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Home My WebLink About15998-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No . ~15~8.~ . . Date June 26, 1987 THIS CERTIFIES tkat the building ...an accessory utility shed. Location of Property .. 27.5 ....... S.u.n..L. an.e .............. S. ou.t.ho, ld... House No Street Hamlet County Tax Map No 1000 Section 7 6 . Block 1 .... Lot 1 4 Subdivision .We.s.t. Cr.eek..De. ve.lp~.m.e.n.t...Filed Map No... 12. 3. .6.Lot No....5 .& .6 .... conforms substantially to the Apphcat~on for Braiding Permit heretofore filed in tins office dated g.ay..1, t. 1.987.. . pursuant to winch Building Permit No 15998Z dated . M.a~ 2.0., 1. 9.8.7. .... was ~ssued, and conforms to all of the reqmrements of the applicable prov~sions of the law The occupancy for wbach tins certfficate ~s issued ts ..... An.a.cc.es.$9.ry' ,bukld. J. ng, . ....................... The certificate is ~ssued to .... MJx~RY JANE GROSS (owner, YeT~r.~XiXlee,)O{~ of the aforesaid building. Suffolk County Department of Health Approval ............ N./A ................. UNDERWRITERS CERTIFICATE NO ............. N./.A .................. PLUMBERS CERTIFICATION DATED: N/A Rev 1/81 TO~'N OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CO~P~ION OF THE WORK AUTHORIZED) 15998 Z Permission is hereby gronte~to: \ , _ d ~ ........................ ~ ....... :_~ ............... ................... ~ .......... .~ ....... ~ ...... ..~.... ot promises ,o~o,,~ o, ..~.~.~......~....~..~.........~~.....~.:~.: ........... pursuclnt to opplicotion doted .......~..~-~.! ................... , 19.'~..'~., °nd approved by the Budding Inspector. 'x ~'~Bu.aln~ inspectora~ Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD 13uild~ng Department Town Hall Southold, N,Y, 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions Th~s apphcat~on must be filled in Wpewnter OR ink, and submitted m ~ to the Budding Inspec- tor w~th the following; for new bu~tdmg$ or new use: 1. F~nal survey of property with accurate Iocatmn of all buildings, 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 installation from Board of Fire Underwriters. 4. Commercml buildings, Industrial buildings, Multiple Residences and similar buildings and instaila- tions, a certlfmate of Code comphance from the Architect or Eh§meet responmble for the budding 5. Submit Planmng Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses' 1. Accurate survey of p~operty showing all property hnes, streets, buddings and unusual natural or topo§raph~c 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 buildings or premises, or other pertinent mforma- uon required to prepare a certificate. C Fees Additions $25.00 1. Certtf~cate of occupancy New Dwellxng $25.Q0, Accessory ,$10.00 Buszness $50.00 2. CertW~cate of occupancy on pre-existing dwelhng $ .50.0 0 3, Copy of cert~flcate of occupancy $ 5.00, over S years $~0.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date .., New Cons tpuc t,lon ...... OId,orPre-e×lstlngBuddlng .,. ........ VacantLand . ........ . ... Hou~ No Street Ham/et Owner or Owners of Prope~ .~ t~/. ~ .~¢~. ........... ~ ...................... ¢o~.t~ ~ ~ ~o. ~ooo s,~,o~ . F~. ~'.~ ~o~ ..... ~ ........ ~ot. 4~.~:. ..... · Subd,v,s,on ~ ~n~. ~X ......... F,led Map No..4~.e .... Lot No . ~ ...... Health De~t Approval ..................... kabor Underwriters Approval ................... Planmng Board Approval ..................... Request for Temporary Certificate ............. . Final Certificate ..... ~ ............. Fee S ,tted ....... Construction on above described building and p~,it mee~'all apphcabJCuodes and regulations. ~)2~"~/~ Applicant ~.~.~..~',~......~,...~ . . ................. Rev 10 ~0 78 OUNDATIO~ (1st) OUNDATIO~ ( 2nd ) OUGH FRAHE & PLUMBING :~SULATION PER N. Y. STATE ENERGY CODE ADDITIONAL CO~MENTS: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING ]~FINAL INSPECTOR~ q ~ LoT ~ / Loro~ ,/ BOHN & BONACCI, P.C. CONSULTING SURVEYORS 72 E. OLD COUNTRY rD. glNEOLA, NY. 11501 OTS ~ :fi- ~ BLK *AP OF A./~...¢7- C,~..~/4' z~,~ ),/~'.~.t~,,~.,~:/v'7'' BOARD OF HEALTH ...... 3 SETS OF PLANS ....... FORM NO I SURVEY CHECK TOWN OFSOUTHOLD BUILDING DEPARTMEN~ SEPTIC FORM ............. : TOWN HALL NOTIFY SOUTHOLD, N.Y. 11971 TEL.: 765-1802 CALL MAIL Examined . ~.c,.~-o , (Budding Inspector) APPLICATION FOR BUILDING PERMIT Date ................. 