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Home My WebLink About15692-z FORM NO 4 TOWN OF 5OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N ¥. Certificate Of Occupancy No Z]5291 Date Feb. 23, 1987 THIS CERTIFIES that the bmldmg , ~..d d.i.t..i .o n .......................... Location of Property! ....2.4..0. C.h a.mp 1. i n...P.1 q c. e ................ .G F.e.e.n. ? .o.r.t, ........ Mouse No Street Ham/et County Tax Map No i 1000 Sect:on . 034 Block 3 .Lot 4 3 Subd:ws:on .... ~ .............. Fried Map No ..... Lot No ............ conforms substantmlly to the Apphcahon for Buridmg Permit heretofore fried in tins office dated .... .F.eb....2p.; . ] 9.87 , . pursuant to winch Building Permit No . .1.5.6.9.2.Z ......... dated . ¥.e.b. .2.3, [ 1.9.87. ... , was ~ssued, and conforms to all of the requirements of the apphcable provisions of the law The occupancy for which this certificate is issued is ....... ...Copst. r.uct. ~ .d.ec.k,..re.a.r .of..ex. zs. ti.n.g..dwe.ll..~n.g... ............... Thecertfficatemmsuddto . .D.a.n. ze.l..&..S.a.l, ly.G.r.a.tt.a.n,..,Jr ................. (owner, ~3r~k of the aforesaid building Suffolk County Department of Health Approval N/A UNDERWRITERS CERTIFICATE NO ........... .N/.A ..................... PLUMBERS CERTIFICATION DATED: N/A Braiding Inspector Rev 1181 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF TH?~ WORK AUTHORIZED) N~ 15692'1Z Building Inspector. Fee $..~..~..~ ............. 6/30/80 FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A, This apphcat~on muSt be fdled m Wpewmter OR ink, and submttted m ~ to the Building Inspec- tor w~th the following; for new buddings or new use: 1. F[na{ survey of p~operty wtth accurate location of all buildings, property lines, Streets, and unusual natural or topographic features. 2.Fma[ approval of Health Dept, of water supplv and sewerage d~sposal-(S-g form or equal), 3.Approval of electiical ~nstaHation from Board of Fire Underwriters. 4. Commercml buddings, I~dustrml buddings, Multiple Residences and similar buildings and installa- tions, a cert~ficate of Cdde compliance f~m the Architect or Engineer responsible for the building. 5.Submit Planmng Board approval of completed rote plan requirements where applicable. B. For existing budd~qgs (prior to Apml 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 0f owner or previous owner as to use, occupancy and condition of buddings° 3. Date of any housing code or safety inspection of 17dildings or premises, or other pertinent informa- tion required to p~epare a certificate. ~ $25.00 C. Fees' Additzon$ 1. Cer~ff~cateofoccdpancy New Dwellzng $25.00, Accessory 'SI0.00 Business $50.00 2. Certificate of occdpancy on pre-existing dwelling $ 50.00 3. Copy of certlflcate of occupancy $ 5 00, over 5 years $]0.00 4.Vacant Land ]C.O. $ 20.00 ,; /~ ~.. ~ ,-~ 5.Updated C.O. ,, $ 50 00 ,Date .¢h../...~'?.....'q..~,~.../. .... NewConotructzo~ ...... Old orPre-exmtingBuddmg ...~.. ...... Vacant Land ............ Locat,on of Property.· .~. ,~.'.?, ............ ~.~.~z~.,/~), fL~'~. ............ ~'. HOUSe NO, ~,? ~ F ~ ~t j Ham/et County Tax ,o. ooo Se0 ,on . ¢ ..... B,oo ... ......Lot... ......... Subd,vmton . .~'.~/.~.. ~ .J'./.~ ................. F,led Map No. ~.~ ..... Lot No ............. Permit No .......... Date of Permit ......... Apphcant .................................. Health Dept Approval , Labor Dept Approval Underwmters Approval ..................... Planmng Board Approval .................... Request for Temporary ~ertificate .................. Final Certificate ....................... Fee Submitted $ , Construction on above described building anM'~erm~t meets..311 applicable codes and regulations, Xpplieant .................... TOWN OF SOUTHOLD Blyrf,BING DEPARTMENT Town Clerk's Office Southold, N. Y. No. Z. e999. THIS CERTIFIEI Certificnle Of Occupnncy Da~e . ~.Y that the building located at 2/~0 1 .. ., 19..7.8 Champlin, ...Place. ... Street Map No .... Block No.. Lot No.. REGUIREMENTS FOR ONE FAMILY DWELLING BUILT BEFORE conforms substantiall ' to the ~~ 23 , fiE~IF. IfiA~E..OF OCCUPANCY dated April. . . 19 ~.7. pursuant to which ~No. Z$9.~9 dated ...M.a.y. ........ [J ...... , 19.7.8., was issued, and conforms to all of the require~ ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .. PRIVATE. ONE. FAMILY. DWELLING. .................. Ch6rles Y..R,ay~or ............. (owner, The certificate is issued to Pre-Existing of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE No .............. Pre-Existing HOUSE NUMBER 240 Street Champlin Place New .York Building Inspector FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL,: 765-1802 .xam,n d __ Approved ._ /. I9 No. >. 7. Disapproved a/c .......... : ....................... (Budding InspeCtOr) BOARD OF HEA~TH .,-,,. 3 SETS OF PLANS ....... SURVEY .......... CHECK .......... SEPTIC FORM ............. NOTIFY CALL ................ MAIL TO: APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a Ttus application must beI completely filled m by typewriter or in ink and submitted to the Budding Inspector, wit sets of plans, accurate plot plan to scale· Fee according to schedule. b. Plot plan showmg locatmn of lot and of buddings on premmes, relatmnshlp to adjoining premises or pubhc stp, or areas, and giving a detailed dlescription of layout of property must be drawn on the diagram which is part of this ap cation. c. The work covered by tin~ application may not be commenced before issuance of Bui/dmg Permit. d Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such per shall be kept on the premises available for mspection throughout the work. e. No building shall be occupied or used in whole or ~n part for any purpose whatever untd a Certificate of Occupm shall have been granted by the Bhilding Inspector APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Bmlding Permit pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinance- Regulations, for the construct~dn of butldmgs, additions or alterations, or for removal or demohtion, as herein descnb The applicant agrees to comply~ with all apphcable laws, ordinances, buillt~n~ code, housing code, and regulatmns, and admit authorized inspectors on premlsesl and m building for necessary ..... lnsp~c~[ons.~ ~~' · '~ ~}~/~ ., t~ .__~ .... · ...... -- (Mailing address of applicant) / State whether applicant ts owner, lessee, agent, architect, engineer, general contractor, electrician, ~lumber or build ! (as on the tax rolI or latest deed) If applicant is a corporatmn, mghature of duly authorized officer. (Name and title of cqrporate officer) ALL CONTRACTOR'S MUST B~tJIUFFOLK COUNTY LICENSED Builder's License No ........... ,,~. Plumber's License No ..................... Electncmn's L,cense No.., ..................... Other Trade's License No. I ............... Location of land on which proposed work will be done. ~. ........................................... .. ........... .... House Number Hamlet / ¢o~t~Va,~ap~o ~000Sectio...e.~3..q ..... B~ock. ~. .............. Lot...q...7. Subdivision ........ Filed Map No ............. Lot ...... (iqan~e) 2. State existing use and occupancy of premises and intended use and occupancy of propo~sed construction' a Existing use and occupancy.. ~~~*~'a~2'~.'~ ~.~,'~__ -- ~.~'~'~ ,. ................ Nature of work (check which apphcable). New Budding ...... Addition . .g... . teration ...... Repmr ........ V'' Removal .............. Demolmon ........... Other Work .............. Esnmated Cost .~..b ~ .afrO. ~. · ........................ Fee .... ~. ,W~. ! ............................ / "" ' ,to be pa,d on fihng tb,s apphcat~on) If dwelhng, number of dwalhng units ............. Number of dwelhng units on each floor .............. If garage, number of cars .... , ................................................................ If bumness, commercml or m~xed occupancy, specify nature and extent of each type of use ................... D~menmons of existing structures, if any Front .......... Rear ............ Depth ........ Height .............. Number of Stones ........................................... w~th alteranons or ad&nons' Front ............ Rear ................ Dunenmons of same structure ·. Depth ................... J.. Hexght .................... Number of Stones ............. D~menmons of entire new construction Front .............. Rear .................. Height ............... Nun~ber of Stones ...................................................... S~ze of lot. Front I Rear Depth Date of Purchase .......... ~ .................. Name of Former Owner ........................... Zone or use district in which pr~mises are situated .......................................... Does proposed construction vlo!ate auy zoning law, ordinance or regulation· . ......................... Wall lot be regraded ...................... Wtll excess fill be removed from premises' Yes No Nmne of Owner of premises .. ' ................ Address ................... Phone No ............... Name of Architect ....................' ..Address ................. Phone No ................ Name of Contractor .'.' '"'.''"'.' .''"'" Address ............. Phone No .............. Is this property located within 300 feet of a tidal wetland? *Yes ..... No ..... · If yes, Southold Town TrWstees Permit maybe required. I PLOT DIAGRAM Locate clearly and dmt~nctly allI buddings, whether emstmg or proposed, and.~ndicate all set-back dLmenmons from perry hnes. G~ve street and block number or descnphon according to deed, and show street names and ~ndxcate whether nor or comer lot. oF . s s .~ ./~c~.fO/~'+..w07... 3~[~(~ ............ being duly sworn, deposes and says that he ~s. the apphcant (Name of md~wdual signing contract) named .................................................... / ~.~. ' (Contractor, agent, corporate off~cet, ere) md owner or ownem, md ~s dul~ authored to perfo~ or have perfo~ed the said work and to m~e and file t~s [~cation, that all statements contained ~ this apphcation are true to the best of h~s ~owledge and belief; and that the will be perfo~ed m the mmner set forth ~ the apphcat~on filed therewith. ,m to before me this ........... ......................... ~~ / ~ (S~ature of apphcant)