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Home My WebLink About16006-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 bmldtng .... a..ce.ess..ory..b..ui.l, di. ng .............. Location of Property ~65. Ga~ens Landinq Soutkold County Tax Map No 1000 Section . .7.0..Block ....... .1.0..Lot .... .3.6. ........ Subd~wsion ....... ;K ........ Fried Map No . ..X... Lot No ..... .X ...... conforms substantially to the Application for Building Permit heretofore filed ,n tins office dated May 20, 1987 pursuant to wluch Bmldmg Permit No 16006Z dated .. ..May.. 21,. . 1987.. ... .... . waslssued, and conforms to all of the reqmrements of the apphcable prowsions of the law. The occupancy for winch flus certificate ~s ~ssued ~s ..... An accessory buzldzng. W. Paul & Clara T. Allen The certificate is issued to ........... (owner, I~Y~ .................. of the aforesaid building. Suffolk County Department of Health Approval ............ ~I/A ......... UNDERWRITERS CERTIFICATE NO N/A N/A PLIJMBER$ CERTIFICATION DATEB: Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT fi.HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No_ ]6006 Z Permiss,on is hereby granted to: r" ~ ....... ............. ..~.~.......~.....q........J.!..~.q...t ...... County Tax Map No IO00 Sect,on ..... .~.."~.....~.... Block ....... !...~.. ........ Lot No ..~,'~ .~. ..... Budding Inspector. and approved by the Building Inspector 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 Instructions A. This application must be filled [n Wpewnter OR ink, and submitted m ~---.-~, to the Build,nE Inspec- tor with the follow,nE; for new buildings or new use 1 Fmal survey of property with accurate location of all buddings, property lines, streets, and unusual natural or topographic features. 2.Final approval of Health Dept. of water supply and sewerage dmposal-(S-9 form or equal). 3.Approval of electrical Installation from Board of Fire Underwriters. 4. Commercml buddmg$, Industrml buddmgs, Multiple Residences and simdar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responmble for the building. 5.Submit Planning Board approval of completed site plan requirements where applicable. B. For existmg buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses' 1. Accurate survey of p~operty showing all property lines, streets, buildings and unusual natural or topograph m features. 2Sworn statement of owner or prewous owner as to use, occupancy and condmon of buddings. 3. Date of any houmng coda or safety inspection of buddmgs or premises, or other pertment mforma- lion requ?ed to prepare a certlfmate. C. Fees: 1. Certfficate of occupancy $25.00 -- BUSINESS $50.00 ACCESSORY $[0.00 2 Certffmate of occupancy on pre-existmg dwelhng $ 50. O0 3 Copy of cert~fmate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date ......................... NewConstruction .. ~... Old or Pre-exmtmg Bulldmg ............ Vacant Land ............ · ocat,o, of Property ....... o.t.J.. House No _~ -- Street ~ Hamlet Owner or Owners of Property ...(~.~l..~.~l~.~..~ .~--.-~[Z.. ¢....'~... /~//~¢~..~... ..... County Tax Map No 1000 Section .............. Block ............... Lot ............... Subdlwmon ........................ Filed Map No ......... Lot No .............. Permit No \.kC..0~¢ ~ Date of Permit .~).'~.~./.~.?.Apphcant..~./:~.6~ .~~ .... Health Dept. Approval ..................... Labor Dept. Approval ........................ Underwmters Approval ...................... Planmng Board Approval .................... Request for Temporary Certffmate ................. Fmal Certificate ... ~ ............. Fee Submitted $ .~.~..~.ff' ~-~. ~ ...... Co.~slructlon0 0 '4Re ::~- ~-~ C~%On above described, buddmg andz..._~/~/. ~'~'permlt m e_~e.t~ all ~¢appllcabte,/~ ~/'~, .c°des and regulations ,%pp ~cant .. ~-~ .~ ............... ; ,~;~ .......... Rev 10 10 78 $ccdc: 40 '= I" 7'lf/~ to~ O?-5QtOO 140.33 OUNDATIO'; ( ls t ) OUGH FRAME & FLU~BING NSULATION PER N. STATE E~ERGY CODE FIi:AL ADDITIONAL COMMENTS: ~ ~ ...... BOARD OF HEALTH ...... FORM NO. I SURVEY .......... BUILDING DEPARTMENT SEPTIC FORM ............. : r TOWN HALL NOTIFY T.,__.~O~ O~' ~ SOUTHOLD, N Y 11971 TEL.. 765-1803 CALL ................ MAIL TO: Examined Approved .~ .o~.;:qU , 19~17 Permit No./ 6.OOG-~ Disapproved a/c ..................... (Building Inspector) APPLICATION FOR BUILDING PERIVtlT Date .......... 