19.. INSTRUCTIONS a Ttus application must be completely filled m by typewriter or in ink and submitted to the Building Inspector, with sets of plans, accurate plot plan to scale Fee according to schedule. b. Plot plan showing location of lot and of bmldmgs on premises, relationship to adjoining premises or pubhc stree or areas, and giving a detailed description of layout of pro, perty must be drawn on the diagram which is part of this appl cation. c. The work covered by fins application may not be commenced before issuance of Buddmg Permit. d. Upon approval of this appllcahon, the Building Inspector will issued a Bufldmg Permit to the applicant Such perm shall be kept on the premises available for inspection throughout the work e. No budding shall be occupied or us,c~ln whole or in part for any purpose whatever uhtd a Certificate of Occupant shall have been granted by the Bmldm. g~Ir~"l~lkor. APPLICATION IS HE.R~ ~ t_o-~tlii~ [~g D.~,l~rtment for the issuance cfa Bmldmg Permit pursuant to ti Bmldin=~ Zone Ordma~nf~td~]~lr~ .n~f~d .i~,_.S~kf~'l~'~..~unty, New York, and other apphcable Imws, Ordinances r Regulations, for t~t~[c_lJgt%~tlon~ ,~=§,g ~/~"alterations, or for removal or demolition, as herein describe, The applicant agr~'"'6.grn~l~w}l }~aIl[gl~l~ ~'~a~v~,-ordtnances, bmldmg code, housing code, and regulatmns, and admit authorized msp~o~em ~ ~ ~g for necessa, lnspecho~ ~ ~ ' (Szgnature of apphcant, or name, ,f a corporat,on) ~ (Maihng address or apphcant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bmlde .. ................... Name ofownerofpremmes . ,'~'y. J~.~'~'~ (as on the tax roll or latest If applicant isa corporation, signature of duly authorized officer f (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No .... 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 7~--/T /¢ Subdivision/.~4.7c d~ ~'~_. ..... (Name) Hamlet Block ........ Lot. FdedMapNo J~,~O. .... Lot ¢'.4 t~ 2 State existing use and occupancy of premlses and intended use and occupancy of proposed constructlon a. Existing use and occupancy .......... b Intended use and occupancy &/. ~ 2./.7'7 ."f/~. ' . ...... · Nature of work (check which apphcable) New Budding Repair ..... Removal ,. Estimated Cost /~.0o, If dwelhng, number of dwelhng units ...... If garage, nmnber of cars .......... Addmon . Alteration Demohnon ........ Other ¥,ork ....... (Description) · Fee .... .. ..... · .. ... --~ .. " (to be paid on filing this application) Number of dwelling units on each floor ..... If bumness, commercial or mixed occupancy, specify nature and extent of each type of use .......... Dimenmons of existing structures, if any Front .. Rear ..... Depth ....... Hmght . Number of Stories ....................... D~rnenmons of same strUcture with alterations or additions Front ...... Rear ......... Depth ........ Height . .. Number of Stones ............ Dm~enmons ofentlre.nev~.c, onstruction Front . z~"; ' Rear ff./.. Depth .~' ' Hmght ' Number of Stones ............................. Size of lot Front ... qo [ ....... Rear . /.~.o / ....... Depth .../.~. t. ....... Date of Purchase . ./. ~./ ........... Name of Former Owner "7-.~e'~,.. ~. ~.'~'ed..~..~ ........ Zone or use district in which premises are situated .~..o.c-/~./2,~/(/t..dr, ~ .................... Does proposed construction violate any zoning law, ordinance or regulation . .,~.O ........................ · Will lot be regraded A-/..O. ............. Will excess fill be remo~ved from premises ,Yes *If yes, Southold Town Trustees Permit maybe requzred. P LOT DI AG RAM Locate clearly and distinctly all bmldmgs, whether existing or proposed, and indicate all set-back dmaenmons from operty lines Give street and block number or description according to deed, and show street names and indicate whether enor or corner lot. ATE OF NEW YORK,/ , )UNTY OF. e,'f/~*' /o~/.F_,~... S S (Name of individual signing contract) ove named being duly sworn, deposes and says that he is the applicant ~$ the ................ (Contractor, agent, corporate officer, etc ) said owner or owners, and m duly authorized to perform or have performed the said work and to make and file this t~hcanon; that all statements contmned in th~s apphcahon are true to the best ofhm knowledge and behef, and that the ~rk wdl be performed m the manner set forth m the application filed therewith. om to before me thru tary Public, . ...... ////, ~..~,.. II d, .' ~CHA[L ! SHAY'/ ~ ~U '~ No, 31'4,C84~7 .... ~ au ~ed m New York Coun~ County (Signature of applicant)