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Home My WebLink About16245-zFORM NO 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall $outhold, N.Y. Certificate Of Occupancy No....Z.-. 1.6. .72.8 ....... Date ...g.a.r.c.h...2..,...12.8.8. ............ THIS CERTIFIES that the building CONSTRUCT ACCESSORY Location of Property .... .2.0.0..L.e..g.~.o.n...Aye. n..ue Mat t ituck, New York House No. '....... 's'tle;i ....................... County Tax Map No. 1000 Section . .Iff. 2. ....... Block 2 .Lot 22 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore flied in this office dated July 15, 1987 pursuant to which Building Permit No. 16245 z dated......July 19....., I987 ........ 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 ......... ACCESSORY BUILDING The certificate is issued to . ADVENT LUTHERAN CHURCH .................... ? o¥/o 'r, .................... of the aforesaid building. Suffolk County Department of Health Approval ........... .N/.A. ........................... UNDERWRITERS CERTIFICATE NO .......... .N/?. ............... PLUMBERS CERTIFICATION DATED: N/A Building Inspector Rev. 1/81 FOB~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~6245 z Do,e ...... .~.~.../...~. ................... , 19..~..~ Permission is hereby gran : ~j.~ ,-, at premisos located ~t ..~.......1[~.. ..... ~ ....................... Building Inspector. Fee ,.,~2,~ .......... and approved by the Building Inspector Rev. 6/30/80 NAR I 5 1988, r.~l.b~, ot~ ~'. , ~ Southold, N.Y. 11971 TOW~" OF SOU'n~rAL~ ~ 765 - ] 802 ..................... APPLICATION FOR CERTIFICATE OF OCCUPANCY FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hell Instructions A. 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 topo~lraphic 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 property 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. C. Fees: Additions $25.00 POOLS $25.00 1. Certificate of occupancy New Dwelling $25.00, Accessory ,$]0.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3, Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 .~,~.~_.,,~. /..~, f~7/ 5.Updaked C.O. $ 50.00 Date ............ /, ....... New C on.~: t r u c t, ~ on ...... Old or Pre-ex isting Building ............ Vacant Land ............. Location of Property . 2.~...~. ................. z~,., .~-.~'./..O..~.. ?. ,M', .~, ............ ~.~ .~..~.¥.~..~ House No, Street I'tam/et Owner or Owners of Property ..................................... ~/Z~...z~. ' . ...... Subdivision ................................. Filed Map No ........... Lot No .............. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Submitted*.. 9. O... Construction on above describedApplicantbuilding.~:¢,.~. "~' '~ ~'~' ' ~and'~(~meets"ell applicable codes and ~'~u lations. ............. Rev. 10-10-78 UNDATION (1st) UNDATION (2nd) UGH FRAME & PLUMBING SULATION PER N. Y. STATE ENERGY CODE FINAL ~DDITION~L COMMENTS: 8OUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF HEALTH ..... . 3 SETS ~O~F.. )~.~..~.. ~(D ~-~ FORM NO. I SURVEY /OWN OF SOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC FORM . ..: TOWN HALL NOTIFY ...¢'~-.'~.-t4f~...~...~ Examined . . .~..~. I ~ .., 19~. .~. Approved ...... fl~ [. ~.., 197.'7. Permit No.~.. CALL BLDg. DE. TOWN OF SOIJi'HOLJ3 Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must sets of plans, accurate b. Plot plan or cation. d. Upon shall be kept e. No shall have been r filled in by Wpewriter or in ink and submitted to the Building Inspector, with 3 g to schedule. s on premises, relationship to adjoining premises or public streets must be drawn on the diagram which is part of this appli- may not be commenced before issuance of Building Permit. ~ Building. Inspector will issued a Building Permit to the applicant. Such permit ghout the work. or in part for any purpose whatever until a Certificate of Occupancy g Inspector. MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone ' the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o~ 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 .~'~ _ ....: .t,.' ": ~:~'" ~ ~' '~ 'i ...... in building for necessary i tio s..~ ~.~ (Signature of applicant, of ~ame, if a corp at'on) · ?.f. ~.C .~..~. ~.~...~...r...Z~....../¢'..~. '.rr.~ .re .~x<~. ~7.. (Mailing add~ess of applicant) /! ~.