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Home My WebLink About15962-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy ZI5770 ~0 ............ Date May 21, 1987 THIS CERTIFIES that the budding . Addxtzon Locatlon of Property 7 15 Champlin Place Greenport House No Street Hamlet County Tax Map No. 1000Section 034 .Block 03 ..Lot p/o 37,53 Subdivision. . ....... Filed Map No ....... Lot No .......... conforms substantially to the Apphcahon for Buridtng Permit heretofore fried in ttus office dated A p r i 1 2 2, 1 9 8 7 pursuant to wtuch Building Permit No. 1 5 9 6 2 Z dated .. Iff a..y 7., I..9 8 .7 ..... ... .. was issued, and conforms to all of the reqmrements of the applicable provlmons of the law. The occupancy for whtch tlus certificate is issued is ...... · .a..f ib.er g. 1 .a.s s..rs.of. .&...s.c.r e.en..i.n..e x i.s.t.i.ng..df.ck.,..as .a..p.pl. ie. d. f o .r..... JACK LEDEN The certificate ~s issued to .............. row. or,'~o~lr Soxt~;~ x x ............. of the aforesaid building. Suffolk County Department of Health Approval ...... ~ ./A. ........................ N/A UNDERWRITERS CERTIFICATE NO ................................... PLUMBERS CERTIFICATION DATED: N/A ..... ~uiic~ln~'In;l~ec't;~" ............ R~ 1/81 ~'OI~,M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15962 Z Permission is hereby granted to: 'T '-;-~-';'":7"; ...... 'G~'--~- ~' .... ~..~.~..~.~....~....~.:...!.!.i~ ........ . ~o ..~m....~:~.~..~..~..~...~.~..~...~,x~¢. .~....~.~.~ ............................................................................................................ ~ ..... ~.f....~.~.~... '~ ............................................................................................ co~, ,~ ~,p so. moo s~,o~ ...... ~..~.~ ..... m~k ...... ~..~ ...... ~o~ Uo .~...g~:.~} pumu~nt to o~licotlon d~t~ ..~.....~..~ .................... 19.~.., ond ~pprov~ by th~ ~uildln~ In~p~clor. ~ ,.~.,..~... Bulldln~ I~tor 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 9 Instructions This application must be filled m typewriter OR ink, and submttted l~ to the Building lnspec- tor w~th the following; 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 topographtc features. 2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrmal ~nstallat~on from Board of F~re Underwriters. 4. Commercta[ buddings, Industrml buddings, Multiple Residences and similar buildings and installa- t~ons, a cert~fmate of Code comphance from the Architect or Engineer responsible for the building. 5. Submit Planmng Board approval of completed s~te plan requirements where applicable. For existing buddings (prior to Aprd 1957), Non-conforming uses, or buildings and "pre-ex~sting" land uses: I. Accurate survey of p~operty showing all property hnes, streets, buddings and unusual natural or topograph ~c featu res. 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 premises, or other pertinent mforma- t~on required to prepare a cerbflcate. C. Fees 1. Certlficate of occupancy $25.00-- BUSINESS $50.00 ACCESSORY $[0.00 2. Certificate of occupancy on pre-ex~sting dwelhng $ 50.00 3. Copy of cert~flcate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.C. $ 20.00 5.Updated C.C. $ 50.00 Date ......................... NewConstruc tlon ..... Cid or Pre-ex,sting Building ........... Vacant Land ............. Location of Property . .~ ! House No. Street Hamlet Owner or Owners of Property . .~..~ .... ~.~,~ ~O ......... County Tax Map No. 1000 Section ...3.~, ....... Block ..... ~ ....... Lot. ~,,/,0., Subdw~s~on .............................. Flied Map No ......... Lot No .............. Permit No..~ ~..~.(~z~ Date of Permit .'~/?/~'.~. Applicant...~..~f'~.-.~. ~.S¥.~..k,.~.~, ............ Health Dept Approval Labor Dept Approval , . , Underwriters Approval .................... Planning Board Approval .................... Request for Temporary Certificate .............. F~nal Cert~fmate ....................... Fee Submitted S ................... Construction on above described budding anc~m~eets.~all~app~d regulabons. OUNDAT!ON ( 1 st) OUNDATION (2nd) OUGH FRAME & ?LUMBtNG r~SULATION FERN. STATE ENERGY CODE Ye ADDITIONAL COMMENTS: 2198-[ [ii II OEPT TO¥'~N k~ CJUTHOLD Approved . .'~.c~"~. Disapproved a/c FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N,Y. 11971 TEL., 765-1803 ., 19'27 Perm,t No ! ;~'.c~'Tz.~. (Budding Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .. CHECK --:~ SEPTIC FORM ............. NOTIFY CALL ................ MAIL TO: Date .. ., 19 INSTRUCTIONS a. Ttus apphcat~on must be completely filled m by typewnter or m ink and submitted to the Building Inspector, Wl~ sets of plans, accurate plot plan to scale Fee according to schedule b Plot plan showmg location of lot and of bmldmgs on premises, relatmnshlp to adjoining premises or pubhc str or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of tlus at cation. c. The work covered by this apphcaUon may not be commenced before issuance of Budding Permit. d Upon approval of this apphcatlon, the Bmldlng Inspector wall issued a Building PelTmt to the apphcant. Such pe~ shall be kept on the premises available for inspection throughout the work. e. No bmldmg shall be occupied or used m whole or ~n part for any purpose whatever until a Certificate of Occupa shall have been granted by the Bmldlng Inspector APPLICATION IS HEREBY MADE to the Bmldmg Department for the issuance of a Bmldlng Permit pursuant to Bmld~ng Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordmancc Regulations, for the construction of bmldmgs, ad-dlhons or alterahons, or for removal or demohtlon, as herein descnl The applicant agrees to comply with all apphcable laws, ordinances, bulldmg code, housmg code, and regulaUons, an, admit authorized mspectors on premmes and m bmldmg for necessary inspections. _ . .4' ~ /7 iS1 t~ure'of~./k~. ~ apl;hca'nt [ ~r nk~e~ ~f ~ ~;;t;oia'tldn)' (Marling address of apphcant) State whether applicant Is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bull, Name of owner~6f p~'m]ses.? l ~ ~1~ ~_..~ ~:..~ ~. ~ ",-~'~,~.~,--.~ ~ ,~ ,, (as on the tax roIl or latest deed) If appl~ant'lf~'do~dtbd}~gn[~g~F~y authorized officer .... .... (Name and tztle of co,orate officer) ALL CO~TRACTOR'S MUST BE S~FOLK COUNTY LICENSED BuddersL]censeNo .. 1300 H~ Plumber's License No. Electrician's License No Other Trade's License No Location of land on which proposed work will be done House Number Street County Tax Map No 1000 Section ,-~ ('/ Subdivision (Name) Hamlet B ock ..a .... Filed Map No . Lot ....... State existing use and occupancy of premmes and Intended use and occupancy of proposed construction use and occupancy O~ ~ ........... ,,. ~ ..... ,. a Existing 3. Nature of work (check whxch apphcable). New Bufldlng .... Addmon .~'. .... A/terat]on ..... Repmr ...... Removal ........ Demohhon ............ C~her Work ..... (Descnptmn) 4 Est]mated Cost .... '"" ----~,.,~[.0 ..~.< .~. ................. Fee ................................. ". (to be paid on filing this apphcation) 5. If dwelhng, number of dwelhng umts .......... Number of dwelhng umts on each floor ......... If garage, n. umber of cars ..................................................... 6. If business, commerma[ or mixed occupancy, specify nature and extent of each type of use 7. Dnnenslons of exmtmg structures, ff any. Front ......... Rear .......... Depth .......... Height ............... Number of Stones ................................................ Dtrnenmons of same structure with alterations or addmons Front .......... Rear ........... Depth ................. Height ................... Number of Stones ................. Dm~ensions of enhre new constructmn. Front ........... Rear ........... Depth .......... Height ........ Number of Stones ......................................... 9. Size of lot Front .......... Rear ................. Depth ............. 10. Date of Purchase ................ Name of Former Owner ...................... 11. Zone or use district in which premises are situated ..................................... 12. Does proposed construct]on violate any zoning law, ordmance or regulation ................... 13 Will lot be regraded ...................... Will excess fill be removed from premises' Yes N 14. Name of Owner of premmes ~¥.%%. %g¢.~O....Address .'-. '.9..k.. ~.~.'~Y.'C~!?.PhoneNo ............ Name of Archxtect .............. Address ............. Phone No ......... Name of Contractor .................... Address ................. Phone No ........... 15. Is this property located within 300 feet of a tidal wetland? *Yes ..... No .~. *If yes, Southold Town Trustees Permit maybe required. PLO*r DIAGRAM Locate clearly and d~stmctly all braidings, whether existing or proposed, and indicate all set-back dimensions fro~ property hnes. Give street and block number or descnphon according to deed, and show street names and mdmate wheth. -8. FO~, Ow hfr~ I~~, ~uC ' fF)!~~ f~O,~) il~ rt(j,~ ), /~' gOD ~(J~ "J,'"-~ ' ~ .~ IN~'~, IL,~, II v 4 F~l tic ~.l,r<,, .... ~, ~UST ~1 ~")~,'~ ~" ' .... ,~ ,~. MEET STATE OF NEW YORK, S.S COU~Y OF (Name of lndiv~dual sigmng contract) above named OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY being duly sworn, deposes and says that he is the apphcar He is the ....................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and Is duly authorized to perform or have performed the said work and to make and file th apphcahon, that all statements contmned m thru apphcation are true to the best of Els knowledge and belief; and that tk work wdl be performed in the manner set forth m the application filed therewith. Sworn to before me thru ...... 4.[ ...... day of .... ~ .... , 19 ~..~ Notary mubhc, ~.~-..~.~..~.d~..... County (Signature if al, piA; ~Z 0 Z 0