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Home My WebLink About13163-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildin§ Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...Z.l.~. 3..5.g ......... Date ........ .~.p?.~.3:...2.9 ................ 19.8.5. THIS CERTIFIES that the building ..... h. } bp.Ea..t .~ 9.n. ............................... Location of Property .... 5 .T,~.. T g j2.p.Q ~..D.r. 5, V fi ............... ~ 9 .u.t,.h.o. ~ .d ................ House No. Street Hem/et County Tax Map No. ]000 Section . . .QD3 ...... Block ..... ~ ......... Lot ..... .~ ........... Subdivision. ~.O.~T.E.O.~.D.. ,5.~.0.~..~.~ ............Filed Map No..3.8.5..3...Lot No...~? .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .A.u.6,. J.7. ~ ....... , 19.3.4. pursuant to which Building Permit No. 1.3. ~..] .0.g. .............. dated . .S..e p.~.....4 .................. I q.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 ......... .... ?.~. r .t.L~.~. ~. ?.n. .~. ~..~?.~.~. ?r..qr.. p.?.s. ? .n.a.~., .d?.R~. ~..~.R~..' .......................... The certificate isissued to ROBERT &. LINDA BRACKEN .................... ?otC, go;, 'g~ix& }id ~ir~'o ...................... of the aforesaid building. Suffolk County Department of Health Approval .......... ~/.~ ............................. UNDERWRITERS CERTIFICATE NO .................. N.. 5.8.6. ~ .0 .3 ........................ Building Inspector Rev. 1/81 I~OBM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13163 Z County Tax Map No. 1000 Section ..... ..~..~...~ ..... Block ......... ~ .........Lot No ....... ..~. .............. pursuant to application dated .............. ~ ..................... , 19 ., and approved by the Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CI=RTIFICATE OF OCCUPANCY IIo b Instructions This application must be filled in typewriter OR ink, and submitted i. ~ 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 Archite~t or Engineer responsible for the building, 5. Submit 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 pZoperty 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- t/on required to prepare a certificate. C. Fees: 1, Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $15.0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5.updated C.O. $15.00 Date .......................... New Building ............. Old or Pre-existing Building ,, ,~/ ....... Vacant Land ............. Location of Property . ,~.7..~. .... 'Z/~r. ?.~..~.,~.., .~. ~/..~'.g ...................... House No, Street Ham/et Owner or Owners of Property .... /~. ~..~. ~ .~...-'~..., .~.., .~../.z?.~..z~. ...... ~ ./~..~..~,..,~. ....... County Tax Map No. 1000 Section .............. Block ............... Lot ............... Subdivision....~ .~?/,~...O.c: ~ .... ~'./¥~.~ .~.~....Filed Map No.. ?'..~?. ?..Lot No....Y? ........ Permit No. ./.3. f.ff.'3..~', gate of Permit ~-P-¢-f~/ /3 zlf/~2 ,~ .~.~ ~?plicant.../~./'~z~, ¢~',./~X.,~z .~ ./~. ?..,~. ...... Health Dept. Approval ........................ Labor Dept, Approval ........................ Underwriters Approval Planning Board Approval Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and permit meets all applicable codes and regulations. Applicant .... Z~.~/~..~. % . . i ~( ~ .................... f OU;~DA'r loll (1st,) 2. ( 2nd ) f~OUiJ}l :"RAME & ?LUMBING COIh~l D'¥ A'r E C,ODE F i I'!AL ADD1 TIO,~IAL C(~MMENTS ' DATE: __ _~t/_ B.P- ~ ,'L~J ~"~::: ..... FEE:.,~.,~,. '- BY: ~ , ~, 765-1802 9 AM TO 4 PM FOR THr- FOLLOW[N~ 1. FOUNDATION . TWO REOUIRED FOR P~URED CONCRETE 2, ROUGH - FRAMING A PLUMBING 3. I~SUI.ATIflN ~LL CONSTR~ICT ON S~ ~1 / STATE CONSTRUCTION & EHFRGY CODES, NOT RESPONS~BI.~ DESIGN OR CONSTRUCTION Examined. Approved . FORM ~0. 1 TO~ OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL S~UTHOLD, N.Y. 11971 TEL,: 765-180~ ,~~...., 19~[ 9.., (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .... .~ .~.-./..~. ....... 19 .~5~. 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 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 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 in~ec,~'.'o~. (Signature of applicant, or name, if a corporation) . .4 . 