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Home My WebLink About15922-zFORM NO 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ~15R59 ..... Date aul~.!~., .19~? ....... THIS CERTIFIES that the budding .... F o u.n.d.a, t .i.o.n. ..................... Locatxon of Property . . 50 .Bay Road Greenport ' Ho.~ No. ' ...... 'Svebi ................... County Tax Map No 1000 Section 4 3. .... Block .0 5. .....Lot .. 1.3.: 1 ........ Subdlvisxon ..................... Fried Map No ..... Lot No ......... conforms substantially to the Apphcat~on for Building Permit heretofore filed in thru office dated ·,..A p,r,i, 1, .I .3.,,, .t .98.7., pursuant to which Butldmg Penuit No. 15922 Z dated . tx p r i 1 1,7, . 19.8.7 .. . . was msued, and conforms to all of the reqmrements of the apphcable provm~ons of the law The occupancy for which this certificate is issued ~s ...... B3o, ck..fo.u.nd,a,~ig.n ..un.d.e.F an existz.ng..on,e, fa. rn,zl.y .dy,e.l.l.i.n,g... ........ BELtx BAKO The certificate is msu~d to ........... of the aforesaid bmlding Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE NO .. PLUMBERS CERTIFICATION DATED: N/A Rev 1/81 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. N_O BUILDING PERMIT CFHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15922' Z D,t~ ......... l ......................... , i~..~..7 Permission is hereby granted to' ................................. ,o ot premises located at i.~-~.......~,...- ~ ...~..~..~..,.....~1....~.,.~ .~.~ ................................. County Tax Map No 11000 Section ..... .,~, ,,.~...,~. ..... Block ...... .~.,,~-,, ...... Lot No ....,~,..~.;.,~. ..... pursuant to application dated ..... t~b~-~, ' ~..~.~.~....~...~.. ....... Building Inspector. ............ , 19.~.1., ond approved by the Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- [802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcatlon must be filled in typewriter OR ~nk, and submitted m~ to the Building Inspec- tor with the followmg; for new buddings or new use 1. Final survey of property with accurate location of all buddings, property lines, streets, and unusual natural or topographic features. 2. Fmal approval of Health Dept of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical Installat~on from Board of Fire Underwriters. 4. Commercml buddings, Industmal buildings, Multiple Residences and s~milar buildings and installa. t~ons, a certificate of Code compliance from the Architect or Engmeer responsible for the buddmg 5. Submit Planning Board approval of completed rote plan requirements where apphcab~e. B. For exist~ng buddings (prior to April 1957), Non-conforming uses, or buddmgs and "pre-exlstmg" land uses 1. Accurate survey 'of p~operty showing all property lines, streets, buildmgs and unusual natural or topograph lc featu res. 2 Sworn statement of owner or previous owner as to use, occupancy and condition of buddings 3. Date of any housmg code or safety inspect~on of buddings or premises, or other pertinent informa- t~on required to prepare a certificate. C. Fees: 1. Cert~flcateofocqupancy $25.00 -- B[T$INgS$ $50.00 ACCESSOR¥ $10.00 2. Cert~fmate of occupancy on pre-exmtmg dwelhng $ 50.00 3. Copy of certlf]ca~e of occupancy $ ~.00, over 5 years $]0.00 c.o. $ 2o oo /9 5.Updated C.O- $ 50.00 Date ..................... NewConst~'uctlon ...... Old or Pre-ex,sting 8uddmg z./ Vacant Land Locat,on of Property. ~.~.. ~..~. ,~..~, ?. ~ ...................... .~.~'~..~..~. ~ ...... House No. Street Hamlet Owner or Owners of Prbperty . .~.~ ....................................... County Tax Map No. 1000Section ..~.,.'.~. ....... Block . .C:.~. ........ Lot../~.'../ ..... Subd~ws~on ........................ Fded Map No ....... Lot No ........... Health Dept. Approval r ..................... Labor Dept Approval ........................ Unde~r~ters Approve{ ~ ..................... P~anmng Board Approva~ ..................... Request for Temporary,Cert~fmate ................ F~nal Cert~fmate ....................... Fee Submitted $. Construction on above described bulldlng~ ~e codes and regulations Apphcant ~~ ............. OUNDATION ( 1~ OUNDATION I2n~) OUGH FRAME & ?LUMBING NSULATION PER N. Y. STATE ENERGY CODE ADDITIONAL COMMENTS: / / 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION I' ] FRAMING [~FINAL DATE FORM NO. 1 SURVEY .. TOWN OF SOUTHOLD CB. ECK ........ BUILDING DEPARTMENT SEPTIC FORE ............. : TOWN HALL NOTIFY C, OUTHOLD, N Y 11971 TEL,: 765-1802 Examined Approved .(7~-~. ~.q.., 19~] Permit No D~sapproved a/c .................................... (Budding Inspector) APPLICATION FOR BUILDING PEFIMIT CALL ................ MAIL TO:so ~ B~D~ OEPT, i Tow. ....... Date ........... 