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Home My WebLink About15865-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy PLUMBERS CERTIFICATION DATED: No. Z15785A Date May 22, 1987 THIS CERTIFIES that the building ....... .cl.e.c.k., .a.d.d.i..t.i.o.n.: ........................ Location of Property ,......5.5 ........... Azalea Road Matti~uck ,ou~o ,vo. ' ............ 's't/e~i ....................... fi~,~ie~ County Tax Map No. 1000 Section ,.. 1. .1.5 ...... Block ...... .0.6. ...... Lot 16 Subdivision ...... .M,a.~fi..i.fi,u. qk...E,s.~..a.t.e.s. .... Filed Map No...4.4..5.3..Lot No. 16 conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... A.D.ri.1' .1. ,..1.9.8.7 .... pursuant to which Building Permit No. 15865g dated ......... .Ap.r. ~. .1. .4. ,. . .1.9.8. 7. .... 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 ......... ..... Deck..aclct£.giOV..t.o...a.n..e..x.i.s.~fi..ng..qn..eT.f.a.m..i.ly' .d.¥?.~.~.J; .nlt.. ................. The certificate is issued to EDITH CULLEN FENN ..................... ?o¥.'o;,i i i ic ffn'iri ..................... of the aforesaid building. Suffolk County Department of Health Approval ..................... N./.A. ................. UNDERWRITERS CERTIFICATE NO ............................. 1)I/.A. ................. N/A Building Inspector Rev. 1/81 l~Oll~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ Z5865 Z Permission is hereby gronted to: ...~.~%.~.~........~.... ........................... .... ot premises located at ...~.~.. ........ ..-~,.~---'~....~ ........... )..~ ......................... pursuont to opplicotion doted .... ~.../. ............................ , 19.~....-].., ond opproved by the Building Inspector. Fee $..~.. ............... Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hell Southold, N.Y, 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A, This application must be filled in Wpewriter OR ink, and submitted I ~ 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 Res[dences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning 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 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, 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 .......................... New C on s t r u c t i o n Old or Pre-existing Building Vacant Land Location of Property -5-~ ,~.. JSl .'~.../:). ~ ~../~....~. Q.Q.~. .... .)~,/?.?- ' ./~. ( ~- ~ 0 ~.7~ iv;." t .................... Owner or Owners of Property .c..~.c,7~..f.' .7-. ~....~. ?.. !.l. ?..~..d/... [~-. ~ ~ ~ ................... County Tax Map No. 1000 Section ....\kd ....... Block .... .(4) ......... Lot....2~ 1 .L~ ..... Subdivision.. [~-~9¢~. ,~..~:~..'~..~<4 ......... Filed Map No. fi.L/~_~., .Lot No. I(~. Permit No. . Date of Permit .......... Applicant . , .............. Health Dept. Approval ....................... Labor Dept Approval ............. Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............... Construction on above described building and permit meets all applicable codes andcr~j~ulations. ~e,,%, ~0~0 Applicant . .~X~..~~¢~ ..... t..~.-~ .... Rev. ~0-I0-78 OU~;DATIO~ (1st) OUNDATION (2nd) OUGH FRAME & ?LUMBING 'NSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITION~L COMMENTS: Examined,---~ -'~" .~/ ...... 19 $'~. Approvec~ ~..~. .... 19 .~.7. Permit No. Disapproved a/c ..................................... ................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT 3 SETS OF PLANS 'rom No. ~ sURVEY. TOWN OF SOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC FORM ............. TOWN HALL NOTIFY SOUTHOLD, N.Y. 11971 TEL.: 765-1802 CALL ....... MAIL TO: INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work, e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to. admit authorized inspectors on premises and in building for necessarg inspections. (,S,~ignature of applicant, or name, if a corporation)/. . / ,"htgzV',r,;cd, d ,~'-~. State whether applicant is_owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ,~,h ? ~¥ .&. ~ - Name of owner of premises ............................. ,~ ............. (as on the tax roll or latest deed I£ applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) · ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED -- Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done~ . .~..~ ~...7..,h/. .'2...'~.( ¢..~'....o ..~.. 5.f.~..d.5.~ ............ ....................... .... .... ............ House Number Street Hamlet County Tax Map No. I000 Section.././..-..~. ......... Block....Q .~. ........... Lot. '....~....~.../.7. Subdivision .~ t~.£ qP.,.~, f(O..etd ~. it.q. 6 ff.'. ..... Filed Map No ............... Lot .......... r' "r '(~I'ame)' ~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .O~d.~.'[. ~--;Z~/'A7 d J-' .~. dZ~/UC~ b. Intended use and occupancy ¢..q Z.~0..a..C5-.~ ~ .c.....q_~.. .......................................... 3. Nature of work (check which applicable): New Building ' ' A~Idition /)(~' Alteration Repair Removal Demolition "Other Work ~ ' (Description) St.t.~ ' 4. Estimated Co · · ~) Fee ............ ~ ..... (to be pa!d on filing this application) 5. If dwelling, number o f dwelling units ............... Number of dwelling units on each floor ................ If garage number of cars . 6. If business, commercial or mixed occupancy, specify nature and extent of each type Of use ..................... 7. Dimensions of existing strUctures, if any: Front ............... Rear ......... i ..... Depth ............... Height Number of Stories Dimensions'of same structure with alterations or additions: Front " Rear Depth Height Number of S~ories . 8. Dimensions of entire new construction: Front .... . ..... Rear : Depth /9 Height ............... NumYer of Stories .............................. I ........................ · Size oflot: Front z,~,~.:/'~'D- ... Rear....~..~..Q ............ Depth~./.~,~-t.? ........ f/~.'.O.o.&~ .- Zone~or-.use~d~n Mu~h-tCr~om ......... ma ................................. , ....................... 12. Does proposed construction violate any zoning law, ordinahce or regulation: ...... !A~..~ .................... 13. Will lot be regraded ....~..F~). ............... ..l. Will excess fill be removed ~ rom premises: Yes No - Name of Arcllitect ...~..'..~..L..~. .............. Address .................. Phone No ................ Name of Contractor Address ' : ! PhoneNo 15. Is this property located within 300 feet of a tidal wetland? *Yes ..... No .~. · If yes, Southold Town Trustees Permit maybe required. PLOT D~AGRAM Locate clearly and distinctly all buildings, whether existing or proposed, an&indiCate all set-back dimensions from ~roperty lines. Give street and block number or description according to deed, and show ~treet names and indicate whether gTATE OF NEW YORK, 2OUNTY OF ........... / .....,~ S.S '-7~ (Name of individual signing contract) ~bove named. being duly sworn, deposes and says that he is the applicant is the ................................................. (Contractor, agent, corporate 'o'f~i~;;,'e't;.')' i .......................... said owner or owners, and is duly authorized to perform or have performed the saf work and to make and file this tpplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the gork will be performed in the manner set forth in the application filed therewith. ~worn to before me this t. NOT~ HELEN K. DE ~ ~ ~lltl¢ teofNewYodc (Signature of applicant) OCCIJMNCY OR USE IS UNLAWFUL W~THOUT CERTIFICATE OF OCCUPANCY /9~' L