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Home My WebLink About12830-z FOI~M NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, bi. Y. BUILDING PERMIT CT'HIS PEP. MIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORI(AUTHORIZED) 12830 Z Permission is hereby granted to: ....... ;~~.~ ...~.~. ~t~:....~x~ ...... ........ ....... ............... ....... ~.~.....~ ........ ~'~...i ./.. .......... ? at premises Iocatea ar ....~...~.~. ........ .~...~;~.~4.~.~ ...............~ ..... .~. ..... ~/~..;......~ .......... : · ...... ,,~:~..~.~:~.~....~~ ..... ~ .~ ....................... ~.....~...../.. ......... County Tax Map No. 1000 Section .....~....'~.'.~..~.'. ....... Block. ...... ..(~....~.. ....... Lot No..~-/'~ ~)~ pursuant to application dated ........................................................ , 19 ........ , and approved by the Building Inspector. I~ev. 6/30/80 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z12573 Date June 22, 1984 THIS CERTIFIES that the building .... ~¢.c.e.~ ~ 9F,7, ,~ ~,e,d~ ........................... Location of Property ,...~ ,7..0:..Dg.l.p.h.$.n..D.~?$yp .......... Southold ~ouse rye, Street Hamlet County Tax Map Ho. ] 000 Section .Q ~ .~ ........ Block ....0 .7 .......... Lot....0.~ ............ Subdivision .S.q .u.~.h.q 1..d. ~S.h.o..F 9.s ............. Filed Map No. 3.8.5..3 .... Lot No. 1 .5 ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated .... 4~....3. ........... 198.4.. pursuant to which Building Permit No. q..a.s3.qz. .............. dated .. v!a.n. 3 .................... 19.8.4., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which ttfis certificate is issued is ......... .... /{ ~ 9.e.s.s.o. ? y..s.h..e.d ............................................................ The certificate is issued to ... CB.ar. 3, ~ ~..T ~ ~.~.&. ~. P,.~ ~,¢ V..%0. s..~.a ........................ (owner,~e.~ ~I2t~IX7~ of the aforesaid building. Suffolk County Department of Health Approval .., ~l [g, ................................... UNDERWRITERS CERTIFICATE NO ........... .i31 [.A. ................................... Building Inspector Rev. 1/81 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ,~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitte~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. 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. Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling/ land use 3, Copy of certificate of occupancy $1.00 --Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 ~ , Date. ,~(~ .~ .... .<~. ......... New Building ,~.~,~,~,C~. .... Old or Pre-existing Building ............ Vacant Land ............. Location of Property . .\'.-~..~. . .~...Q .~ .~....~..~... ~.~ .~. ~ Hou~ No. b'treet , (~q~ Ham/et ........... Own,, o~ O~,e~, o~,ro,.,t~. ~~... ~. ~..~;~ ~.. ~ ...... % nty ,o0OS c,,on .......... ..... s,~,io, ................................. ,,e~ ~,,o. %<~.~..~ot ~o. ~ .......... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ...~... ................. Fee Submitted $ ............................. a~_~ a~b~ Construction on above described building ts es and regulations. Applicant. ~..'.~. ~-~ .,~...~. y~,c,<~-¢, re. ........................... Rev. 10-10-78 FOUNDATION~ FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION FERN. Y. STATE ENERGY CODE~ FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examine .. .-.~. :'. .... ,19 .--7 v Appro ed.. (3..~-c-~ .... 5~-.., 19:.~-Permit No././~¢¢. . .~.4..~ ~ ................ :7 ................... r (B'uilding Inspector) APPLICATION FOR BUILDING PERMIT Date. 3...~.?~. ·~ ......... 19 .~.9 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 timid 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, buildiJ}g code, hounding code, and regulations, and to admit authorized inspectors on premises and in building for necessary i/n~e~on~ (Signature of applicant, or name, if a corporation) ...~: ............ .~..GV,....~.~ ...... ."'/ ..... (Mailing address of applicant) is~ lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. State whether applicant .... ~D.~,,..~E;.I',, ................................................................................ Name of owner of premises . .C--..~'~:a)~,..~.~... ~ .~\.~.' .C,.~...~.~..~..~..--~...~. ................................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title o? corporate officer) Builder's License No .... .~..~,.~.,IZ; .............. Plumber's License No...~ 9..(~.~.~ .~t~..~ .%'5.~ .... .~ Electrician's License No..~'-'-~.%..~..¥.~...~. Y?.~.~...~-~ ~~ Other Trade's License No ...................... 1. Location of land on which proposed work will be done...~F.../.~.~... ~.~..~...~. ~.~)q~. ~...~]. ...... ~o %~\~¥ .~..~5 ~q~,,.x.~ ................................................ House Number Street Hamlet County Tax Map No. 1000 Section . .').~..~.O/~..~. ........... Block ......................... "~ Lot...[ ~ ..... Subdivision ..................................... Filed Map No. %~'8'~ Lot '} 5" (Name) 2. State existing use and occupancy of premises and intended nsc and occupancy of proposed construction: ~×isting use and oco~pan0y ... ¢..*.e,.~..~>.~....~-..r...~. m..~.~.. ,~."5.%.',.t~,~; % .............. b. Intended use and occupancy ............................. '?...'~. .... ,~...'~ .............................. 10. I1. 12. 13. 14. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair'. ............. Removal .............. Demolition .............. Other Work ............... ~ ~(~0~O F z~/(5) ~ (Description) Estimated Cost · ee .................... (to be paid on filing this application) If dwelling, number of dwelling units ............... Number of dwetling units on each floor ................ If garage, number of cars ............ = ............................................................ If business, commercial or mixed occupancy, specify natt.zre and extent of each type of use ..................... Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Nun~ber of Stories ........................................................ Dimen§ions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... ,.. Heigf~t ........ :, ............. Nur~b~er of Stories ........... .t .......... Dimensions of entire new const etlon' Front ? Rear ru . . ......... . .................. Depth . .'~' ........ Height ~..~../ ........... Number of Stories ..... ./ ................................................... Size oflot: Front.. !.~)x~ .... , ........... Rear . . .~.~ ................ DelXh..~._ .L~! S.~f~h~q~ .......... Date of Purchase ~C-,4- .c_~, .~. .. Name of Former Owner ...... Zone or use district in which promises are situated ..................................................... Does proposed construction vioiate any zoning law, ordinance or regulation: . .~0. ...................... Will Io~ be regraded . .~,~0..;, i.' · · ·. '--' ............ Will e~cess fill be r~moved from premises: _ Yes ~N~ Name of Owner of premises %1..LI~...~..W~. ......... Address ?~.0.: .~9~'..6,."1 Name of Architect ......... ................. Address .~.~..g.?..~.~.'~ ...... Phone No .............. Nmne 'of Contractor ......................... Address ................... Phone No ................ PLOT DIAGRAM Locate ~ clearly and distinctly alt buildings, whether existing or proposed, and, indicate all set-back dnnensions from property ilines. Give street and blocknumber Or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NF~V.~ COUNTY OF ........ \, ~'". ....... ~....~..~..Dfl. Y//~..~)~..~-I,._ being duly sworn, deposes ~d says that he is the applicant (Name of individual signing contract) above named. He is the ........................ ~ .................................................. : (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have perfo~ed the said work and to m~e and file this application; that all statements contained ~ this application are true to the best of his ~owledge and belief; and that the work will be perfo~ed in the m~er set forth in the application filed therewith. Sworn to before.~ne this , ...... , ~ ~8~, ~k ~ k LMgnature o~ appdcant) /