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Home My WebLink About16323-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. ZI6023 Date August 6, 1987 THIS CERTIFIES that the building ...fi i ~ i 5.k~ d. ~.e.q 9 r~.d., f..1 p p.r. .................... Location o f Property ... ~ .6.0. ~ .................. D..e .e.p...H 9.1.e,. D..r ............ .M.a. t..t .i.t.u.c..k House No. Street Hamlet County Tax Map No. 1000 Section ..... 1.1.5. .... Block ... !4. .......... Lot I I, I Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... A..u g.u.s.t...6 .... 1..9 .8.7 pursuant to which Building Permit No. 16 3 2 3 Z dated ...... A~gu ~ ~..6. ~. J 9.8.7. ..... was issued, and conforms to aH of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is . .t.o~ ..... finish second floor addition of exis.t.i.n.,g..o.n.e..,f.a.m.i..ly, dwelling as h'p'l~ ~[ ih'd' 'fbi:'. ............................................... The certificate is issued to .................... .R.i.c.h..a .r.d..&,..A.n.i.t.a...W.i. 1. t. 9.n ............. [owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .......... I~./.A ............................ UNDERWRITERS CERTIFICATE NO .......... ~/A ..................................... PLUMBERS CERTIFICATION DATED: N/A Building Inspector Rev. 1/81 ~0~ NO. ~ TO~N O~ SOfT, OLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, H. Y. BUILDING P~RMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: .~.o..~...~.L~ ................................................. ~0, , I1~--... ,o ..V..~.....~..~......~...~....~.~...).~ '~'"'"'~'~'~"~'"'"'"~ ' ............... ,..~'! .................... ~'~-~t~.,~:'"'~ : ....... ' · "~'r ............. ~ .................. ~ .......................... at premises located at ...~..~....0....~.......~,..;~:..~,.:.~....~......., ...... ....,..,..,..,~,,~m~.~ .............. County Tax Map No. 1000 Section ....... ~...,,~ ......... Block ....... I..~. ......... Lot No....[[.:..I ............ pursuant to application dated ..... ~~.~......~ .................. , 19.~...'J.,-- and approved by the Building Inspector· ~ee ~..~:.~ ........ Building Insl:mctor Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y, 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUP Instructions Ao This application must be filled in typewriter OR ink, and submitted ,.. I~mamJmm 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~Operty 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 bui)dings, 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 1. Certificate of occupancy New Dwelling,$25.Q0, Accessory fSI0.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50 o 00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10,00 4.Vacant Land C.O. $ 20.00 ~3//o !"~/3/0-~ 5.Updated C.O. $ 50.00 Date .......................... NewConstrucbion ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ..o~.~;~. .~'~'/O /7/~- ~[~ ~/~ ~,~. Hou~ No. Street Hamlet Owner or Owners of Property ~<~d~ C' .................................... County Tax Map No. 1000 SectJo~ ............. Block ........... Lot .......... Subdivision ................................. Fi[~d Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept Approval Labor Dept Approval ' Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporarv Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and permit meets all applicable codes and regulations. /0~ ,,a,~ ~' ~' '~ Applicant .................................................... =- Rev. 10-10-78 UND~TION (1st) JNDATION (2nd) 3GH FRAME & FLUMBING SULATION FERN. Y. STATE ENERGY CODE FINAL , ADDITIO~AL COMMENTS: C BOARD OF HEALTH ...... 3 SETS OF PLANS ....... 'FORM NO. 1 SURVEY ........ TOWN OF SOUTHOLD CHECK .. BUILDING DEPARTMENT SEFTIC FORM ............. TOWN HALL NOTIFY SOUTHOLD, N.Y. 11971 TEL.: 765-1802 CALL ................ MAIL TO: Examined.~..I.~..~-...l[O.., 19~. .7. Approved ...~4,9~t~.~...~..., 19~7. Pe~it No..I. ~. ~ Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT BLDG. DEPT. TOWN OF SOUTHOLD ' ~ ' Date ................... I9... 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. e. No building shall be occupied or used in whole or in part for any purpose whatever unffi 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 Buildifig'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, b.,u~ff~ code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessar))jfisp~a~o}?. (Signature of applicant, or name, if a corporation) oO ............ . (Ma'ihng address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .O.C .O4..e ....................... ............................................................. Name of owner of premises ~ ~ .t'.C..k..t~..~, .0.;..~. :...(~. i.C..T.O...~. .......................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) · ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. 6O..r ..... t.v.e ..... .... .... I.! o7.3 ............ House Number Street Hamlet County Tax Map No. 1000 Section .//..'-~.. ........... Block . ./..~.. ............ Lot../e4.'.~. ............ 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 ~. . :s./. . . . .< .? .......................................... b. Intended use and occupancy .................................................................... 3. Nature of work (check which ~pplicable): New Building ..... ' ..... Addition...~. ...... Alteratio.n .... ., ..... 2.. Repair .............. Ren~oval .............. Demolition .............. Other Work... ............. 4. Estimated Cost ~0 ........... ~. t ........................ 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 mixed occupancy, specify nature and extent of each type of'use .:.. ............ ...... f a ~th 7. D~mensmns of ex~st~ng stmctu[es,~ ny: Front ................ Rear ............. ~ De ............... Height Number of Stories D~ension~of ~ structure With alterations or additions: Front ................. Rear '. ................. Depth . .' .IJ...r3~(~. ........ .~'.. HeiSt ...................... Number of Stories ...................... -"8. Dimensions of entire new construction: Front .......... Rear Depth Height ............... Number of Stories ................ ..,. ..................................... 9. Size of lot: Front .......... i .......'..'...' Rear.; ............. ....... Depth ...................... 10. Date of Purchase ..........'..' Name of Fo~er Owner 11. Zone or use district in which p~emises are situated ............... 12. Does proposed co0struction viglate any zoning law, ordinance or regulation: .~.O ........................... 13. Will lot be regraded ...~ ~ .................. Will excess fill be removed from premises: Yes No 14. Nme of Owner of premises . ~ .......... Address ................... Phone No ................ Nme of Architect ..... ~.~ ............... Address ................... Phone. No ................ Nme of Contractor .... ~. · . Address Phone No. i5. Is this property located~ within 300 feet of a tidal wetland? *Yes ..... No ..... · If yes, Southold To~ TrBstees Permit maybe required. .. ~ PLOT DIAGRAM Locate clearly ~d distinctly ~1 buildings, whether existing or proposed, and, indicate ~1 set-back d~ensions from property Hnes. Give street ~d blocg number or desc~ption accord~g to deed, ~d show street nines and indicate whether interior or corner lot NOTIFY ~ILDI~G DEPAR~M~ A~ OCCUPANCY OR STATE OF N~W YO~E, 8.8 COU~ OF ................. .......................... .... . ~.m ........ . ........ .... being duly sworn, deposes and says that he is the applicant (Name of ind~wdual slgmng contract) above named. He is the ..................... ~ .................................................................... ~ (Contracto~, agent, corporate officer, etc.) of said owner or 6w~ners, m~d is du)y authorized fo perfoim or have performed the said work and to m~e and file this application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the work will be perfumed in the m~n~r set forth in the application filed therewith. Swum to before ~e'this ............. ~...~ ...... day o~ ....... ~ ....... , 19~ ~ ' Notaw Public,.. ~..~ [. ~-. ...... County NO, 47~78'/8, ~Suffolk'Count~ ~ , Term Expires Mi,rcA ~, ~9~