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Home My WebLink About16481-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z]6378 Date November 9, 1987 THIS CERTIFIES that ti~e building .. Ac.c.e $ ~ o.r.y. ................................... Location of Property .... ! .2 .3.0.. H. 9 .r.s.e.s..I2 p.e.. D..r .i.v.e. ........... q u..t .c.h. q ~ .u .e .............. House No. Street Hamlet County Tax Map No. 1000 Section 0 9 5 ...Block 04 .Lot 18. 16 Subdivision ............................... Filed Map No ......... Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .8.e.p.t.:..2.3. ,...1.9.8.7. · pursuant to which Building Permit No...1.6.4. .8.1.Z. ............ dated .S.e.p.t. :..2. 7. :..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 ......... Accessory shed as applied for. The certificate is issued to DONALD C. DE LALLA ..................... ?o¥.'e;, ............ ....... of the aforesaid building. Suffolk County Department of Health Approval . .N/.A. ..................................... UNDERWRITERS CERTIFICATE NO ......... .N/.a. ..................................... PLUMBERS CERTIFICATION DATED: N/A / / Bui/6ing Inspector Rev. 1/81 lrOw'~v NO. 0 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"_ 1 6 4 8 1 Z D,~e .~.~.....~..~. ........... , ~9~.].. Permission is hereby granted to: [~ -,,, ~~.~.~.~~..~,.,~,..~... .....'E~...~.~'E.~.~ .............................................. ...~~.~.....~.~..~....u.~.~ ...... ~ ,o ........ c...~ r.~ M., No. ~000 S.~o. ..... .~.~.~ ...... m~k ...... ~..~ ........ Lot N~ ..... I..~.,..l.g ...... Building I~spector. 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 Instructions A. This application must be filled in typewriter OR ink, and submitted aa~ to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate location of ail buildings, property lines, streets, and unusua~ 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 featu res. 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.$25.Q0, ory.,$10.0 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 5 0 1 0 0 3. Copy of certificate of occupancy $ 5.00, over 5 years $]0.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date .... .~/ Newc°nstructi°n ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property / ~ ~, 0 ,~ E; ~ /~/Oz~ /.~,~1~/~ House No. Street Nam/et Owner or Owners of Property C; County Tax Map No. 1000 Section ...~..7..~.. ..... Block ...(?. ~ ....... Lot.../..~.~ ./~ ...... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./~.~.. g~./... Date of Permit . .Applicant.~,~..'~/',??, (~,,., ,~.(¥..-~./-./~ .......... Health Dept. Approval ........................ Labor Dept. Approval ....................... . Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $.. /(2¢ ~0 Construction on above described building and permit meets all applicable codes and regulations. Applicant ' Rev, 10-10-78 I 19 I I0 ~chorge Basin $$ Matwi#cz.v, FOUNDATION FOUNDATION (2nd) ROUGH FRAME & ,FLUMBING INSULATION FERN. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: CARRIAGE i.~OUSE Our most popular model. An exce~len~ "on loca- tion sales office", pool house, or general storage area for your home. A beat~tif~lJ way to meet your storage needs. Single or double doors are available on ALL MODELS. 4--* ~ BOARD OF HEALTH ..~,~.. 3 SETS OF PLANS ....... FORM NO. I SURVEY ........ TOWN OF SOUTHOLD CHECK .~$0:. d5,0u BUILDING DEPARTMENT SEPTIC FORM ............. : /OWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined ...~~ .~.-']., 19%.~. Approve~~..%.].., 19~..']. Permit No../.~..9.~. t .'~.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT NOTIFY CALL ................ Date ................... 19... INSTRUCTIONS a. Tkis 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 necessary inspections//') -- ,~ (Signature of applicant, or name, if a corporation) (Mailing address-gf'~'p~ii>can~/ (Name and title of corporate 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 ...................... \ State whether applicant is_owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................../>..6. ]_~kL0 ) />~NJgL/) {. ~' JT:/..N..~. ~i~O%,'g~) ~t~ ~O7'i~ ................,, : .......... ~ Name of owner of premises (as on the tax roll or 15t{~eed)~ B,p ~ If applicant is a corporation, signature of duly authorized officer. F~.~' ..~_ '~ BY~ ._~ ~'~ NOTIFY ~ILDtNG D[PARTM[~t' AT F~L.OW~N(J ~NSP~CTR~NS: 1. Locatmn of land on wtuch proposed work will be done ................................... ~. -~..~. · · House Number Street ' ~/ X County Tax Map No. 1000 Section ...~* .... :* Block .~.~. [.O ........ 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 ................................. ,L, .~% ', q': '~ '.'! ................'; ..... kb Intended use and occupancy ~/'fi~b.~.~. ../j..O..~..-~..~... · ;" ;;%' '""" , 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ........... in Repair .............. Re oval .............. Demolition .............. Other Work ............... ! (Descrip~tion) ?._c lad ' Fee 4 Estimated Cost (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 ' ' If business, commercial or mixed occupancy, specify nature and extent of each type of use .. ':... ............... Dimensl~3~"6ii,~'~t~l~--~i~j;(Iny: Front ......... : ...... Rear ,... Depth · ~ ;.! _~ ~., U%~ ,~; .. ........ · ......... Hmght .............. df Sto es ........................... , Dnnenmqns'0f same stnLct, lili~th.~!teratmns or additions: Front ................. Rear .................. Depth· 'i' ~' i'' ][~ $~' l' I/[i~ight ...................... Number of Stories .................... : Dimensi~.nfip~f~ntiEe nh~l~st~.~l(~n: Front.. ~. - .~... ,. ..... Rear.,/.0;~-: ....... Depth . .~.~. ......... Height ~....~.. ,.~.h~tl.,~C,~J~it~ ~r~c{f Stones ..... l .................................................. . Size of latkJ~l~o~ti! ~1 ;tO ~WOl' ! . ~ ...... Date Of Purchase I lame of Former Owner Zone or use district in which premises are situated ..................................................... Does proposed construction violate any zoning law, ordinance or regulation: ................................ Will lot be regraded ............................ Will excess fill be removed from premises: Yes Name of Owner of premises .. i .......... Address ........... .~. .....Phone No ................ Name of Architect . 2 ....... i .................. Address .x~(~ ~:0t,/t~..Phone No. Name of Contractorfi/~t~T/'J. ff~'.~)~. ~o.0.1~ .Dt~/~tl~.ddress i .~/~ .~-i~ i .i-10h .~i..511 Phone No..~ '~'~ ~ b'~.' ~"' 15. Is this property locatedi within 300 feet of a tidal wetland? *Yes ..... No~. .... · If yes, Southold Town TrUstees Permit maybe required. " PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions fr(~m~' property lines. Give street and blocl~ number or description according to deed, and show street names and indicate whether: interior or corner lot. 9. 10. 11. 12. 13. 14. COUIxCTY OF...~/~~'~ · .~. '." .~...~· .................... being duly sworn, deposes and says that he is the applicant (Name of individual sig~ing contract) above named· He is the , . '' : ..... (Contractor, agent, corporate officer, etc.) of said owner or ow. nets and is,du!y authorized to perform or have performed the said work and to make and file thisi 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~.(~Sc../~ - // .~ ~thi~' ~ /~ ' "~-'7 ' Notary Public, .'~ .,(~~.~f.-~ount5. ~dZ~j/ . ,/~' ~~, ....... · I~btl~, 8~t~,~ N~WY~ (Signature of applicant) ~. .... .O~. lifled in 8!dfOlk Count,/ ..-:,,.~, ~ommmmon ExpJre~ Deoember 8, 19--~"g ~. ' -