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Home My WebLink About15889-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Date J.uly 30, 198~ THIS CERTIFIES that the building ...D.c.c..15..a.d. d. ~_ .t.l,q n. .............................. Location of Property .9.0..0..R. qg .e.r.s..R..d.,..(.B..e.i.x.e.d..o.n.) .... Southold House No. Street Hamlet County Tax Map No. 1000 Section 066 .Block 02 .Lot 38 Subdivision Beixedon Estates .Filed Map No. I672 .LotNo. 5 conforms substantially to the Application for Building Permit heretofore filed in this office dated ·..A p.r.i. 1...7.,.. ! .9 .8.7 ....... pursuant to which Building Permit No.. ! ..5 .8.8.9.z. ............. dated .... .A.p.r.i..1..I.2. ~..l.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 ......... Replace existing deck with new deck as applied for. The certificate is issued to DR. & MRS. F. C. S YMONDS (owner,/~i~flXXX X of the aforesaid building. Suffolk County Department of Health Approval ............ .N/fi. .......................... UNDERWRITERS CERTIFICATE NO .................... .Iq./.A, .......................... N/A PLUMBERS CERTIFICATION DATED: Building Inspector Rev, 1/81 ffO~l[ NO. ~B 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) 15889 Z Permission is hereby granted to: ....... ~.,.b..~...~ ............................... ...... T' ......... " ............... ~ .............................................. r~' ............ ;~' ............... ot premises Iocoted at ..~....J~. .......... ~......~...~. ~~.~ ....~-~'""~'"'~"'-- ................... ~i'~:'"~ ............ '~"';: ....................................................................... Coun Tax Ma No 1000 Secton . ty p · .,~ ................................... Lot No......~..~. ............. pursuont to oppllcaflon doted ..... .~f-,-:n~......o. ........................ , ond approYed by the 19.....'].., Building Inspector. Building Inspector Rev. 6/30/80 FORM ~O. 6 TOWN OF SOUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This opplicotion must be filled in typewriter OR ink., and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: ]. 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 disposol--(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 installations, a certificate of Code complionce 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 in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 New Building ................ Addition ....~7.., ........ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .................................................................. .~.. ................. Owner Or Owners Of Property ...................................... ..~ ............................................................. Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fined Certificate Fee Submitted $ ~ ~'~' '~' Construction on above described building and,permit meets all gpplicable codes and regulations. Appl cant ................... , - . ................................................ Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) OU~DATION (1st) OUNDATION (2nd) OUGH FRAME & ?LUMBING ?~SULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined .~,4~..I.~..., 195J. .(~.~..t..~. .... 19~?. Permit No./.~..~ .$ .~. ~..~. Approved Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTION8 BLDG. DEPT. TOWN OF SOUTHOLD Application No .................. 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, mad 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 necessary inspecldoJarrfc r', /, ~ .... ...... ......... ...--(.Signature of applicar~ 0.~' ~J~e, if a corporation) State whether applicant is owngr~ lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder.' ............................ .... . .¢&.: ........................................................ ,~,~..-.."_.__.~-'~---'~--~./,~ r,, .~ , /~Jr~ ,~ ~-'-F'~ C. ~/o- '"- "' Name of owner of premises .'~ :. '...: .... ?..t .\~,_ .J~../t..wT. :? .~.."~....~.,...k~.,..~,._~ .c~../~....~'. ~Q)..._~.... ........ (as on the tax roll or latest deed) ~ If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location ofland on which proposed,.,work will be done. ~ /t/,--a/., c ~ ....................... ff~cclk'l ~o ,,o ^ ........................... ..... .q. u~. ................ vt../w.: .r-:'.7:: .......... . .......................................... House Number Street Hfftmlet County Tax Map No. 1000 Section ....... (~(~ ........ Block .... o~ ............ Lot..~ .~. ............ Subdivision.. ?.'?..x.~.0. e ................... Filed Map No../..~. ?.~-~ . . . Lot .......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: / a. Existing use and occupancy ' ' · ~zz_:.f~ .................. d" .......... L.'. ':' },'. ,' 7,' ' ~ .............. b. Intended use and occupancy ...... ~ . .--~'..~. · -~.; .................. ::'(.. i..':..'...'i f., .;~ ............. 3. ,N~ture of work (check which applicable): New Building .......... Addition .- ... Alteration .......... ~ R~pair .............. : Removal .............. Demolition ~....". ........ Other Work ............... ~ ! ~'~ '~ ~ ' *'7 ~: ~ (Description) 4. Estimated Cost ..... ~ ............ Fee ...................................... '~ (to be paid on filing this application) 5. If dwolling, number of dweiling units ............... Number o f dwelling units on each floor ................ If garage, number of cars .... q ................................................................... 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 .............. D&pth .... ~ .......... Height . 2 ............. 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 Stories ........................................................ 9. Size of lot: Front .......... : ........... Rear ...................... Depth ...................... 10. ][)ate of Purchase ............................. Name of,~ormer Q._wner ............................. 11. Zone or use district in which pr~mises are situated .......... ?'~:. :o~'. ............................... 12. Does proposed construction violate any zoning l~ordinance or regulation: .. .... ; .......................... 13. Will lot be regraded ............................ Will excess fill be removed from premises: _ ~Yes ~ 14. Name of Owner of premises ~.~. ( ,~/.~?...o~. ....... Address .. ~.f. ,~... Phone No..?.~..'..~..~.~./.... Name of Architect .............. Address ................. Phone No ................ Name of Contractor..~..'.~.~. ~-~... ......... Address ~.~.~.t.~....~.?../g'~_Phone No. ~.~.~'; I-~../.~. PLOT DIAGRAM Locate clearly and distinctly alli 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 .............. ,'- ..... ' ......~..~..,.~. =.. ~.~.~. ......... being duly sworn, deposes and says that he is the applicant (Name of individuagsign~ contract) above named. 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 this application;that all statements contained 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 ................ ~. ...... day of ............ , 19 ?~ ........... County ~' Notary Public, . .... ' HELl[II K. DE rOE ...................... NOT~W PU~UC, ~te of H~W Yo~k (Signature of applicant) No. 4707~78, Suffolk Te~ F. xplre~ M~rch ~0,1~