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Home My WebLink About12822-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupnncy No...Z3.3.~.2. 9 ......... Date .......... .ff.a.r~u..a3:~...9 ............198.5.. THIS CERTIFIES that the building -v.-a~cessnry. b.uJ. ld£ng ........................ Location of Property ...5 House No. Street Hamlet County Tax Map No. 1000 Section ...q l-~3 ...... Block .... Q 5. ......... Lot ...Q Q.9, .2. ........ Subdivision...X. ........................... Filed Map No..X. ...... Lot No...X ........... conforms substantially to the Application for Building Permit heretofore fried in this office dated · .D. ec¢~ber. 20 ....... 19 83. pursuant to which Building Permit No...2,2 ~2.2..g ........... dated .... ff. OP.~q~Y..4~ ............. 19.8.4. , 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 ......... ...... .a.n...a.c.c.e. ~..s.o.r.~..s.e. qr..a~.e..b..ui3.d. ~..n~... ..................................... The certificate is issued to ..... ~. gl~D.~g$.C:~ .¢ ,..& .~T~q~T...S....T-5..B.O.R. ................... (o wner, l'~e~'~' t~rra~ of the aforesaid building. Suffolk County Department of Health Approval ....Nf..R ................................... UNDERWRITERS CERTIFICATE NO ........... .N~R. ................................... Building Inspector Rev. 1/81 FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CI'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12822 Z Permission is hereby granted to: ......... : ................... f~ ................. /g~, -[7i ....... ...... .~?...,~.../..x_J... ~.f./~?. ......... ..~:d~.../~..~....~.-~ ...... ............ to ....................................................................................... ..~.. ..............? .......... '7'" at premises located at ...., ..~.'.~ ............... / ............... County Tax Mop No. 1000 Section .(..~./.~... ............ Block ...... ~/M.w'.... ...... Lot No. pursuont ,0 opplicotion doted ...~..~f/:~.,~G.. .......... ~/~ ...................... , 19~-~d o,d approved by the Building Inspector. Rev. 6/30/80 FIELD IN~P~.~ON COMMENTS FOUNDATION ( 1 st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY FINAL ADDITIONAL COMMENTS FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 BLDG, DEPT. ~OWN OF SOUTHOLD APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate 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 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 p~Coperty 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. ~.~ t~,.~,-~ ,'~.,/.~.~'J~. ...... New Building X ........... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ......... /. ~,/~. · ,~'.', · ~ ............. ; House No. ~treet ~ ~ Ham/et Owner or Owners of Property .. County Tax Map No. 1000 Section . .~.z'. ~. ....... Block .. ~'2. ~' ........ Lot..4~.~., .~..<~-.. ..... Subdivision ................................. Filed Map No ........... Lot No .............. -'---'- Permit No../.~?.~.~).~-. Date of Permit ~)./~.~ plicant . ~,~ .~2¢. J.-,~-..1. ~. ~2~. ~ ........... 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 ap, pl~od, es,~/' ~/' and regulations. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:~ Examined '.~4.-:. ?. ..... , 19 ' _ Disapproved ....... ......... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received .......... ,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 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. c. 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 codec, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessa~ inspections./~ (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. . .O...C~. ~;.~h .................................................................................. N~me of owner of premises ,1.~,~O.~.... Ic.~.cd¢~.,.e. C ..~...~..¢., ....................................... (as on the tax roll qr latest dee.d) 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 License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done..~,O (4 J.~...{ .c~...]..o.oo.L?. ......................... ....,57~.. ........ 0 [.I.t. r4 ~.<,. . .b.a ~. .~ ...... ~.~ !k .,x .rT. . . IV-.W. ............................. ttouse Number Street Hamlet County Tax Map No. 1000 Section ../ff. :.. ~.7...q.'~. 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 ..................................................................... b. Intended use and occupancy .. 3. Nature~ofwork (check which applicable) ~New Building .......... Addition .......... Alteration .......... Repair~ .............. Removal .... ~Demolition .............. Other Work ............... .~/ .~ ..~ (Description) 4. Estimated Cost. :.O.O ........................ Fee ..... ./. : ~. ~. ........................... i (to be paid on filing this application) 5. If dwelling, number of dwelling ~nits ............... Number of dwelling units on each floor ................ If garage, number of cars ......................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structurels,if any: Front ............... Rear .............. Depth ............... Height .............. Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... i" Height ...................... Number of Stories ........ .> ............. 8. Dimensions of entire new construction: Front ...~....,..,. Rear .. ~ ....... -- Depth ............ ~'. Height ............... Number of Stories ...... /. ................................................. 9 Size of lot: Front . Rear Depth 10. Date of Purchase ............... Name of Former Owner 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction vinlate any zoning law, ordinance or regulation: 13. Will lo~ be regraded ......... : ................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ... ................. Address ................... Phone No ................ Name of Architect Address Phone No Name of Contractor ......... : ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly alll buildings, whether existing or proposed, an& 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 c'orner lot. SPECIFICATIONS Floor size: 96" wide x 92" long i' Door size: 5'-10" widqx 6'-0' high Building height: 8'i-0" .high , STATE OF NE,W/Oldie, . COUNTY OF ~ · .. -% ~'~.. ~ ..... ~7.~: ........ b~g dul~ sworn~poses and says that he is the applicant [ (Name of individual signing contract) above named. ~ ~ ~ - (Contractor, agent, corporate officer, etc,) of sakt owner or owners, ~d is dul9 autho~zed to perform or have perfo~ed the said work and to m~e and file this application; that all statements cont~ined ~ this application are true to the best of his ~owledge and belief; and that the work will be perfomed in the m~ner set forth in the application filed therewith. Sworn to before me this