¢c~z, State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ,~ ~ ~--/b'7" . ~ ....... Name of owner of premises . .~.~).['/,&~..~../'~....~/~...~¢/~ ............................... (as on the tax roll or latest deed) If applicant ~s a corporation, signature of d~ly authorized officer. ~0%%~]~ ................ : ............................. ,,T~: (Name and title of comorate officer) ~: ~ ~'~_~gy, ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED ~OT~' ~tLDING O~PARTM~ AT Builder's License No .......................... 76B~*~2 FOL~OW~Nr/~ Plumber's License No ......................... FOUi,)~gY~Oh{ Electrician's License No ....................... BO Other ~ade's ~icanse ~o ...................... ~. F~J'~A~ · , ' ALL Ct')~<,f: 1. Locatmn of land on which proposed work will be done .................... ~,, ~ ~. q~,, ...... O~ .~-~,~ ~y ........ .................................. 26 _; .................. X':t_>t)~/~m-~' ~ ..... o nt xM p,o.,000S c,on ........... ,,oc .... .a .......... Subdivision ................ ~ ................. Filed Map No ..... ~ ....... Lot ...~ .......... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................. v, .~¢> .;.~<~a <.. ...................... b. Intended use and occupancy h t 01~ o/~ ~ ~ ~ ~o 3. Nature of~work (check which applicable): New Building ...... Addition .......... Alteration .......... Repair Removal .............. Demolition Other Work .... · . (Desc p ion) 4. Estimated Cost.. · ......................... Fee , (to be paid on filing this application) 5. If dwelling, numbeI of dwellingiunits ............... Number of dwelling units on each floor ................ If garage, number of cars .... i ..................................................... ............... 6. If business, commercial or mixeld occupancy, specify nature and extent of each type of use ' . ......... 7. Dimensions of existing s~rgctur~s if any: Front ............... Rear ...; .......... ' Depth ............. Height ......... ~ umber of Stones ........................... ' i i Dimensions of same structure With alterations or additions: Front ........... Rear . .' ................ Depth ...................... Height ...................... Number of Stories ..................... Dm~enaons of entire new construction: Front .. 7. ........... Rear . .7. ............ Depth . .7./~ ......... Height .. ~. , , ........... Number of Stories .......................................... ~ .............. 9. Size of lot: Front . .7.d. ..... ............ Rear . .'7.0. ................. Depth . ..]~ .................. 10. Date of Purchase .......... i .................. Name of Former Owner ............................. 11. Zone or use district in which pr~mises are situated ........................................ . ............. 1 2. Does proposed construction violate any'zoning law, ordinance or regulation: . .A,/.O. .......................... 13. Will lot be regraded .. ~.~.., ~ .................... )~ill excess fill be removed from_pge~ises: Yes 14. Name of Owner of premises /q.~.U~. ?..L..t/ff.'ff. ~.~..Cff.~/~"~ress . ,~..~.~./.~?/.,q-?.~.,. ~.~.~.t~ No. ,~ .~.-..~.O.g.2.= ~.. Name of Architect ......... .~. ................. Address ................... Phone No ................ Name of Contractor ........ : .................. Address .... : .............. Phohe No ................ 15. Is this property locatedlwithin 300 feet of a tidal wetland? *Yes ..... No . .~.. · If yes, Southold Town Trustees Permit maybe required. ~ PLOT DIAGRAM Locate clearly and distinctly alt buildings, whether existing or proposed, and, indicate all s~t-back dimensions from and indicate whether "8. property lines. Give street and block number or description according to deed, and show street names interior or corner lot. STATE OF NEW YORK, COUNTY OF .-,,%~q ?, .~.O./'r 1¢ ..... S.S .../~.[ ~../~.~. ~..~.....~. *../~..~.-.g~..~../~..~ ................ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. lie is the ....................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duJy authorized to perform or have performed the said y~ork and to make and file this application; that all statements contained 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 ~ ' -..T"O ,f ...... ~.. · .~..._ ......... day of..._.'~.~.. ~.~ . ._ ......... 19..7 . .... N~,~~ya~k -- [ (Signature of applicant) Commission Expires December 8, lO