19 INSTRUCTIONS a Tlus application must be completely filled m by typewriter or m ink and submitted to the Building Inspector, wi sets of plans, accurate plot plan to scale. Fee according to schedule b Plot plan showmg location of Iot and of buddings on premises, relationship to adjmnmg premises or pubhc str or areas, and giving a detaded description of layout of property must be drawn on the diagram which is part of ttus al cation c. The work covered by this application may not be commenced before msuance of Braiding Permit. d. Upon approval of this application, the Building Inspector will issued a Bmldmg Permit 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 in whole or in part for any purpose whatever until a Certificate of Occup; shall have been granted by the Building Inspector APPLICATION IS HEREBY MADE to the Bmldmg Department for the issuance of a Bmldmg Permit pursuant tc Bml&ng Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordmanc, Regulations, for the constnlchon of buddings, additions or alterations, or for removal or demolition, as hereto desert The applicant agrees to comply with all apphcable laws, ordinances, budding code, housing code, and regulations, an. admit authorized mspectors on premises and m budding for necessary inspections .,-"'h .,-o ~ (Si=nature of apphcant, or nfi~e, if a corporation) (Malltno address of apphcan¢) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bml (as on the tax roll or latest deed) If apphcant ~s a corporation, s~gnature of duly authorized officer (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No Plumber's L~cense No Electrician's License No Other Trade's License No Location of land on which proposed work will be done ltouse ill, amber Street County Tax Map No 1000 Section ~'~ ~) Hamlet Block I O Lot ~p Subdivision Filed Map No .... Lot (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction a Exlstlng use and occupancy ff~dK, ?~t"~<'~ "O"~ ~~p~~-'~T"'/~'~"-"-" b Intended use and occupancy ............... 3. Nature of work (check which applicable) New Bmldxng .. Addition .... Alteration .. Repmr .. Removal .... Demolition .... Other Work '~ .~. ~ e'~..~. '~ " (Descnp.tmn) 4 Estimated Cost ~ ................ Fe · (to be pa,d on filing this apphcatlon) 5. If dwelling, number of dwelling units ..... Number of dwelling units on each floor. If garage, number of cars .......... 6. If bus~ness, commercial or mixed occupancy, specify nature and extent of each type of use ............. 7 Dimensions of existing structures, if any Front ..... Rear .............. Depth ........... Height . Number of Stones ....................... Dimensions of same structure with alterations or additions Front ....... Rear ............ Depth .... Hmght .. Number of Stones ............... 8. Dimensions of entire new construction. Front ...... Rear ........ Depth ............ Height .... Number of Stones .................................. 9 Size of lot Front ........ Rear ............ Depth ............... . 10 Date of Purchase ............ Name of Former Owner .................. 1 1 Zone or use d~strlct in which premises are situated. 12 Does proposed construction violate any zoning law, ordinance or regulaQon ..................... 13. W~ll lot be regraded .......... Will excess fill be removed from premises' Yes N, 14. Name of Owner of premises ......... Address ........ Phone No .. Name of Architect ....................... Address ................ Phone No Name of Contractor ........... Address ........ Phone No ....... 15. Is this property located wzthin 300 feet of a tidal wetland? *Yes ..... No ..... · If yes, Southold Town Trustees Permit maybe required. PLOW DIAGRAM Locate clearly and distinctly all buHdmgs, whether ex~st~ng or proposed, and indicate all set-back dnnenslons fro~ property hnes. Give street and block number or description according to deed, and show street names and indicate whethc mterior or corner lot. STATE OF NEW YORK, S S COUNTY OF ..... (Name of individual signing contract) above named being duly sworn, deposes and says that he is the apphca 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 tl application; that all statements contained m this application am true to the best of his knowledge and belief; and that t work w~l be performed in the manner,set forth m the apphcatlon filed therewith. Sworn to before me this Notary Public ........ ' ........... County ~ pIJSL C, State ef 1~ York ........ ~. 4707878, ~ffolk Ce, untl¢'.~ (Signature of apphca lerm Expre~ Uarch 30, 19,-~~.~