19 INSTRUCTIONS a. Ttus apphcatlon must be completely filled ~n by typewriter or ~n ink and submatted to the Budding Inspector, w0 sets of plans, accurate plot plan to scale Fee accor&ng to schedule b. Plot plan showing location of lot and of bmldmgs on premmes, relahonshlp to adjmmng premises or pubhc sir or areas, and giving a detmled descnptmn of layout of property must be drawn on the dmgmm whmh is part of flus al catmn. c. The work covered by this apphcatmn,aa~lr ~ ~cona~enced before ~ssuanee of Building Permit d Upon approval of th~s apphc~t~i~/~Idn ~wfll~,k~ued a Building Permit to the apphcant Such pe~ shall be kept on the premises e. No building shall beto,{~k~l'~r' us%~] ~ o;~l~k~l~]n-y purpose whatever untd a Certfficate of O¢cupa shall have been granted by APPLICATION IS HEREIIk~,I~E~.~I~a~u~ ~'I~l~rtment for the ~ssuance ora Bmld~ng Permit pursuant to Bufl&ng Zone Ordinance of thl~F6~lalalSI~ t~l~ounty, New York, and other apphcable LawL Ordinance, Regulations, for the constructt0~l~.~cl~ ~6'ffalterat~ons, or for removal or demohtmn, as herein descn~ The apphcant agrees to comply ~1~ all~!t%laws, ordinances, building code, housing code. and regulations, an, admit authorized inspectors on prer~ a~q~'~'~ufldmg for necessary inspections (S~gnature of applicant, or name, ff a corporatmn) (Marling address of appbcant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electncmn, plumber or bmh £, U3. xJ. ./X ., ................. Name of owner ofpremlses f'-~ '~ '/-~/~' '~) ~ /<~ ~OVEO nS nOX~ If apphcant IS a corporation, m~nature of duly authorized officer ~ ~ / BY ~ ~L (Name and Utle of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No ........ 2 Plumber's License No Electrician's License No .. Other Trade's L~cense No' . ./YO~J/q"~4~"20 C?~-4~'t~ Locahon of land on which proposed work wall be done .. House Number Street County Tax Map No 1000 Section ~ Sub&wsmn (Name) Block Filed Map No Lot State ex~stmg use and occupancy of prenuses and intended use and occupancy of proposed construction a Ex,stmguse and occupancy ~ Inteffded use and occupancy* 3 Nature of work (check which apphcable) New Budding Addition ..... Alteration ~--. Rep~tr .~. .... ~,. Removal ~. x, - ~.,. - Demokhon ......... OtherWork ..... ~/~. .... ~~ ~,~'~_~k~ ~ ~o~&~ ~ ~ (Descnpnon) 4. Esnmated Cost q ................................................. ' (to be prod on fihng th~s apphcat~on) 5. If dwelhng, number of dwelhn~ units .. /... Number of dwelhng units on each floor ............ If garage, number of c~ ................................. ~ ......... 6. If bus~ness, commerclal or m~xed occupancy, specify nature and extent of each type of use ............... 7. D~menslons of exmtmg structures, ~f any Front ..... Rear ....... Depth ..... Height ...... Number of Stones ............................ D~ens~ons of same structure w~th alterahons or add~tmns Front ...... Rear ............ Depth ............ Hm~t .......... Number of Stones .............. 8. D~ens~ons of enhre new construction Front ........... Rear ............ Depth .......... Hel~t ........ Number of Stones ................................. 9. Size of lot Front .. . Re~ ............ Depth ............... 10. Date of Purchase ................ Name of Foyer Owner ..................... 1 1. Zone or use d~stnct m which premises are s~tuated ................................. __ 1 2. Does proposed constructmn vkqlate any zoning law, ordinance or regulation . .~ .............. 13. Wtll lot be regraded ...... ~O ....... Wall excess fill be removed from premises' Yes No 14. Nme of Owner of premises ......... Address ............... Phone No. 77:. 6 . N~e of Architect ............... Address ............. Phone ........... Nme of Contractor ................ Address ............. Phone No ............. 15. Is thzs property located within 300 feet of a tidal wetland? *Yes ..... *If yes, Southold Town Trustees Permit may be required. PLOW DIAGiUkM Locate clearly and d~stmctly ail buddings, whether ex~st~ng or proposed, and ~nd~cate all set-back dunenslons from )roperty hnes G~ve street and block number or descnptmn according to deed, and show street names and indicate whether ntenor or corner lot ..... ; . ,. .... being duly sworn, deposes and says that he ~s the apphcant (Name of md~wduaI s~gnmg contract) hove named. te ~s the .................. (Contractor, agent, corporate officer, etc.) ~":~ ~ ..... ,f smd owner or owners, and ~s duly anthonzed to perform or have performed the smd work and to make and file flus pphcatmn, that ail statements contmned m this apphcat~on are true to the best ofhm knowledge and behef, and that the /ork will be performed in the manner set forth m the apphcatlon filed therewith. ,worn to before me thru ........... ...... ..... ...... lotary Pubhc, ~":~' '~' ' ~'~'~.. [4tl~ & D£V0, ........ Count~..~~ ..... . ~ 4707,878, Suffolk Co~nty~ O