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Home My WebLink About16081-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall $outhold, N.Y. Certificate Of Occupancy No ...... 33.5.9.4~ ..... Date ............. July 13, 1987 THIS CERTIFIES that the building ....... .a.qc. e..s.~.o.r.~..~.u.J:..1 .d.i.n.~..f.o.r., .s~.o.r.a..9-.e.. .... Location of Property .... J..0.qo ~ ................. .sp~.a..%~.. 5y.e.~..w .... .s.o.u.~.~. ? 3.~.... House No. Street Hamlet County Tax Map No. 1000 Section ..... .5.9. .... Block ..... .2 ......... Lot 6 Subdivision .............. g ................ Filed Map No...X. ..... Lot No ..... X conforms substantially to the Application for Building Permit heretofore filed in this office dated May 27, 1987 pursuant to which Building Permit No. 16081Z June 16, 1987 dated ............................. 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 ......... An accessory building for storage. LLOYD H. & M. CATHERINE CLARK The certificate is issued to ........................................................... (owner,~v~I1~) of the aforesaid building. N/A Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO ............. N/A PLUMBERS CERTIFICATION DATED: N/A t Rev. 1/81 FOR~ NO. ~ TOWN OF SOUTHOLD BUILDIHG DEPARTMEHT TOWN HALL SOUTHOLD, N. Y. I~UILDIHG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) County Tax Map No. 1000 Section ....... ~....~. ........ Block ............ ~ .... Lot No ......... ~.. ........... pursuant to application dated ...... ~..<~.....,,~...7. ....................... 19J~.L~., and approved by the Building Inspector. Fee $.~.~ ulldlng Irk~:~ector ' 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 This application must be filled in typewriter 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 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 p~operty 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: Add±t ±.ohs $25.00 1. Certificate of occupancy New Dwelling $25.00, Accessory I$ ]0.00 Buszness $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 5.Updated C.O. $ 50.00 Date ........ New C on s t r uc t i on., .~... Old or Pre-existing ~ilding ............ Vacant Land ............. County Tax Map No. 1000 Section ....~. ~. ........ Block ...~. ........... Lot..~ ............ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Fina) Certificate ... ~ OUNDATION ( ls t) OUNDATION ( 2nd ) OUGH FRAME & ?LUMBING ~NSULATION PER N. Y. STATE ENERGY CODE FI~.AL ADDITIONAL COMMENTS: BOARD OF HEALTH 3 SETS OF PLANS 'FORM NO. 1 SURYEY TOWN OF SOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC TOWN HALL $OUTHOLD, N,Y, 11971 TEL.: 765-180:3 CALL MAlL FORM ............. : TO: 'Examined...~'~.../~ .... 19 .~.7 Apiprov;d:~ .~..../~.., 1~.~. Permit No./~'..~. E/' .~. Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT ' ' 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 occupzed or used ~n whole or zn 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 Departmdn~ for'the, is~d'ance of a Building Permit pursuant to the Building Zone Ordinance of the Town of South61d; Snff01k County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, addLtio'ns or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all';app~lidgble l'h~vs, ordinances, building code, housin~ code, and regul~ions, and to admit authorized inspectors on premises and in building for necessary~insp ' . . ~oJ' J~pli~a'nt i ;r name, if ~ 'C;~l~;;a'tio'~) .... · . .... (Mailing address of applicant) ' State whether applicant is~owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises... C~'~.,~,~".,,*... ~..d'~' '~.;. ~.. · -/..~..~- .............................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized office'r. · ' (Name and title of co.orate officer) , ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No ..... ~ ............ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on whictt proposed.work.~ will__be done .................................................. ,~ / oao,.5- _ A" f. . Z. .... . . . ...... a r. mo, ........................... House Number Street Hamlet County Tax Map No. 1000 Section ...... "~' '--' 7 ......Block ..... ..~ .......... Lot....~. .............. 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 .. O ...... .~ .~ ~.. ~.~. ................. 9. '.10. '~11. 12. 13. 15. ]rs this *If yes~ Locate ctea property lines. interior or corn Nature of work (check which applicable): New Building ... ~ Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... $r : ~ ' (Descfip;Hon) Estimated Cost.../.. ~.~ .... ~' .......................... Fee, ...................................... (to be paid on filing this application) If dwelling, number o f dwallingl units ............... Number of dwelling units on each floor ................ If garage number of cars ' If business, commercial or mixed occupancy, specify nature and extent of each type of use ........... Dimensions of existing structurbs, if any: Front .... ~ ...... Rear .... ~ ...... '13~pth i. i~..i . !... Height .'~[ll~. ....... Num. ber of Stories ........................................................ Dimensions~t same structure With alterations or additions: Front ................. Rear .................. Depth ................... i' ' ' Height ...................... Number of Stories .............. / ....... Dimensions of entire new construction: Front ...... ,/~,~.~ ..... Rear .... .,~',~.~ ......Depth ....~. ......... Height 21...~.~. ....... Number of Stories, .......... .~...., . Size of lot: Front ..... ~./~a~ :.. _/O.~,~,ff..R~ar .... ~./.t~a,../0~.,.~$.'.. Depth .. i~ i,~a~i ;.. i ~3~'2~. Date of Purchase .../,,~,~'~. i..../.'~ ./~ ./ ....... Name of Former Owner /q. ~*egat~ .~... Mf'~t'~. ......... Zone or use district in which premises are situated .......................................... Does proposed construction violate any zoning law, ordinance or regulation: . .~.~ ...... .....................' .......... Will lot be regraded ...... ,eg.a ........... ~ ....... Will excess fill be removed from premises: Yes Name of'O,/ner of premises . ~/.~.~ .,../~.,Y'4 Iv. ~,~,'~ddress ~'O.il ~.,*--/~,;,,;.~pePhone No.~'6'~'r.,~,'*O%.~*..~"~ Name of A~ ehitect ...I ...... ;' ' ' i ' ' ' i ......... Address ................... Phone No ................ Name of Cc ntractor . 'l' '" ,n~'4e'~'_~ ........... Address .... : .......... [ ....Phone No.... 'l ............ roperty lpcal:ediwithin 300 !eel: of a t±d~l wel:land? ~¥e]s ..... No ./~. ~uthold T~wn Trustees Perm~: maybe requkred. proposed, and, ind~e all s~fb~k~imensions from g to deed, and show street names and~ndicate whether y and. distinctl~ al} buildings, wh ~ther existing o ive street and bl~ckl number or description accordin lot. STATE OF NEW YORK, S.S COUNTY OF .................. being duly sworn, deposes and says that he is the applicant (Name of individual sigOing 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 ~fild W'ork and to make ahd file this application; that all statements contlained in this application are true to the best of his knowledge and belief; and that the SwomW°rk willto beforebe performedme thisin the manner set forth in the application filed therewith. g7 .............. ._~N%4707878, ~.~_lk Cout~ ~, .- , . , ~ (Signature of applicant) 12' 8' SHED RID&E. BOARD PLATF- )T OUT ~OTTOM ~t. AT£ AFTE.~ I~L,L, PAN~,L, I~ IM PLAC~ '~. IlL I057~.'' FRONT- PANEL ~',~ ~." FRONT FRAMING SO.ALE ~ ~/~." ~ I'-0" '~/4" ?cYuuOoO ~ --T. ~r"~-" .EFT SIDE FRAMING iii ~ 11'-I0~/4.'' REAR-PANEL, "A REAR FRAMING RIGHT SIDE FRAMING CONC. SLAB TRIM PLYWOOD PLOOR AT THIS END FLOOR PLAN ~G SCALE: VgI-' I*'0'' ~ . , SHEET B- 2 0 0 4 TOTAL