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Home My WebLink About13133-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z. J .2.6.7.4. ......... Date .... A..u.g.u.s.t?..8 .................... 19.8.4. THIS CERTIFIES that the building . .~e..~.a.~..s.~.o.~.a..g.e..a.c..c .e.s.s.o..r.y..b.u. ~.l.d.J:.n..g ........ Location of Property 3085 Bayshore Road Greenport House No. Street Hamlet County Tax Map No. 1000 Section 053 .Block 006 .Lot 006 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... ~..p .~.5.1.. J J ........ ,198. 6.. pursuant to which Building Permit No. q 3 q 33 Z dated . ?l.a.y.. J 7 .................... 198,4.., 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 ......... .... ~?.~.M...s.~.o.~. ~..~.~..~. ? .?.~.~..o ry' .~..~.~.z?.t..~¢.. ..................................... The certificate is issued to I3 r u c e B a 1 t z ..................... ?o¥,,'e;,~&-~f~-~j ...................... of the aforesaid building. Suffolk County Department of Health Approval N/A UNDERWRITERS CERTIFICATE NO N / ^ ~~2... Building Inspector 1/81 IPOB,~ NO. O TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, hi. Y. BUILDING PEt. MIT (THIS PEP, MIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13133 Z Permission is hereby granted~..~/~..~. ~...~ ~ .~.._~:~~~to'.' -- ~- '~---~ .... ~.,~:.~~'..~..~. ....... .,:.~ ~o ........ ~.~.~...~..~. ........ AZ..~.~.~...~...~:P,,z:~.,....~... ................ ..... z22...Y..~..zz,,~..............~. .............. ~ .................. ~;..'--~ .................................................... at premises located at ...~.~...~.~;~..~......~--.~....d...q'~.~../~/..~,~.../~- .~'~7.~... ..................... , ................................................................. ~.~../z.a~ ...... ~..~. Ca.n~ Ta× Map Na. ~000 Section ..~..~.. ...... B~oc~ ..~.~d ....... Lat Na..C~7~. ........... ~u~ont ,o opp,,~o,,on dot~ .... ----../-.~'..~.....X.'. .................... , ,~ ond opp~v~ by the Building Inspector. Rev. 6/30/80 FORM NO, 6 TOWN OF $OUTHOLD 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;to 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 featu res. 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. 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 prop~,fty lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner asito 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 --Fz~e-~;×±st,±ng C .0. $15.00 3. Copy of certificate of occupancy $1,00 Vacant land C.0. $ 5.00 Oate. ...... New Building ... ,/.~. ....... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ..... ; ........ House No. Street Owner or Owners of Property ............................................... County Tax Map No. 1000 Section Subdivision ................................. Filed Map No ........... Lot No .............. Permit No,//.J./,'.~,~.~. ~ Date of Permit .Applicant ~.' ..... ~,~ ....... -. Health Dept, Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ... ,'~ ................. Fee Submitted $..'~ · .~7-. ...................... Construction on above described building and permit meets all applicable codes and regulations. IE~ I~?ECTION DATE COMMENTS____~~.~__.~ OUNDATION (1st) OUNDATION (2nd) OUGH FRAME & PLUMBING NSULATION PER N. Y. STATE ENERGY , ~,ODE m FINAL ~ ADDI?IO~AL ,, ' ........ 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:3 Examined.,, .~. ~..../.7.., 19~..5Z Approved../..~..~..~... I.f.., lsd. Permit No.../.~...t/?.~'.~.~. Z Disapproved a/c ................................... /. ' (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .~./~.'< './. ~/ ........ 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 scheduie. 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 IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of tke 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 inspectio~ (Signature of applicant, or name, if a corporation) .... ?../: ....... ./..,/, ...... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ ?. ?. ?. ............................................ ......... Name of owner ofpremises ~.~'W ¢.e ~6)~ /.'~...~--:~.... E.~.. ~ .~..O..rr~....~.~./7.~ ......... '" (as ~'~he'tax roll or i~t~s~t deed) / If applicant is a corporation, signat~ure of duly authorized officer. (Name and title of corporate officer) Builder's License No. ~57~.0...~.'/J.' .~.°.z~..vJ....~-%.5'..~- ''~ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... on be done.'~59~ ~ ~ -/e /~o ~'o'~.' :> >, ~--~ ' o ~'//~,. ~ Location of land which proposed work will . .-.-...~.. {~ House Number Street Hamlet O~9 6 County Tax Map No. 1000 Section . .~ ?...~.~.. Block ........ OqJ ~. .... ..... Lot..-----'-~:.~. 7.~.-.3..'?.'-~.'... Subdivision../~.~.c.p.~.t .c..&~.(~qa~.ji(+?. ?._y. ........ Filed Map No.././?.~. · ...... Lot ............... State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...)5..~.~./....~./..< ?-/~ .... . tj-- ../_,_/ -.~...; :,,~ ,,',', ',m b. Intended use and occupancy y' e~ ~ q[*e ~ t t ~/ ~ .,, ' ..... , 3. Nature of work (check which applicable): ~ew J~uilding ~...e.~.~{.. 'Addition .......... Alteration .......... Repair .............. Removhl .............. Demolition .............. Other Work ............. 4 Estimated Co ~ Fee ........................ ~ '" (to be paid on filing this application) 5. If dwelling, number of dwelling uOits ...............~-~- Number of dwelling units on each floor ............. If garage, number of cars ~7. ................ ~. ................................................. 6. If business, commercial or mixed Occupancy, specify nature and extent of each type of use ..................... 7. Dnnens~ons of ex~stmg stmctures,~ ff any: Front...~ ....... Rear .~ .... Depth Height.. ........ ..... Numb:er of Stories ........................................................ D~nensions of same structure with alterations or additions: Front ................. Rear .................. Depth ..................... ;. Height ...................... Number of Stories ...................... 8. D~ensions of entire new constru}tion: Front .... f~ ........ Rear .... ~ ........ Depth . .~ ........... Height .............. Number of Stories ..... ~ .................................. 9. Size of lot: Front .... ~O...; .......... Rear .................................. 10. Date of Purchase ............ : ................ ~Namefif F~er~wner ............................. 1 1. Zone or use district in which premises are situated.. ~Tt ~.~'.O.~ ~ ...... t ............................ 12. Does proposed constructi~p violate any zoning law, ordinance or regulation: . ~ .................... 13. Will lot be regraded ...~..~ .i ..... ..~..~ ~ ....... Will ex~ess ~be re~v~fr~ premises: 14. Nme of Owner of premises ~V&.q ~ ~/. [.~.. Address q~.J/P.~K~ ~..~/~hone No ................ ~ . Address ................... Phone No. Nme of Architect '~ ~¢~~. Address ~(~[ff~ ~ . · Phone No. N~e o~ Co~tmcto~ .................. PLOT DIAGRAM Locate cle~ly ~d distinctly ~1 ~ufld~gs, whe~er existing or proposed, ~d. indicate ~1 set-back d~ensions from prope~ 5nes. Give street ~d block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW ~,. ff ~J~' [ ~0 (~ i4ividual si[nin~ontract) above named. .............t B; ...... . .... ........................ : 0~, agent, cot rate officer, e . of said owner or owners, ~d is duly author~ed to perform or have perfo~ed the said work and to m~e and file this application;that all statements contained ~ this application are true to the best of his knowledge and belief; an~ that the work w~l be perfomed in t~ m~n~r set forth ~ the application filed therewith. Sworn to before me this N Publ?, ............. ~ . . unty NEW[~ (Signature NOTARY PUBLIC, ~e ~ Nw Yo No, 52~81258~,~k ~