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Home My WebLink About15905-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall SouthoId, N.Y. Certificate Of Occupancy ZI5649 No .... Date Aprzl 16, 1987 THIS CERTIFIES that the bmldmg . .Ad.d } .t.i.o.n ...................... Location of Property ...1159. BL.U.E..M. AR..L I.N DRIVE 80UTHOLD House No Street Hamlet County Tax Map No '! 000 Section 0 5.7. .... Block . 0 I ........... Lot 3 3 Subd~v~mon ................ Fried Map No . .Lot No ........ conforms substantially to the Apphcahon for Building Permit heretofore filed in tins office dated ·..A p.r z l. l 0., . ! 987 pursuant to which Building Permit No. 15905 Z dated. .A.p.rll 1.3~. [9.87 ...... wasissued, and conforms to all of the requirements of the apphcable prowsions of the law. The occupancy for winch ttus certificate is issued is ... Dqc.k a.d.~d.i.tzo..n.s..to.a.n .e.xz.s.t~n.g o.n.e .f. am.i.ly...dw.el, lz.n.g.. ..... i MURRAY WEITMAN The certificate is ~ssu~d to ....... of the aforesaid building Suffolk County Department of Health Approval UNDERWRITERS CI PLUMBERS CERTI Rev 1/81 ;RTIFICATE NO ........ ?ICATION DATgD: (owner, N/A N/A ~ No. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERA~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No 15905 Z Permiss~on is hereby granted to: . ...~..,.-;~.~.~. ............ ,o.~~..?.~&....~...~....~..~..~.' ............... ~7';": ....... ~" ....... ' ................ ' ....... :' . '~'""-~' ~.~..~.....~...~~...~. ........ ~...,...~ ............ .~ ...... ~ ........ ...;... ,t pr~, ~t,a ~t IJ..~......~.....~..~_..~.~ ............. ~~....~ . 8uild~n~ Inspector. Fee $..~....i ............ Bu~rdlng Inspector ' Rev. 6/30/80 FORM NO 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A Instructions This appllcatlon must be fdlad in typewriter OR ink, and submitted m laamm~maa to the Bui[dmg Inspec- tor with the following; for new buddmgs or new use: 1. Fmal ~urvev of property with accurate location of a([ buddmgs, property lines, ~reets, and unu~al natural or topographic fea~res. 2. Final approval of Health Dept. of water ~pply and sewerage dmsposal-(S-g form or equal} 3. Approval of electrical mnstallat~on from Board of Fire Unde~riters. 4. Commerc[al buildings, lndu~rml buddings, Multiple Residences and mmdar buildings and in~aila- t~ons, a cert~fmate of Code comphance from the Architect or Engineer responsible for the budding. 5 Submit Planning Board approval of completed site plan requirements where applicable. Bo For existing buddings (prior to Aprd 1957), Non-conforming uses, or buddings and "pre-existing" land uses: 1. Accurate survey Of property showing all property hnes, streets, buildings and unusual natural or topographm features. 2. Sworn statement Df owner or previous owner as to use, occupancy and condition of buddings 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 1. Cert~ficate of occupancy $25.00 -- BUSINESS $50.00 ACCESSORY $10.00 2. Cert~fmate ofoccdpancy on pre-exist~ng dwe ling $ 50 00 3 Copy of cert~flcat~ of occupancy $ 5.00, over ~ years $t0.00 4.Vacant Land'C.O. $ 20.00 5.Updated C.O. $ 50.00 Date .......................... NewCons%ructzon ...... Old or Pre-exmtmg Building ........... Vacant Land ............. Locatton of Property ....................... ~. ................. House No Street Hamlet Owner or Owners of Property_ .... _'~ .A?~ .... .... .~..~ .......................... County Tax Map No. 1000 Section .., Jr.."/. ,- ..... Block .... /. .......... Lot...~..--~. ........ Subd[v~mon ........................... Fded Map No ........... Lot No ............. Permit No ...................................... Health Dept. Approval ....................... Labor Dept. Approval ........................ Underwriters Approva{ ...................... Planning Board Approval ..................... Request for Temporary ~ertff~cate ................ Final Certificate ....................... Fee Submitted $ ..... : ................... Constructton on above d~senbed budding an,~rmlt meets all apphcab,~ codes and ragu{atlons. Apphcan ................. Rev 10 10 78 OUNDATION (1st) OUNDATION ( 2nd ) OUGH FRAME & PLUMBING NSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL CO~ME~TS: BLDG DEPT TOWN OF SOUTHOLD Examined ~ ,/~,~. , 19;~'~ Approved ~ Disapproved a/c FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y, 11971 TEL.. 765-1802 (Building Inspector) BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... CHECK .......... SEPTIC FORM ............. NOTIFY CALL ................ MAlL TO: APPLICATION FOR BUILDING PERMIT Date ........... 