4 /..< . />. , r, / Y,. . . . (Mailing address of applicant) State whether applicant is ow~ner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. F ................................................................................... Name of owner of premises ....,~.~.~..~...,¢.'(. · ?...fi-..'(..'f(.~..~. · · ./~.d ~..~.'~. ..................... (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 .......................... Plumber's License No ......................... Electrician's LicenseNo ....................... Other Trade's License No ...................... ....... 7' d .................................... ¢ 1. Location of land on which proposed work will be done. . ........ .................. ........................ House Number Street Hamlet ,/ County Tax Map No. 1000 Section ..... ~..,~ ......... Block ...... .~. ......... Lot ..... ~. ............. ~' Subdivision../~fi.~...~.~. ~. ~.q .~d/4¢~..._(.///.off.~.. ...... Filed Map No....~.. ~..~.'~. ..... Lot ....~.~ ......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... ./fle,'ff. ~d.& ........................................................ b. Intended use and occupancy ..... 3.~.,4~4~.~.~:~..,d&d.f,,q& : .... .................................. 3. Nature of work (cheek winch appheable): New Building .......... 'Addition .......... Alteratio~ .......... Repair .............. Rem6val .............. Demolition .............. Other Work. d~¢~t~ ..... (Description) 4. Estimated Cost ............. : ......................... Fee ...................................... '~" (to be paid on filing this application) 5. If dwelling number of dwelling pnits ............... Number of dwelling units on each floor ................ If garage number of cars i 6. If business, commercial or mixe~ occupancy, specify nature and extent of each type of use ..................... ~'7. Dimensions of existing structure}, if any: Front ..... ~6 ....... Rear ... ~ ........ Depth . ~ ........... Height ...~,~ .......... Num~ber of Stories ...ff,~. ................................................. Dimensions of same structure with alterations or additions: Front ..... ~. ......... Rear . ..,f~. ............. Depth ..... ~ ............ '.. Height . .-,:?d) ................. Number of Stories..~;.~ ............... 8. Dimensions of entire new constrUction: Front ............... Rear ............... Depth .............. Height ............... Num!ber of Stories ........................................................ 9. Size of lot: Front .... /¢~..~..~' ........... Rear .... /~k~.../ ............ Depth ...z'..~.,:C'../. ............ 10. Date of Purchase ..... ~./. ~")-~ ................ .,4Name of Former Owner ...,~4t~/~ ...... . ............. ,/11. Zone or use district in which premises are situated.. ~ed./.~ ~,~..~./~4.& ....................... ............. 12. Does p{:oposed 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 ~]~4~4~,~?,.~. 4./.w.~,4..4f~,f~',4~dress ~. ~..~.v..7'¢~.,~,/4'.~ g.,~.~. Phone No...~.. ~.: (~. ~'~'~.... Name of Architect .......... i ................. Address . ~.f~.,{. 4~./.~'.~Zr2.~.. Phone No ................ Name of Contractor ~ Address Phone No PLOT DIAGRAM Locate clearly and distinctly MI!buildings, whether existing or proposed, and~indicate all set-back dimensions from property lines. Give street and block: ~umber or description according to deed, and show street names and indicate whether interior or corner lot. / 2D, 0" STATE OF NEW YORK, ~'COUbrl'Y OF. ~/F~ ~.-/~ .... S.S ,/ ff ),e zr .... . ... ......................... .(Name of individual sign ng contract) above named. being duly sworn, deposes and says that he is the applicant *"He is the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duli~ authorized to perform or have performed the said work and to make and file this application; that all statements cont~ ined 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 this v../~ ........ day~_~. ~ ............ 19~5¢/... */Notary Public~.....~..f:. ~.. County iqOx ~oa .... ~u Co~_~..g (Sign~;;r'e' of applicant) i ,