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Home My WebLink About13181-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y, Certificate Of Occupancy THIS CERTIFIES that the building Fa. vil.iqn Location of Property .. .... : .... C.' .o.x..~...L .a.n.e. ..................... .C ...... County Tax Map No. 1000 Section 084 .Block 1 ,Lot 24 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... J.u..n.e..4. ......... 19 .8.4. pursuant to which Building Permit No... 1 $ J ,8.1. ~ ............ dated ... 7 ~,~... {~ ................ 19 8.4., was issued, and conforms to all of t~he requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ...... ~.~.1~0~ ................................................................. The certificate is issued to .... M, .a.t.t.~. ~..u.c)c..q .up..C. ~. ~u.b..In..c'... ........................... of the aforesaid building. Suffolk County Department of Health Approval .......... N/. ~ ............................. UNDERWRITERS CERTIFICATE NO N f ~ Rev. 1/81 Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CTHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13181 Z Permission is hereby gronted to: , _ / ...~..~..~.....~..~ .............................................. Co,,n~, To× Mop No. ~000 Sec,o,, ......O...~.'.q.. ........ B~o~k ........ } ............. ,or No.....~. ............ ................X/~/~,,, :. ~ ............ 9.~.'.~. and the pursuant to application dated ..~..~.¥..-~r...~.(~. ~.~ ....... 1 .., approved by Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ,~Jouthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY ~[nstruetions A. This application must be filled in typewriter OR ink, and submitte~t~to the Building Inspec- tor with the following; for new bu[Idings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, aod unusual natural or topographic features. 2,Final approval of Health Dept. of water supply' end sewerage disposal-(S.9 form or equal). 3.Approval of electrical installation from Board of Fire Underwriters4 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 featu res, 2.Sworn statement of owner or previous owne~ 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, Certifie,.,te of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling / land use --Pr.e-Ex±s b:i.n~ C. 0, $15 · 00 3- Copy or certificate of occupancy $1.00 Vaca~; .].a~d C~O. $ 5.00 ! , // Date .......................... New Building ........, ,1~,,. Old or Pre-existing ~uilding ............ Vacant Land ............. House No, Street Ham/et Owner or Owners of Property ..... '. ,~,'~2~,/::~'.MC .~..~. M/~...~,.4 ,~/.~., ! County Tax Map No, 1000 Section ...... ~,' ....... Block .............. Lot ........... Subdivision ................................. Filed Map No ........... Lot No .............. Permi[ No. [3~.g.].~'. Date of Permit , 4. ~(Apphcant .... ~~(~. Health Dept, Approval ........................ Labor Dept. Approval Unde~riters Appr6val Planning Board' Approval Request for 'rempora~ Certificate Final Certificate Fee Submitted $ ............................. Construction on above described building and permit meets all applicable codes and regulations. FIELD INSPECTION COMMENTS (1st) FOUNDATION (2nd) ROUGH FRAME FLUMBING INSULATION FER N. STATE ENERGY CgDE FINAL ADDITIONAL COMMENTS: ' FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ~bkgx-~...q ...... , 19~. ~.[. Approved :~.kz, v¢~..q ..... , 19 .~.~. Permit No.)..~. I.~.../. ~.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................... 19... INSTRUCTIONS a. This 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 promises 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 grantgd 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· .PT (Signature of applicant, or name, if a corporation) .P.,.O,. X . . T. T I77. . .c,K, (Mailing'address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... 0 .................................................................................. Name of owner of premises .,r~.~.~. JT~..&t.~... ~. (J..~.. ~ ~../~.~. · ! .A/,~ .................................... (as on the tax roll or latest deed) If applicant i~ a corporation, signature of duly authorized officer. .. .................. (Name'and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other ~Prade's License No ...................... Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section ...~.'/.. t/. ..~.~ ..... Block Lot ................... Subdivision ..................................... 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 .... ¢.~./,/~./'/O.(J.~..~...'/2. f~..~.~.~. ..... ff.~...O¢.~.td~/~.A/.~. .................. b. Intended use and occupancy ... ~d/7'~../.W..~.~./g~. ,t ~c 3. Nature of work (check which apphcable): New Buil&ng ........ Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... I (Description) 4. Estimated Cost...~. 3.-~.~.t?. T.~.O. ..................... Fee ...................................... ~" (to be paid on filing this application) 5, If dwelling, number of dwelling ~units ............... Number of dwelling units on each floor If garage, number of cars .... ~ ............................................................. ' ...... 6. If business, commercial or mixe~t occupancy, specify nature and extent of each type of use .... .... . . ~t ~ ~ t, "' :.~'r~,~/ ....... 7. Dimensions of existing, structures,, ,f any: Front....~...-.~. ....... Rear..~.~.:~. ' ....... Depth-~: :~ .~::: ...... Height .../6 .......... Number of Stones..... / ........................................... Dimensions of same structure wlth alterations or additions: Front ...5'ff..?~.~. ......... Rear . .ff.~ .'~.~. ........... $~./~/~. ~ Height ~. Number of Stories ~'4/.~/~: Depth .................. ~ ................................ construction Fro t .~.0. Rear //19' Depth ~ ~ ~ 8. Dimensions of entire new n .................................... Height ....~. .......... Number of Stones... ,I ....................................... ~ ............ 9. Size of lot: Front ... ~/'~'~,~'/'i '. .......... Rear . .~ ?.{ ~/~.t ............. Devth . ~.~..7~. (JZ.'.":..7..~'~.ff.~.. 10. Date of Purchase 3/. 2<5./..6./ .......... Name of Former Owner . .ff~..~./~.x./../.2~9~.~9,~../. ...... 11. Z~ne ~r use distnct in winch pr~mises are situated . . . ~.~.~.~.U. .~T. (~?~.~. . . .~.~.~./~.~/~i.7?~ ~- ................ 12. Does proposed construction viotate any zoning law, ordinance or regulation: ..~.~. .......................... 13. Will lot be regraded ../V0...; ................... Will excess fill be removed from premises: Yes '(~) Name of Architect .... /~.0.g#. ........... Address'" ....... "'" "'""" Phone No ................ Name of Contractor .... /').~.V.~. ................ 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 blocklnumber or description according to deed, and show street names and indicate whether interior or corner lot. Jo/vT, STATE OF NEW YORK, ' iS.S .... ~.J~.'ff. · · M~ .... J .................... being duly sworn, deposes and says that he is the applicant ~ (Name of individual sigr lng contract) above named. (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is du~ y authorized to perform or have perfomed the said work and to m~e and file this application; that all statements cent tined ~ th~s application are true to the best of his knowledge and belief; and that the work wffi be perfo~ed in the m~n~r set forth in the application filed therewith. Sworn to before me this ' ~ ~, ....... / (Signature of apphcant) C0mm'issi0n Exp~r~s March 30, 1~