe~m~ss On ts hereby granted to : ,,, ~,;,,~ ................. ; ....................................... ~ ...;:..:,;4~?.1,~.i, ~ , ~tion t~a .................... ....... ;:.. 'crud a~proved by the FORM NO. $ TOWN OF SOUTHOLD Building Department Town Hall Southold, 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 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. 5. Su bm it Planning Board approval of completed site plan requirements where applicable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of pL~operty 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 SB.00 2, Certificate of occupancy on pre-existing dwelling $15 o 00 3. Copv of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 Date ./~ar;,¢.~....~.~. New Building .... . ./¢2~....... Old or Pre-existing Building ............ Vacant Land ............. Location of Property .~..~. ~..<~..~.. ....... . .~. ,R. { '.N.. ,~..~.: .................... House No, Street Owner or Owners of Property . .~.~.t~. 5~f~.%. ~.'.. ~.0. ( .S'.h ................................. County Tax Map No, 1000 Section ,. ,,C~, { .~ ....... Block ...... [ ........ Lot ..... }, .~, ........ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. /. ~. l O<~Date of Permit ~/~/~'[ lc~'~Applicant Health Dept, Approval ........................ Labor Dept. Approva~ ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $, , .~, ,:.~. ,~ ..................... Construction on above describedApplicantbUilding...~--4~.~-~. ,~.-~and permit/~eets all applicable codes and ................ rlgilations. Rev. 10-10-78 C 0.4¢ i"I ELD I, ,,~ EC[ION 1, gU'ADA'; ~ON (1st.) FOUNDATIOtl 2. ROUGH FRAME & PLUMBING ~NSULATION PER N. STATE ENERGY C,ODE (2nd) F £:,,~A L ADDITIO~AL COMMENTS: FOI~M NO, 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. ~proved ................. ~.~.~ ......~.5 ,9.~Permit No..~.~.q..5 ............. Disapproved a/c ............... ~....~~ .......... (~uildin~ Insp~tor) Application No...?....?....~....~.. ............... APPLICATION FOR BUILDING PERMIT Date ................................................ , 19 ............ 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 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 o~ areas, and giving a detailed description of layout ofproperty must be drown 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 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 o Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o 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 buildings for necessary inspections. (Signature of applicant,~r name,~if a corporation) ................ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................................ ...................... ..................... : ............. : ..................................................................... Nome of owner of premises ...~..L.~/.~...~..~....~...~.~...~..~.~....~. ~ ~.~..~..~..~..,~ If applicant is a corporate, 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 ............................................... Location of land on which proposqd work willie d(~,e. M. ap No.: ........................................ Lot No ......................... Street and Number .~..~..~.x...~J.~..~ U~...~y. ~.~. i..~f.~ ..L.~. ~ . ................. '0' ........................ ........ State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended use and occu anc ......................................................... 3. Nature of work (check whichjapplicable): New Building,. ................. Addition .................., Alteration ................ Repair .................. Removal ................... Demolition .................... Other Work ....... -~' ( Desc ri~tio~) 4. Estimated Cost .)..~).0..~. ............................................. Fee ..: ....................................................................................... ,i (to be paid on filing this application) 5. If dwelling, number of dwelliI g units ............................ Number of dweliing units on each floor ............................ If garage, number of cars ..... i ........................................................................................................................................ ~ 6. tf business, commercial or .m~xed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of ex st ng structulres, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Numl~er of Stories ................................................................................................................. Dimensions of same structur~ with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ................... , ................ Rear ............................ Depth ........................ Height .................... Numbe~ of Stories ...................................................................................................................... 9. Size of lot: Front I ................. ; ....................................... Rear .......................................... Depth ................................ 10. Date of Purchase ................. ~ ....................................... Name of Former Owner ........................................................ 1 1. Zone or pse district in which !premises are situated ..................................................................................................... 12. Does proposed construction vlolate any zoning law, ordinance or regulation; ........................................................ 