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Home My WebLink About15866-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Date May 26, 1987 THIS CERTIFIES that the building .... .a.c.qe..s.sp.r.~: ................................ Location of Property .... 5.~ 7 7.5 ................... M.a. Southold House No. Street Hamlet County Tax Map No. 1000 Section ...... 5..6 ....Block ...... 2 .Lot 3 Subdivision .......... X ................... Filed Map No. X .Lot No. X conforms substantially to the Application for Building Permit heretofore filed in this office dated April 1, 1987 . pursuant to which Building Permit No. 158.66Z dated April 4, 1987 ............................ 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 ......... Accessory building. DR. JEFF WILLIAMS The certificate is issued to ........................................................... fowner. ~W~,~ of the aforesaid building. N/A Suffolk County Department of Health Approval .......................................... N/A UNDERWRITERS CERTIFICATE NO .................................................. N/A PLUMBERS CERTIFICATION DATED: / ~lding Inspector Rev. 1/81 FOB~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NB 15866 Z Permission is hereby granted to: · ...~.~.~........~./.~~' ~ ....... ,..~~ .......... ~ ......... .~.~..ff.. ................................................ ,o at premises located at ..~,~.~ ......... .~. ....... ~ ............ · ..~... ............. .c~..~ .............................. County Tax Map No. 1000 Secti°nc~'"~r~-- ....... B,ock ........ .~.....~:'...... Lot No......~.~ ............ ~. I ........ 19~.~. and a roved b the pursuant to application dated ....... ...':T~...~ ...................... , ....... . pp y Building Inspector. Fee $...~...~.:~ Building Inspector Rev. 6/30/80 FORM NO, 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ~ ~ 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 Residences 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. C. 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 ' ~ ~-//, ^ /~.~7 NewC°nstructi°n. . ~ . Old orPre-existi~g 8u[ld[ng ............ Vaca'nt [an/--d ............. Hou~ No. ~ [ ~ Street Hamlet Oounty T~x ~ap No. 1000 Section . ...~..~ .~ ..... Block ............... Lot .............. Subdivisio~ ................................. Filed ~ap ~o ........... Lot No .............. PermitNo...~.~. Date of Permit ..¢/~/~2AppHcant .,*.~ Health Dept. Approval Labor Dept Approval Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... · ' bu ildi:'~.~:/r~ :ts a, a. op/able/odes an~regu ,ations : -. . .. .. .. . ...... ..... TOWN OF $0UTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 May 19, 1987 TEL. 765-1802 WATERFRONT BUILDING CORP To Whom This May Concern, We are unable to complete your Certificate of Occupancy because.of the following reasons. /_-/ /-/ An application for Certificate of Occupancy is not on file.~ffc~,d) No Underwriters Certificate on file. The check is(outdated/not on file.)~ 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 ~ _~ ~--~ ~2_ ~ Z (~e~) Building Dept. ***/~/ No Plumber Solder Certificate on file. ( all permits involving plumbing being issued after April 1,1984 ) OUNDATION ( ls t) OUNDATION (2ndl OUGH FRAME & PLUMBING ~NSULATION PER N. Y. STATE ENERGY CODE FINAL · ADDITIONAL COMMENTS: £AuRE£ AVENUE 490.86' (,4 4 9085'[DEED) N/F 17o10'20"E. iRWIN FR. HSE. Z/TEK MA P OF DECCRIBED PROPER T Y AT $OUTHO£D TO~/IV OF $OUTHOLD SUFFOLK CO.,A/Y. Sas. ZO'(ACTUAL) C ~ R TI FI£D ¢OMMONW£A/.TH LAND T, rrL~ ~/~'PF~ ~. ~¢/J~AM$ ~ MARY ~q/.~/A&~' ill donack associafes land surveyors and consulfing enginee 313 west main streef riverheod,new york 11901 (516) 369-i717 (212) 746-:302 Apdl 26,1983 dob Na 85'~50 BOARD OF HEALTH ...... 3 SETS OF PLANS ....... FORM NO. 1 SURVEY .......... TOWN OF SOUTHOLD CHECK .......... BUILDING DEPARTMENT gEPTIC l~0RIq ............. : TOWN HALL NOTIFY $OUTHOLD, N.Y. 11971 TEL.: 765-1803 CALL ................ MAIL TO: Approved . .~.... ~..., 19~.7... Permit No./.,.%'-$Gb.......... ~; a ~,,,~,~ Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely fiiled 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 appilcable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. ........... ¢?. . :T. ...... ". ! ...... se ...... (Signature of applicant, or nmne, if a corporation) ....... ..... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, gener~ electrician, plumber or builder. Name of owner of premises .... D}IC.. ~ .... ~U.~.t.~.l .' .o'A~. ............................................ (as on the tax roll or latest deed) If 2pplicant is a coz;por~on, sigt~ature of duly authorized officer. \ (Name and title of corporate officer) - AL~_.,C,OI~,TRACTOR'S MUST BE SUF.FOLK COUNTY LICENSED ~ .~l~uilder s License No ..... I. 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 7 5 .......... House Number Street Hamlet County Tax Map No. 1000 Section .... .~..~. .......... Block .. ? ............. Lot. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... ~ ......................... ., ;..,.. ~ b. Intended use and occupancy ................................... , ............ 3. Nature of work (check which applicable): New Building ......... Addmon. f~I ., ~!.~:. :, .Alteratlgn ......... Repair .............. Removal' .............. Demolition' .......... ~.; ....Other Work...,~ .~ .} .......... '~ Or_) al ~'~f~l /[ ,,,~ II~escripti°n) 4 Estimated Cost Fee } (to be paid on filing this application) 5. If dwelling, number of dwelling: units ............... Number of dwelling units on each floor ................ If garage, number of cars .... .................................................................... 6. If business, commercial or mixe~d occupancy, specify nature and extent of each type of use ........ ............. 7 ..... if any: Front Rear Depth · Dimensions of existing structurgs ............................................. Height ............... Number of Stories ........................................................ Dimensions'of same structure with alterations or additions: Front ................. Rear .................. Depth ................... .... Height ...................... Number of Stories ...................... "-8. Dimensions of entire new construction: Front .......... . ..... Rear ............... Depth ............... Height ............... Number of Stones ........................................................ 9 Size of lot: Front I Rear . Depth 10 Date of P chase ~! Name of Former Owner 1 1 Zone or use district in which prlemises are situated . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ........ I .................... Wilt excess fill be removed from premises: Yes No 14. Name of Owner of premises .. ~ ............ Address . Phone No ...... Name of Architect ......... . .................. Address ................... Phone No ................ Name of Contractor ........ ( ................. Address .... : .............. Plione No ................ 15. Is this property locatedlwithin 300 feet of a tidal wetland? *Yes ..... No ..... *If yes, Southold Town TrCstees Permit maybe required. . PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block~ number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ~ S.S COUNTY OF ...... >~-,~.~Z~ ..ok). Jl..~ .4~'.....: ..................... being duly sworn, deposes and says that he is the applicant (x ] (Name of individual slgqing contract) ab~v.~ n_Mned. He is tlie ..................... ! ....................... ~ .... ~ ............................... ; (Contractor, agen C~orate of~tc.) of said owner or owners, and is duly authorized to perform or ha~ed the said work and to make and file this application; that all statements con[ained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this