19 INSTRUCTIONS a. Tlus application must b~ 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 location of lot and of bmldmgs on premises, relationship to adjommg premises or public str. or areas, and giving a detmled description of layout of property must be drawn on the diagram which is part of this ap cation c. The work covered by ttus application may not be commenced before issuance of Budding Permit. d Upon approval of this application, the Building Inspector will issued a Bmldmg Permit to the applicant Such pet shall be kept on the premises available for inspection throughout the work e No budding shall be occupied or used in whole or In part for any purpose whatever until a Certificate of Occupm shall have been granted by the Building Inspector APPLICATION IS HEREBY MADE to the Bmldmg Department for the issuance of a Bmlding Permit pursuant to Building Zone Ordinance of th~ Town of Southold, Suffolk County, New ~York, and other apphcable Laws, Ordmance- Regulatlons, for the construction of buddings, additions or alterations, or for removal or demolition, as herem descnb The applicant agrees to comply with all apphcable laws, ordinances, bmldmg code, housmg code, and regulations, and admit authorized msprectors on 13remlses and m building for necessary inspections ~, i'* ~ * t ,~ ~, ~ ~ , (Signature of apphcant, or name, if a corporation) ~,, ~*' ~ ~x. ~ i~l-~: ~ ~ (Mailing address of applicant) State whether appla:3~pt;lis~v~. ~ssec, agent, architect, enCneer, general contractor, electncmn, plumber or build Nameofownerofpremlses ~'~ ~ 1~ ~}7 (as on the tax roll or latest deed) If applicant is a corporation, slg~ature of duly authorized officer (Name and title of cqrporate officer) /~LL COtITRACTOR'S MUST BE SUFFOLK COUtlTY LICEtIS, Builder's License No. -- .. Plumber's License No ......... Electrician's License No · · Other Trade's License No ..... Location of land on which p~oposed work will be done ltouse Number Street County Tax Map No 1000 Section Hamlet Block . / . Lot. .~. Subdw]sion .. Filed Map No Lot (Name) 2. State existing use and occupfincy of premises and intended use and occupancy of proposed construction b Intended use and occupan y 3 9 10 11. 12. Nature of work (check which applicable) New Budding Repmr ......... Removal . Estimated Cost . . tr.O .~. ...... If dwelling, number of dwelling units . / .. Addmon .... Alteration .... ..... Demolition ........ C~ ~iDescn pt'l; in · (to be paid on filing this application) .[ ...... Number of dwelhng units on each floor ...... If garage, number of cars .. / ............................................. If business, commercial or mixed occupancy, specify nature and extent of each type of use .~e.~. ..... Dimensions of existing structures, if any Front ..... Rear .......... Depth ....... Height .... Number of Stones .......... Dunenmons of same structure with alterations or additions Front .. d~.. ...... Rear .~e~.. ....... Depth ... ~. ~-, ..... Height '2~ ~,~ ....... Number of Stones ...'~7 ............ D~menmons of entire new constructmn' Front .~.~.. .. Rear .... .~.,,~7.. .. Depth ,~"...~- ...... Height . .~ ..... Number of Stones . . //0 . . Rear Size of lot Front Date of Purchase . . Zone or use district ~n which premises are situated. 7~ Does proposed construction violate any zoning law, ordinance or regulation ../~ ............... 13. Will lot be regraded ! ........... Will excess fill be removed from premmes Yes N, 14 Name°fOwner°fpremlsest~'Rl~'~'~t~'*'~'~''~''Address-~.~ .t~- /I,I'~ [I~' ~¥' .~l,~,~t Phone No ~'.~.4"./~.~... Name of Architect /(~'~#~.~t · .. Address ~ ~ ......... Phone No .......... Name of Contractor ,~&~'4*~'~. ¥.~..~ ...... Address~,~'~.t'.*~. ~t~.. Phone No ......... 15. Is this property located within 300 feet of a tzdal wetland? *Yes .~ No ..... *If yes, Southold Town Trustees Permit maybe required. PLOT DIAGi~AM Locate clearly and dmtmctly all buddings, whether existing or proposed, and indicate all set-back danenmons fron property hnes. G~ve street and block number or description accordmg to deed, and show street names and red,cate whethe interior or corner lot. ~OTI~Y ~ILDING DEPARTMENT AT ~rk CONStRUC~t~ & EN~ OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY STATE OF NEW YORK, S S COUNTY OF ......... .... ~ ............. being duly sworn, deposes and says that he is the apphcan (Name of mdw~dual sigmng contract) above named He is the ............................ (Contractor, agent, corporate officer, etc ) of said owner or owners, and is Ouly authorized to perform or have performed the said work and to make and file fin appbcatmn, that ali statements contmned m thru application are true to the best of his knowledge and belief, and that th, work will be performed in the manner set forth m the application filed therewith. Sworn to before me this (Signature of applicant