13. Will lot be regraded....,...,.....,.,............I Will excess fill, be removed from premises: ( ) Yes ( ) No Name of Architect ..............: ............................................... Address ................................ ,Phone No ....................... Name of Contractor : ............. . .............................................. Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and blbck number or description according to deed, and show street names and indicate whether in~erior or corner lot. CTATE OF NEW YORIC. _ ,-,- ~OUNTY OF ...~.6,'..~../~-~......4:'~... ..... ~'~ ....................... .~..].L/....~'....~.....~.......~...;...'~....~..~.?.....~.. .................. being duly sworn, deposes and says tho, he is the oppliconl (Nome of individual s~gm g contract) above named. He is the~ ................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) Of said owner or owners, and is du. ly authorized to perform or have performed the said work and to make and file this application; that ail statements contained in this application are true to the'best of his knowledge and belief; and they the work will be performed 'in ithe manner set forth in the application filed therewith. Sworn to before me th~s /q I ,,~ ......... ./.. ,~.~..: do'~, of ..... ~. · · .~/. ·. ,~. · ,/,'~.: ............. , 19..,~...~.. (Si, gn~ture of bpplicont) ~/J ~r~ c co~o~ ~ Suffolk Count~ No. 52-579~609 ~mm~ion ~xplre~ 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ,~OUTHOLD, N.Y. 11971 TEL.: 765-180:~ Examined...¥~ .... .~. ...., 19~q Approved . .. ~.., 19~'. Permit No.J..~].~..~..2-... Disapproved a/c ..................................... 3 .~ 3 -P ;7 ~ o Received ........... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tins 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 i~remises 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 tlie 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 inspections7 : ...... .............. (Signature of applican¥, or name, if a corporation) ...... ' . ,. , .¢. : ........... (Mailing address of applicarR) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................................ Name of owner of premises ...... ~.Q]g .tl~,~e~...-..)5~..~y:..'.~r-~ .......................................... o (~/s 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..-~7..'...~.~/~-,~.' ............ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. · z ..................... ................ .,. ................ House Number Street Hamlet County Tax Map NO. 1000 Section ~7.~ ................. Block .................. Lot ................... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed ~constr,uction: a. Existing use and occupancy ...... .(~..&g..~__....~'-.~..~>..~/v..6.q,.~....~.'~..(-~..~. [k,J. % ................... b. Intended use and occupancy .'~2W~.. ~.¥-) t'q-,~.~. ·c~. ~..?...~L--O..~.. · · ~-~.t,5' .--~/~-~. · ~'~.. · · - 4. Estimated Cost ............ 5. If dwelling, number of dwellin units. Nature of work (check which a~plicable): New Building ..... ' ..... Addition .......... Alter~ion ......... Repair .............. Removal ............. Demolition ............ _ _ Other Work c~.~. ~.c~ ~ ......... (Description) (to be paid on filing this application) ............. Number of dwelling units on each floor ................ If garage, number of cars .... 6. If business, commercial or mixeld occupancy, specify nature and extent of each type of use .................. 7 ...... Front Rear Depth · D~menaonsofex~st~ngstructures ffany: ............................................ 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 ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9 Size of lot: Front , Rear Depth 10. ])ate of Purchase .......... ~ .................. Name of Former Owner ............................. 11. Zone or use district in which premises are situated ..................................................... 12. l)oes proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ........................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ................... Address ................... Phone No ................ Name of Architect ' Address Phone No Name of Contractor ......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed and indicate all set-baak dimensions from property hnes. Gwe street and_ bl )cklnumber or description according to deed, and show street names and indicate whether interior or corner lot. ~. 33. o9.' STATE OF NEW COUNTY OF .................. ~ b ly th appli ............................. . .................... eing du sworn, e cant (Name of individual signing contract) above named. He is the ...................... .i ................................................................... · "' ~ (Contractor, agent, corporate officer, etc.) of sakl owner or owners, and is dul~ authorized to perform or have performed the said work and to make and file this pphcatmn;!that all statements conto~ned m tins apphcat~on 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· Swgrn to before me this ; ......... ,": ..... '-;'1 k'' ¢" ............ Notary Public ...... /~.f-~-~2.. ~.:.../~..~...~' .~..... County i NOTAR'¥ I ULtl ~(,, Slate of New York ...... ........... '1~ I ~0, 4']07[~78, SLI[t0JII Courtly (Signature of applicant) ----- G''L NOTIFY BUILD H"%~ .... 765-1802 9 A~ TO 4 PM FOR T~4E FOLLOWffJG IN?gCTtONS: 1. FOUNrhATION - TxNO FOR PODR~% coNCrETE 2. ROUGH * FRAMING p ~, ,--r" i ' ALL CONqrq'~CTI~N 5~-~AI- THE R[O~'~r'~NTS ~E TF~ N,Y. STATE CODES. N~T RESpoNS~BI ~ r:O~ DEsIGN OR CONSTRUC'TImN '