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Home My WebLink About15927-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building .. .a..cces. s..o.ry...s~e.d: ........... Locatmn of Property .285 .......... Qu.¢.e.n..str.e.et ......... .Gr.e.e. npgr. t' . , House No Street Hamlet County Tax Map No. I000 Sechon . . .4. q .. ,Block ..... 3. .... Lot .... 8. ........ Subd~viszon .......... X ........ Filed Map No . . .X...Lot No...X ......... conforms substantmlly to the Apphcatmn for Buriding Penmt heretofore fried in th~s office dated April 15, 1787 pursuant to which Build,rig Permit No 15927Z April 25, 1987 dated ..... i .......... was issued, and conforms to all of the reqmrements of the apphcable provfsions of the law The occupancy for which tlus certificate is ~ssued is ......... The certificate ~s ~ssue~l to . ANTONE J. MALINAUSKAS of the aforesaid buridz~g Suffolk County Deparlment of Health Approval . ·. UNDERWRITERS CERTIFICATE NO ....... PLUMBERS CERTIFICATION DATED: N/A N/A Buriding Inspector Rev 1/81 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, H. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMpLETIoN OF THE WORK AUTHORIZED) at premises located at · .~.... .............~ ............................. County Tax Map No. ~000 Sect~ ...... 8lock ..... ,.~.....~ ...... Lot' No......C~.,.~.. .......... pursuant to application, dated .~.....)...~. ................ , 19~..~., and approved by the Budding Inspectar. ! ' Fee $.~..:....~ Building Inspector Rev 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall BLDG. DEPT. Southold, N.Y. 11971 TOWN OF SOUTHOLD 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filmed 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 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 Enqineer responsible for the building. 5. Submit Planning Board approval of completed site plan requiremer~ts where applicable. 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: 1. Certificate of occupancy $25.00 -- BUSINESS $50.00 ACCESSORY $10.00 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 ..~. 5.Updated C.O. $ 50.00 Date.. ./...~../.~.~. ..... NewC°nstruc~ion ~ Old or Pre-existing Building . Vacant Land Location of Proper~ ~.~.. ~.~..'..~~ .... ~~.~ Hou~ No. Street Owner or Owners of Prope~y ...~d~...~...~.~ ~.~.~ ..................... County Tax Map No. 1000 Section ~ Block .... ~ ......... Lot.. ~ .~ .......... Subdivision ................................. Filed Map No ........... Lot No .............. ...7. Date of Permit . ~ZAppmicant.~d.r~..~. Permit No. Health Dept. Approval ........................ Labor Dept. Approval ........................ Unde~riters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ .ff~r.~. ~ .~ .......... Construction on above described building and pe/~it meets all appticabl,~odes a~d r~ulationsL ~'~ ~ /~)' ~ Applicant .... ~ , ~.....'~ .... Rev. 10-10-78 OUNDATIO.U (1st) OUNDATION (2nd) OUGH FRAME & FLUMBING NSULATION FERN. Y. STATE ENERGY CODE ADDITIONAL COMMENTS: F/? o ,V OCCUPANCY OR USE IS UNLAWFUL W~THOUT CERTIFICATE OF OCCUPANCY ; ....... ~ ......... ,:~,~,b ~:^t~u, ~*du~ texture J i-V! sJamg ^lummum jalousie window,or wood window Screened vent Reinforced and framed double swm§ing doors Heavy §au§e galvamzed bin§es and door latch Roof trusses 2X6 and 2X4 double §ussetted for maximum strength [ Maximun head room 5/8 Exterior grade plywood roof 5elf-seahng 240 lb asphalt shingles All wood corner molding Weather tight Immediate delivery from inventory. 3 to 4 weeks on custom orders · COMPARE BOTH OUR QUALITY AND PRICE · "OUR" QUAKER~ · Frae delivery within 20 miles 43305 MAIN ROAD, SOUTHOLD (1/4 rn~e east of Peoom¢ Lane) ALSO: GAZEBOS, DECKS, CUPOLAS AND DOGHOUSES. How TO FIND US ~ SOUTHOLD TOWN .~ Examined ~ ..~' Approve~.. FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N Y. 11971 TEL.: 765-180:a .., .'1. ., 19~'~ Permit No.l~.~")..~. Disapproved a/c .................... BOARD OF HEALTH SURVEY ......... · CHECK .......... SEPTIC FORM ............. : NOTIFY CALL ................ MAIL TO: (Building Inspector) APPLICATION FOR BUILDING PERMIT Date TOWN OF 8OUTHO[.