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Home My WebLink About15956-zFO RM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y.- - Certificate Of Occupancy THIS CERTIFIES thatthe building deck addition, to existing dwelling. Lo cation o f Property ...... 2. 3_ .5 .5 .............. ...B .ay_s?..o _r_e) :R..o .a.d. ............ G.r..e .e.n.p..o_ .r .t House No. Street Hamlet County Tax Map No. 1000 Section ...... 5.3_ .... Block ........... ?...Lot ......... .1.6 ...... Subdivision..P.¢.c.o_n.i..c...B.a.y..E.s.t.a..%~.s..A. .... Filed Map No- ._ .1.1.2.4. .Lot No ...... .4.0 ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ... April..25,. _1987.. pursuant to which Building Permit No ....... .1.5.9.5.6..Z ........ dated ....... ~Ia.y..4,...],9.87 ......... was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... The certificate is issued to . ' ............. .M%..R_Y..L .O.U.I.S.E.. FIOQRi.J.AvN...KOWS.KI' .. . of the aforesaid building_ Suffolk County Department of Health Approval .................... _N/.A.. .................. UNDERWRITERS CERTIFICATE NO ............................. .Nf.A. ................. PLUHBERS CERTIFICATION DATED: I~/A Rev. 1/81 lv~TM NO. ~ TO~N OF SOfT'OLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CFHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 15956 Z Permission is hereby granted to: ........ ...'~.?...~....~J .............................................. ..... ...~.~....~.:~.,.....u.~ .~.../ ..... ......... County Tax Map No. I000 Section .............. .~ .....Block ........... ..~. ....... Lot No ......].~. ......... pursuant to application dated ......... ~....~..f .............. 19..~.....~., and approved by the Budding Inspector. Building Inspector Rev 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 TOWN OF SOUT~C ~ APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcatlon must be filled in Wpewr~ter 0 R ink, and submitted ~ ~ to the Building Inspec- tor w~th the follow~ng; for new buildings or new use' 1. Final survey of property w~th accurate location of all buddings, property lines, streets, and unusual natural or topographm features. 2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal}. 3. Approval of electrmal mstallatmn from Board of F~re Underwriters. 4. Commercml buddings, Industrml buddings, Multiple Residences and simdar buddings and installa- t~ons, a certificate of Code compliance from the Architect or Engineer responmble for the building. 5. Submit Planmng Board approval of completed rote plan requirements where apphcable. .B. For existing buddings {prior to Apml 1957), Non-conforming uses, or buildings and "pre-ex~sting' land uses 1. Accurate survey of pzoperty show~ng all property lines, streets, buildings and unusual natural or topographm features 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buddings. 3. Date of any housing code or safety inspection of buddings or premmes, or other pertinent mforma- t~on required to prepare a cert~hcate C. Fees- 1 Certfficateofoccupanc¥ $25.00 -- BUSINESS $50.00 ACCESSORY $I0.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3 Copy of cert~hcate of occupancy $ 5.00, over 5 years $]0.00 4.Vacant Land C.O. $ 20.00 5.updated C.O. $ 50.00 Date .~..-.'..~...~...' ......... NewConatrucbzon ...... Old or Pre-ex rating Buddmg ........... Vacant Land ............ Locat,on of Property....2_.. .Zf ......... . .e, ....... .c-. :r. s .... House No. Street Hamlet Owner or Owners of Property ..~..~?. .... 9..~t.!.5.~... .c;~P.~'..~... ?...~...9.'~..~. .............. County Tax Map No. 1000 Section O ~, ~ Block . C~ ~ Lot J ~' Subd,v,s,on .~,c,..~;c..(5.o.~..-('6'.4-~t~.~..l~3./~ .Fded Map No 11 Lot No. .C~.~:) ...... Perm,t No.{ ~,~.. Date of Permit ~'1.~.1~.~ .Applicant .~ 9.x'7~).%...~.[.'.W, .O-,~.5 .} ........ Health Dept Approval ~ Labor Dept Approval Underwriters Approval ~ P~anmng Board Approval Request for Temporary Cert~fmate .... ~ ........... F~nal Cert,fmate .... ~ ............... Construction on above described building a~d permit meets all applicable codes and regulations. Rev 10 10 78 OU~DATION {1st) OUNDATION ~ 2nd ) OUGH FRAME & PLUMBING NSULATION PER N. STATE ENERGY CODE Ye ADDIT COMMENTS: TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-I 802 To Whom This May Concern, We are unable to complete your Certificate of Occupancy because .o£ the following reasons. An application for Certificate of Occupancy is not on file. /--~ No Underwriters Certificate on file. The check is(outdated/not on fit~.)~&5-- /5/ No Health Dept. Approval on file. No final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. Building Permit # ~_ ~-_~ ~. ~ Z Building Dept. ***/5/ No Plumber Solder Certificate on file. ( all permits involving plumbing being issued after April 1,1984 ) Occupancy or use is unlawful without a of Occupancy. Clear up this matter as soon so that legal action does not have to be taken. Thank you for your prompt attention. Certificate as possible FOUNDATION 'IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [~]~'F!NAL DATE INSPECTOR 7GSJ.802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND FRAMING [ ] INSULATION DATE / 765-~802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND []/INSULATION / FRAMING [~/J FINAL DATE INSPECTOR ~ ~/~ Approved t/ . Disapproved a/c BOARD OF 3 SETS FORM NO. 1 SURVEY TOWN OF SOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC TOWN HALL NOTIFY $OUTHOLD, N Y. 11971 TEL.. 765-1803 CALL MAIL ,19g3 (Building Inspector) APPLICATION FOR BUILDING PERMIT HEALTH -. oF pANS FORM ............. TO: Date .. , 19 IN ST RUCTION S a. Tlus apphcatlon must be completely filled m by Wpewnter or zn mk and submztted to the Buddzng Inspector, wii sets of plans, accurate plot plan to scale Fee accor&ng to schedule. b. Plot plan showing locahon of lot and of buddings on premzses, relationship to adjmmng premises or pubhc sir or areas, and gwmg a detmled description of layout of property must be drawn on the diagram which is part of this a! cation c. The work covered by tlus apphcatmn may not be commenced before issuance of Budding Permit d Upon approval of this apphcat~on, the Buddmg Inspector wall issued a Budding Permit to the apphcant Such pex shall be kept on the premmes avadable for inspection throughout the work e No bmldmg shall be occupied or used ~n whole or ~n part for any purpose whatever until a Certificate of Occupa shall have been granted by the Building Inspector APPLICATION IS HEREBY MADE to the Budding Department for the msuance of a Bmldtng Penmt pursuant to Building Zone Ordtnance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinance Regulations, for the construction of buddings, addmons or alterattons, or for removal or demohtmn, as herem descnl The apphcant agrees to comply w~th all apphcable laws, or&nances~bufldmg code, housing code, and regulations, an, admit authorized ~nspectors on premises and m budding for necessary~spectlons ~ , (Si=nature of apphcant, or name, ~f a corporation) (Mmhng address of applicant) State whether applicant m owner, lessee, agent, architect, engineer, general contractor, electncmn, plumber or bml, Nameofownerofpremmes 14q.~.r-~ }..~Ot~lS~ )*~.'O~..~L--~'~...rl.k~t(?,5~; . . (as on the tax roll or latest deed) If apphcant ~s a corporation, mgnature of duly authorized officer (Name and t~tle of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's L~cense No. I ~o.~--7 ,_q J'~'~ . - Humber's License No. .. Electrlclan's License No Other Trade's License No Locahon of land on ~vlnch proposed work wdl be done ttouse Ntnnber Street H&nlet 2 County Tax Map No 1000 Section ~ ~3 Subdw~sion071~ TIJ~B~(~j.~'~ ~5~'¢~~ ¢~" (Name) '~ State eMstmg use and occupancy of premmes and intended use and a Ex~stlng use and occupancy ~4 ~1~0C~ b Intended use and occupancy ~ ~ ~ . Block t./ Lot /~' Fded Map No 1/2g Lot occupancy of proposed construction 3. Nature of work (check whach apphcable) New Bufldmg ..... Ad n ....... A/teratzon Repmr ..... Removal ........ Demohtlon ..... Other Work ....... (DescnpIton) 4 Estimated Cost ~ ~- O~, --%':~ Fee ' (to be prod on fihng th~s apphcatlon) 5 If dwelling, number of dwelhng units .... 1 .... Number of dwelling units on each floor . .~ .. If garage number of cars 6. If busmess, commercial or m~xed occupancy, specify nature and extent of each type of use .. % ......... 7 Dimensmns of existing structures, ff any Front. '--' Rear .... - ..... Depth Height ........ Number of Stones ................................. · Dtmenslons of same structure w~th alterations or adO~tlons Front .~e.. ~ ........ Rear "~ ,O ...... ' Depth . . . "~..~ ......... Height . [ ~-. .......... ~ Number of Stones . .~ ........ ~ ..... Dnnensiqgsofie~tt~re'newconstruction Front .~ O ..... Rear .'3 .O ....... Depth ,el-.~ ...... Hmght ~ ~ * ' . Number of Stones Slzeoflot Front .~..7~ ....... Rear.~,~.-.~,.~ ). ..... Depth .'/~-.~.~..~.'~.'¥.) .... Date of Purchase ............. ~% Nametof Fo,.r~ne~r~O~vner I 1. Zone or use d~stnct in which premises are situated .~c-.~,5' ~, ~ ~ .~..~'t L ~_o 3. 12. Does proposed construction wolate any zoning law, ordinance or regulatmn . .~'.c.~ .................... 13. Will lot be regraded .. }~5 ~ .......... Will excess fill be removed from premises' Yes (,~ 14 Name of Owner of premmes ........ Address ........... Phone No ........ Name of Architect .... ~ ......... Address ............. Phone No ............ Name of Contractor -.or.8.e. ..... 7 ..... Address -5o,¥hq/d ¢U z./ .... Phone No '7.. f~.~' . ,5.. q. 15. TS th~.s property located w±th±n 300 feet o15 a l:~.dal wetland? ~5'es ..... I% ..... ~If yes, Southold Town Trustees Perm±t maybe requ~.red. PLOT DIAGRAM '8. 9. 10. Locate clearly and dlst~nctly all bmldmgs, whether existing or proposed, and mdmate all set-back dwnensmns rrm property hnes G~ve street and block number or descnptmn accordmg to deed, and show street names and indicate whetN mtenor or corner lot. STATE OF NEW YORK, COUNTY OF.. (Name of md~v~duaI s~gmng contract) above named. being duly sworn, deposes and says that he ~s the apphcar He is the ............ (Contractor, agent, corporate officer, etc ) of smd owner or owners, and as duly authorized to perform or have performed the said work and to make and file th apphcaUon, that all statements contamed m th~s apphcatmn are true to the best ofh~s knowledge and behef, and that tl~ work will be performed in the manner set forth in the apphcatmn filed therewith. Sworn to before me th~s .... o~/ . .. day of . ~ ..... 19.°~~. Notary Public, . ~.~../~:/c~4d~. ........ County/.. ~ .~,.~.t.' %...~.. '~".~ ~. .......... .la~ ~ I~ ~ ' ' ' (S~'ature,l~,, of apphcan RO/RRY PUSLIC, ~mte ef #ew yeek .q 0 U ,A ~'1 E': ~-.'-'* Ar.L,