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Home My WebLink About13173-zFORM NO. 4 TOWN OF SOUTHOLD ~ BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Z1~177 Jan. 23 1986 No .................. Date .................................... THIS CERTIFIES that the building.., gc.q~ 8 ~.o.r.y. .................................. Location of Property t575 BIRDSEYE R.OAD, ORIENT House No. Street Ham/et County Tax Map No. 1000 Section ...0.q."/ ...... Block ..... 2. ......... Lot .... q . 2 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... ~la~. 2 5 .......... ,19 ~3.4. pursuant to which Building Permit No... 1. 3. ! ? 3 Z dated ....... kl~y. 2.1 .............. 19.8.6. , was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for wtfich this certificate is issued is ......... The certificate is issued to . R.O.BERT & JOAN[E DE VOE ................. ...................... of the aforesaid building, Suffolk County Department of Health Approval N ./A UNDERWRITERS CERTIFICATE NO ................ ~./~ ............................. Rev. 1/81 Building Inspector FORM NO. ~ TOWN OF SOU~'IOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 13173 Z ......... I'~..~.:~ ........................................................... IL.) ~ · ,o ..~.~.....~....~....~.~...~~.,..~.....~...~ .......':'":..:. ' . ............ ...... / County Tox Mop No. 1000 Section ....... .~.,I,,..'~.. ..... Block ........ ~ .........Lot No. ~uon, ,o o~,,,~ot,on do,.~ ...... .~.~..~ ...................... , ~,.~.~., ond oppro¥.~ ~ t~e Building Inspector. Fee $ ........................ Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted m~ 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 ~rom Board of Fire Underwriters. 4. Commercial buildings, Industriai 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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-~. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3, Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5°00 $15.00 Date ...J.a..~....2. 1.. J.9.8.6. ......... New Building . .×X ......... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ...... ~.~,~. ¢¢.e.~.~. ~.d ........... Orient Nouse No. Street Nam/et Owner or Owners of Property ......... .R.o.b.e, .~ .~..&...J .o.~.qq .e..D,q . y .o.e ......................... County Tax Map No. 1000 Section ............ .0.1.?Block ...... 2. ........ Lot ...... 1 . 2 Subdivision ..... ~..~o Ste~-n ...... Filed Map No ........... Lot No .............. Permit No. .1.3.1.?.3. .~. . . Date of Permit 5../.3.1/.8..4..Applicant Joe.~ne D,e Voe Health Dept. Approval . .~;~ .................... Labor Dept. Approval ........................ Underwriters Approval . .×× .................... Planning Board Approval ...................... Request for Tern po raw Certificate ..................... Final Certificate ......... ~× ~ .......... Fee Submitted $ ...... $ 5 ...O,q..¢~.'¢... 7.0. ~) ...... Construction on above described building and permit meets all applicable codes and regulations. Applicant . .~¢~-~-*~....'~.~ ~j Rev, 10-10-7S FIELD fOUUDATIOI (1St) FOUHDg': lOtl (2nd) PLUMBING IUolJt,A'i']O/~ PER N. ATE EN EP, GY CODE AT)DIT'LOUAI., COMNENTS: Examined... N .c~.(~..~. Approved.....~. %..~}..., 19 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL,: 765-1802 Permit No..} .~>~}.?.~..~. Disapproved a/c ..................................... ................................ ........ (Building Inspector) APPLICATION FOB BUILDING PERIVIlT INSTRUCTIONS a. This application must be completely filled in by Wpewriter 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 inspections. ......... .~:~...-?~r .~v~:.....%~.~ .~..~57. ............ (Signatur'eoof applicant, or name, if a corporation) ......... ( 9. .... ..... (Mailing address of applicant) State whether applicant is pwne_r, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . ~--~?.t.~ .fL .'T. '~ .~-tp :~.v3 .% ~..~-t9 --~' ..................................... (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 ....... ...~L> ................ Plumber's License No ......................... Electrician's License No ...... ..-- ................ Other Trade's License No. I. Location of land on which proposed work will be done.. 1~., C..~. .S..--~.. [/..~ ......... :;...C?.l~..~.e ............. House hum ber Street Hamlet County Tax Map No. 1000 Section ..... [ .~ Block '2.---- Lot Subdivision..55~_~....c'~.-~..4. f'..v~. .................... 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 ... / ....................................... b. Intended use and occupancy ........ / ......................................... 3. Nature of work (check Which applicable): New Building ..... ' ..... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... /.,~0 ~-49~-0 (Description) 4. Estimated Cost ........ '"'/" i ....................... ~. Fee ...................................... ~" (to be paid on filing this application) 5. If dwelling, number ofdwellinglunits .... '~- Number of dwelling units on each floor.....~..... If garage number of cars ..*77, 6. If business, commercial or mixeld occupancy, specify nature and extent of each t~yp_~e, of use ... :; ................ 7. Dimensions of existing structures, if any: Front ....... ~... Rear .... ~.- .~. ......Depth .............. LIeight Number of Stories... ~. ...... Dimensions of same structure With alterations or additions: Front ......... Rear ............ . } > I Number of Stories Depth ................... ; .. Height .......................................... . 8. Dimensions of entire new construction: Front ...~.2~ .I... Rear ].~. ~ Depth / )- / Height ............... Number of Stones ................................... 9. Size of lot: Front 1 '3 s ~ pth .......... , ........... Rear .... /. {,.c? .............. De ...................... 10 Date of Purchase Name of Former Owner 1 1. Zone or use district in which pr~mises, are situated ... .............................................. . ... 1 2. Does proposed construction vi~ate any zoning law, ordinance or regulation: ............................... 13. Will lot be regraded ...... .~.?,~. .....~ ~ ........... Will excess fill be removed from premises: Yes 1 4. Name of Owner of premises ~, ? ~...~.~.U.D..~.. ..... Address .Zo ¥;../?. ~.~ ;_,. ...... Phone No..~. '%r~ ": ~' ~ Name of Architect ..... ?./.~[ ................. Address ................... Phone No ................ Name of Contractor .... ~'[ .~. ................ Address .......... /.t ........Phone No .... PLOT DIAGRAM Locate clearly and distinctly alt buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block~number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW ~(ORK, COUNTY OF ................. .................· ..( being duly sworn, deposes and says that he is the applicant above named. He is the ...................... j ................................................................... , (Contractor, agent,.corporate officer, etc.) of said owner or owners and is duly authorized to perform or have performed the said work and to make and file this apphcatmn that all statements contained m thru apphcatton are true to the best of his knowledge and belief; and that the work wi/l be performed in the manner set forth in the application filed therewith. Sworn to before me this Notary Public ....... /' ·' "P"~q-'"~¢~'i'.: ......v.o~.. NOTARY~ PUBLIC, State of New York N0. ~707878. Suffolk Comity _ Term Exp.es March 30, 19~ · County ........ ................ (Signature of applicant)