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Home My WebLink About16053-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. g15937 Date July 9,1987 THIS CERTIFIES that the building . ,d ,e .c.k...a .d,d.~, t. ,i .o.n. ............................... Location of Property/5/~2~o~jo] . M i 11 C r e e k D r S o u t h o 1 d Street Hamlet County Tax Map No. 1000 Section ... 1.3. 5. ...... Block ..... 0. 3. ........ Lot ..... 4. .8 ...1 ........ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... g.ay.. ! .5 ~.. 1.9..8.7 .... pursuant to which Building Permit No. 16053Z dated ..... J.uj~e.. J .1 .... 19 .8.7 ........ was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which ttfis certificate is issued is J:.a ...... construct a deck addition to an existing one family dwelling, as 'a't~ p 1 'i'e'd ' ftyr' .................................................................. The certificate is issued to ................... .~.R.A.~ C..I.S..~.. ~.A.R.I.A..~..D.I.R..8.C.H.E..R.L ......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...... ~ [.,5 ................................. UNDERWRITERS CERTIFICATE NO ........... ~./.g. ................................... PLUMBERS CERTIFICATION DATED: Rev. 1/81 1~0~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF TIlE WORK AUTHORIZED) N~ 16053 Z Date ....................... ~ Lf ...... ...~~ ................... 1~.~.7. Permission is hereby granted to: .~.~...~.:.~.,.....u.~..-1...~ .......... .~.,,,,~~.~.,....~....~~...~.....~- .~ ._.-,., ~-~,.,.~ ~,.. ............ ~ ................................... at premises located at ....~i.:....~'Y.}.~....~...~...~-' ............ ..~.~ ...................... County Tax Map No. 1000 Section ...... J...'~.~.'~.. ..... Block ....... .~..~ ......Lot No......cL?..'..J. .......... pursuont to opplicotion dotod ........... ~..'i~ .................. , 19..~...'L and approvod by the Building Inspector. Fee $..~.~..:...~. .... 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 BLDG~ TOWN OF SOUrHOLD Instructions A. This application must be filled in typewriter OR ink, and submitted m ~ 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: Additions $25.00 1. Certificate of OCcupancy New Dwelling. S25.0.0, Accessory ,$]0.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $]0.00 4.V~cant Land C.O. $ 20.00 5.Updated C.O.~ $ 50.00 Date .... 6.T.,~.D,.q.,~.~. ......... NewC°nsbrucbion ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property House No. Street Nam/et Owner or Owners of Property ....................... .................. County Tax Map No. 1000 Section / ~ Block O~ Lot ~' / Subdivision ................................. Filed Map No ........... Lot No .............. PermitNo. /.~,0¥.~ Z 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 and regulations. Applicant ................. Rev. 10-10-78 OUNDATIO.U ( 1 s t) OUNDATIO~U (2nd } OUGH FRAME & FLUMBING i~:SULATION PER N. Y. STATE ENERGY CODE ADDITIO~A'L COMMENTS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION xST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND []INSULATION [ ] FRAMING [ INAL REMARKS: BOARD OF HEALTH -%.~.. 3 SETS OF PLANS .?,-I.~... 'FORM NO. 1 SURVEY [.~[.~[27[.o TOWN OF SOUTHOLD CHECK -. BUILDING DEPARTMENT SEPTIC FORM ............. : TOWN HALL NOTIFY $OUTHOLD, N.Y. 11971 ~ TEL.: 765-1802 CALL Examined..~.!!..., 19~..7. Approved . . ././..., 19~.7. PermitNo' ]..~..O..~..~..~ Disapproved a/c ..................................... MAIL (Building hispector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tlfis 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 uhtil a Certificate of Occupanc) 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 th~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances 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 tc admit authorized inspectors on premises and in building for necessary~4,~inspe~ct!o, njs~ (Signature o f6~lSplicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) . ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No .... o~. .............. Plmnber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done[ ................................................. .... ~. ........ .o.~..~.q{:-?..,.. . l/fiT/ . House Number Street Hamlet Count:y Tax Map No. 1000 Section ../.4>:. .......... Block ....0.3. ............ ..... ' Subdivision ..................................... 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 .... b. Intended use and occupancy 3. Nature of work (check which apphclable): New Building . 7:...' ..... Addition .......... Alteration Repair .............. Removal .............. Demolition ........... J.. Other Work .~..o.,.~..~. ~. ?.~c..t~ ~ ,~ <760..1 (Description) L Estimated Cost ..................................... Fee ...................................... " (to be paid on filing this application) L If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................. If garage, number of cars ........ ~ ................................................ 7 ............... L If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... z. Dimensions of existing structures, if!any: Front ............... Rear .............. Depth ............... Height ............... Number lof Stories .: ................ ~,..,. Dimensioi~s of same structure with alterations or additions: Front ................. l~eh~-.-~ ....... :~ ....... Depth ...................... Height ...................... Number of Stories ......... ,~ ........... I. Dimensions ofantire new construction: Front .......... ..... Rear ............... Depth ............... Height ............... Number iof Stories ........................................................ ~. Size of lot: Front .............. ........ Rear ...................... Depth ...................... ). Date of Purchase .............. i ............... Name of Fonner Owner ............................. l. Zone or use district in which premisgs are situated ..................................................... L Does proposed construction violate any zoning law, ordinance or regulation: ................................ L Will lot be regraded ....... ; .... ! ................ Will excess fill .be removed from premises: yes No . ~ .......................................... Phone No ...... Name of Architect ,~,~,,v ~ ... Address .... Phone No. Name of Contractor ...... ~',,~ ~r: .. Address ' .... Phone No. ~. Is this property located within 300 feet of a tidal wetland? *Yes ..... No ..... *If yes, Southold Town Trustees Permit maybe required. ' PLOT DIAGRAM Locate clearly and distinctly all buiidings, whether existing or proposed, anti. indicate all set-back dimensions from operty lines. Give street and block number or description according to deed, and show street names and indicate whether terior or corner lot. : 'ATE OF Iq~E~,y_YORK, · .. ~g~c/.r. '~ .~d~ ~.q'~ ........... being du~y sworn, deposes and says that he is the applicant (Name of individual signing contract) ove named. ~ (Contractor, agent, corporate officer, etc.) said owner or ownem, ~d is duly au~horked to perform or have perfo~ed the said work and to m~e and file t~s plication; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the ~rk will be perfomed in the m~ner set'forth in the application filed therewith.' /om to before me this ...................... day of,, , .......... 19, ~ta~ Public, . .............. ~ ........... County ~KARE~W;~BOERGESSON ~ (Signature of applicant) NOTARY PUB[[G Stale of New York Qualified in Suffolk. County