~ , INSTRUCTIONS a. Tins application must be completely filled m by typewriter or in ink and submitted to the Budding Inspector, wit sets of plans, accurate pict plan to scale Fee accordmg to schedule b Plot plan showing location of lot and of buddings on premises, relationship to adjommg premises or pubhc str~ or areas, and giving a detaded descnphon of layout of property must be drawn on the diagram which is part of flus ap cation. c. The work covered by fins application may not be commenced before issuance of Bufldmg Permit d Upon approval of tlus application, the Building Inspector wall issued a Budding Permit to the apphcant. Such pet shall be kept on the premises available for mspectmn throughout the work e. No bufldmg shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupa, shall have been granted by the Bmldmg Inspector APPLICATION IS HEREBY MADE to the Budding Department for the issuance of a Bmldlng Permit pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinance- Regulations, for the construction of bufldmgs, ad~imons or alterations, or for removal or demolition, as hereto descnb The applicant agrees to comply with all applicable laws, ordinances, budding code, housmg code, and regulations, and admit authorized inspectors on premises and in building for necessary ins, gections (Signature of apphcant, or name, if a corporation) ~,q~-.q' ~ a ,~91~Makllng. address of applicant) State whether applicant is owner, lessee, agent, ~chitect, engineer, general contractor, electrician, plumber or build .... .o.w. ............. Name of owner of premises . (as on the tax roll or latest deed) If applicant ~s a corporation, signature of duly authorized officer (Name and title of corporate officer) ALL CONTRACTOR'S HUST BE SUFFOLK COUNTY LICENSED Builder's License No .#P R'I-H ~'p,.~ 1< . ~¢ p.J> ~ ~'~, ~ ~-/v' .. . . Location of land on which proposed work will be done. -/ House Number Street Plumber's License No. Electrician's License No Other Trade's License No County Tax Map No 1000 S~ctlon Ha~le~ Block ,,~ .. Lot g Subdw~slon Filed ?,lap No Lot (Name) State exmtlng use and occupancy of premises and intended use and occupancy of proposed construction a Existing use and occupancy b. Intended use and occupancy 3. Nature of work (check whlct~ applicable) New Budding )<.. Addit, on ....... Alteration ...... Repair ..... Removal ....... Demolition ........ Other Work ..... ~/c,~ ~ "! '~ (Description) 4 Estnnated Cost Z> t~ 0, Fee (to be paid on filing this apphcation) 5. If dwelling, number of dwelling units ............ Number of dwelhng units on each floor ..... If garage, number of cars ....... 6. If business, commermal or m~xed occupancy, specify nature and extent of each type of use ............... 7. Dlmenmonsofexmtingstructures, lfany Front ............ Rear ........... Depth. Height ......... Number of Stones ...................................... Rear .... Danenmons of sal!ke~s, tructure with alterations or additions Front ................ Depth ....... ]~.-.~¥~ . Hmght ..... 't ....... Numberzof Stones ..... .~ · ./ ....... '-8. Dlmensionsofentlrenewconstructmn'Front.. /,2 ..... Rear. ?~Z ....... Depth ..de ......... Height . ~ t ........ .Number of Stones . ( .......................... .~ ............ 9. Slzeoflot Front ..~.~. '/.~.' ......... Rear..C=.~.'./~.f ...... Depth ..-~.~. ............. ..... ~-~ . F<,~?~ ~o;P I0 Date of Purchase ..... ~'.~..~?/.~:. .. Name of Former Owner /M~.~ .~ .............. 1 I. Zone or use district ~n which premises are situated ...................................... 12 Does proposed construction violate any zoning law, ordinance or regulation ..................... 13. Will lot be regraded .. ~. .... ~ .......... Will exce~s filkbe r~oved from premises Yes ~ ix Name of Owner of premises .............. Address ~,~ ~-~,,~,,~. -~,. ~z fid . Phone No. Name of Architect ................. Address ............... Phone No .......... Name of Contractor .................... Address ............... Phone No ............ No .22,... 15. Is this property located within 300 feet of a tzdal wetland? *Yes ..... *If yes, Southold Town Trustees Permit maybe required. PLOT DIAGRA~ Locate clearly and chstmctly all buildmgs, whether existing or proposed, and red,cate all set-back dn~nenmons fro property hnes. Give street and bl ~ck number or descnphon according to deed, and show street names and indicate wheth interior or corner lot STATE OF NEW YORK, S.S COUNTY OF ..... ........ , ........ being duly sworn, deposes and says that he m the apphc (Name of individual signing contract) above named He is the ............ , ................. (Contractor, agent, corporate officer, etc ) of said owner or owners, and is duly anthonzed to perform or have performed the said work and to make and file application, that all statements contmned m this application are true to the best of his knowledge and belief; and that work wflI be performed m the manner set forth m the apphcaQon filed therewith. Sworn to before me this ... /.57... aay of ..... Notary Pubhc, ...~-~... ~..~.¢r .~/.~-v.. County ~ , NOTARY PUBUC, State el New Yelk ' ' 81o 4707878. Su~0fl~ ~unt~ ~ (Signature of apphc Term E. xp~re~ M~Ich 30,19 ,,9_ ~_/