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Home My WebLink About13135-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z3.~.7. g9 .......... Date ...... A. vgg~.t.. ] 7 ................. 19 THIS CERTIFIES that the building .... D.c. g .k..a.n.d...f.u. 1..1..c.c. 1..1 .a? ..................... Location of Property ...] 150..?apt. Kidd Dr. . . ..Matt. ituck . House No. Street Hamlet County Tax Map No. 1000 Section '... q. g .6 ...... Block ...'~': .2 ......... Lot ...0.4. .6 ........... Subdivision...Qa. p .~....K..~ .d.d..g.s..~.a.~.e..s ....... Filed Map No ......... Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·...M.a.y.. ! ,/4 ............ 19 .8.6. pursuant to which Btfilding Permit No. 1.3. ~. 3 5.Z ............... dated .... ~.a.y.. ! ? ................. 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 ......... Deck Addition &full cellar The certificate is issued to ...G.h..p .i.s.. a. n..d..~, g ,a .n.n.e...~ .ap.p.a..s ............................. (owner, ~s~ez~~ of the aforesaid building. Suffolk County Department of Health Approval ...... .i31/.& ................................ UNDERWRITERS CERTIFICATE NO. N /A Building Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING FEIU~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) N? 13135 Z hereby granted to: ' ..... ~........~.~.....~....: ................ ...... ~.~..~.~..7.~.~.g:...~.~.~ ...... /.z?..~.~ ~o ....~c~z, .xr./~.~;z.--....~.~...~.~.zz.O.~-~' ~.....~...~.~a..~.~..~.. ........... ~z~/~...~.~.,~.,~.~..~...z.~ ~....-k..~.~... _~./.......~ ...... at premises I~cated~-~. ................................................................... ........................ ~......~z.~...~.: .......... ~.~.~..~:.~.~... ..~.~......~.....£~,~.~ ............................................. ~....~./...z.5:o, ................... County Tax Map No. 1000 Section ....~..~.....~.. ........ Block ....~....~... ....... Lot No....~...~ ......... pursuant to application dated ...~,~.......~....~.. ...................... , 192.~., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall ,?~uthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitte~-'p~cc*,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 supplv 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 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 --?z~e-gxlstlng C.O. $15 · 00 3. Copy of certificate of occupancy $1.00 Vacant. land C.O. $ 5.00 Date... ~.."~:~..~. · ........... New Building .... ~(, ....... Old or Pre-existing Building ...... . ...... Vacant Land ............. Location of Property. J ! .~.-~..O....~. · .O~."~; · !.~ · .~.. · .~. · .~';,. · ~.' _'._ ~.~L~..~., . ~'-~..~...~. ·. ~ .~'~2 Hou~e No. ~ ~ . I ,~treet [~ [ Owner or Owners of Property .[,~...~'.'[.~,. , ~A, ~...~...~q.~,~,, .... .~.~. ~.~i,~' ................ County Tax Map ,.o. 100~0 Se. ctio, ... ~.0. g ...... Bl~ck...~... ¢~... Lot.~i~..... ?..~.~.. Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporaw Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described bu ilding and permit meets all ap~ble codes and regulations. ~ Applicant ~...'~...~ ...................... FIELD ~INS~CTION DATE COMMENTS FOUNdATiON (~s~) i~.~~ FOUNDATION (2nd) ......... ~ONGH FBAME & PLUMBING ,' STATE ENEBGY ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 lJ ermit No. Disapproved a/c . . .: ............................ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received ........... ,19... 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 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 tins 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 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 inspections.~..z~..~'~?,:tJC'...~..~ .~.'~ .~ (Signature of applicant, or name,'"ff a corporation) · ~yi,:~....~.?. z-. ~ ~. ~e..../_.,.~..~.n~. n,.',~.~ ~/,g~i~/~M ailing address o f applic ant )/'1 ¢-~"~ State whether applicant is owner, lessee, agent, architect, engineer, generaI contractor, electrician, plumber or builder· ...... ~ ~,~.,,?. ~./.~. .... ~.,~ .... ~,-.~... :. ¢.a. ~z... ~.. ~.~... ~.,¢~' .~..m.~.-.,-/. ~ ..................... (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. ~4<[ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No.ff/.~.){.~./a... · 7~... ~.~... ~.~'~Zr'/~'/'F 7' 1. Location of land on which proposed work will be done .................................................. ..... z.z.p..'~. ................ .~..,¢.,ff. ~...~z~,~.....~,~. z :;~'. .......... .z~,¢. ~..f'.4~:/~: ............ House Number Street Hamlet County rax Map No. 1000Section . .~..~.~ ............ Block .~.~-. ........... Lot ~ O4/~ Subdivision .q./]~ 7.. · .~/P~ ]~-57~ ~'~' Filed Map No. Lot ~ [ ~>t:~ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... ~. f~..~7../'r/.~.~. ....... /~.~../~../.~ ........, ............................ - b. Intended use and occupancy . x.~..4~/¢7...~.ff..~.~/.~ ....... ~..t).~..~..~/~...~.~.. ~.. 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... Alteration ........ Repair .............. RemPval .............. Demolition .............. Other Work .... ' ........... 4. Estimated Cost~..~.~f5.".7.O.'~.. (to be paid on filing this application) $.If dwelling, number of dwelling iunits .... .~?~/.~.". ..... Number of dwelling units on each floor..~.~ ......... If garage number of cars , 6. If business, commercial or mixer occupancy, specify natgre and extent of each tgpe of use ............ ., ........ 7. D~ensionso[~xistingstmctures, ifany Front ~ t ....... Rear . ~/{~. Denth . Height .. { ............ Number of Stones ....... ~ ............................................... D~ansions of same structure w~th alterations or additions Front .. fit(.( .......... Rear ..... ~ (. f ........ Depth .... ~.t~ ............ ,:.. HeiSt ... Z~ ~ .............. Number~f Stories ..... ~(~ .......... 8. Dimensions of entire new const~ction: Front.. ~d~c~; .'~.~. Rear ...v: .......... Depth .. Height . .'~ .......... Number of Stories 9. Size of lot: Front .../A3.t. .:. Rear .... Aq~t. ............. Depth ~ r 10. Date o:fPurchase ........... . .................. Name of Foyer Owner ............................. 11. Zone or use district in which premises are situated ............. 12. [ ocs proposed constructmn vm~ate any zoning law, ordinance or regulation: . ~ .............. Nme of ~chitect Address Phone No N~e of Contractor ~7(~(~. ./;~ Address~.Z'~.~ ~ ~q~g~d~. Phone No~ta ' PLOT DIAG~ Locate cle~ly ~d dis~c~y ~1~ bufld~gs, whether existing or proposed, an& indic~le ~1 set-back d~ensions from property ~nes. Give street and block ~number or description according to deed, ~d show street nines and indicate whether interior or corner lot. .' STATE OF NEW YORK, COUNTY OF ................. ............................. ~ .................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named· He is the i (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul~ authorized to perform or have performed the said work and to make and file this application; that all statements contained in th,is 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 this ....................... Y i' ' .":~,' ............ ,19... Notary Public, ...~ ~.-.,~..~ · . ...... '. County - i NOTARY PUBLIC, State of New York ~ · ·" ........... No. 4707878. SuIl0lk C0untY~.~ "- ('Signature of applicant) Ierl~? Expires b~rch 30 19~ "I . i