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Home My WebLink About15467-zFORM NO 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No .... Z-.156~0 Date 6pri!.2.1,..]~8.7 ......... THIS CERTIFIES that the building AC CE S .8.0.R Y.. S.H E.D. .................. Locatlon of Property 1540 Tuckers Lane Southold, New York County Tax Map No 1000 Section 059 ...Block .0.4 ........ Lot . .5.. 2. ........... Subdlvlszon .M./.o.G.r. ee.n. fz.e.l.d. ..... Flied Map No 63 [3. . .Lot No . .2. ..... conforms substantially to the Apphcatlon for Building Permit heretofore filed in tins office dated · N°vember.... . 3, 1986 pursuant to winch Buddlng Permit No. . 15467.. .. z.. .. . .. dated Nov arab e r. 7. ,.. 1986 ..... was issued, and conforms to all of the reqmrements of the apphcable prov,mons of the law The occupancy for winch tins certfficate is issued xs ACCESSORY SHED MILDRED G. The cerhflcate lS issued to .... of the aforesmd bmld~ng Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE NO .. LONG "/own'~;,'~u~X x ............ N/A N/A PLUMBERS CERTIFICATION DATED: N/A BdJmn In;~;ct;~ .......... Rev 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDIHG PEP~,~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 15467 Z Permms~on ~s hereby granted to' ..~~...~:.....~.~ ..................... .....~..o..~..~-.~..~ ..................................... ~ ' ~_ ~.~. II~- .. at premises located at .................. .V.~.. ~.~......~.~ .................. ~unty Tax Map No I000 Section pursuant to apphcatlon doted Budding Inspector. Fee ,.~.: .~. ~ .~~.~.; ....... Building Inspector Rev FORM NO. 6 TOWN OF $OUTHOLD Buildmg Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUP~ Instructions Th~s application must be hlled m typewriter OR ink, and submitted m~ to the Building Inspec- tor w~th the following, for new buildmgs or new use' 1. Fmal survey of property with accurate Iocatmn of all buildings, propertv lines, streets, and unusual natural or topographic featu res. 2. Final approval of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). 3. Approval of electrical mstallatlon from Board of Fire Underwmters. 4. Commercial buildings, ~ndustmal buddings, Multiple Residences and similar buildings and installa- tions, a certificate of Code comphance from the Architect or Engmeer responmble for the buildm§. 5. Submit Planmng Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pm-existing" land uses: 1. Accurate survey of pZ~operty showing all property hnes, streets, bufldmgs and unusual natural or topographtc features. 2.Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housmg code or safety inspection of buddings or premises, or other pertment ~nforma- tion reqmred to prepare a certificate. C. Fees: Add~t ~ons $25.00 1. Cert~hcate of occupancy New Dwelling $25.Q0, Accessory ,$[0.00 Business $50.00 2 Certlfmate of occupancy on pre-ex[stmg dwe[hng $ 50.00 3. Copy of certff~cate of occupancy $ 5.00, over 5 years $]0.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date /~/~ ~ /~ 7 NewConstructzon ~'~ OIdorPre-exlstlngBulldlng Vacant Land Location of Property ................................................................. tYou~e No, Street Ham/et Owner or Ownersof Property ~, ~t t~ ~-- ~ ~l~O /~:- ~ , County Tax Map No. lOOOSectlon ........ <~.... Block ...... c[ Lot %%..~. Subdlv,mon ..... ~.....,.~..j~ c.~ ........... F,led Map NO. ~ ~ ( ) Lot NO. I ~°7 D fP it Appl Permit No .......... ate o erin ......... ~cant .................................. Health Dept Approval .................. Labor Dept. Approval ........................ Underwriters ApprovaJ ..................... PJanmng Board ApprovaJ ...................... Request for Temporary Certihcate ................... Fmal Certificate ...... ~ ............ - Fee Submitted $ ...... ('..c.~ ............... Construction on above described bu dd lng and permit meets all ,~pplm~e cod_es/af~ regu lat~ons. Rev ~o-~o 78 C0 L )S~gD 1/97/ OUNDATION (1st) OUNDATION (Ind) OUGH FRAME & PLUMBING iNSULATION PER N. Yo STATE ENERGY CODE ADDITIONAL COMMENTS: Examined /0~-~.. 7, 19 ~ ~ FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL £OUTHOLD, N Y. 11971 TEL,' 765-1802 Approved Received ........... ,19... Disapproved a/c (Bmldmg Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS 9. Tlus application must be completely filled in by typewriter or in ink and submitted to the Budding Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule 'b. Plot plan showing location of lot and of bmld~gs on premises, relationship to adjoining premises or pubhc streets or areas, and giving a detailed description of la~yDu~4~roperty must be drawn on the diagram which is part of this apph- cation .~ ~' ~, c. The work covered by tbas app[lo~,t~a~y%noI l~ce~ore issuance of Building Permit. d. Upon approval of tlus~ appt~l~e [~t~[l~'~e.~J~*w~ad a Building Permit to the apphcant Such permit shall be kept on the premlsestava~abll~for,4ns]ile~i-j;~[~li~ ~ork e No bmldmg shall be ~cu~p~e~ o~k.~,ed~'wll~]%~llr[' for any purpose whatever until a Certificate of Occupancy shall have been granted by the B~u~ I~ettf~l[Z 1"]' ~ ~1'~ %~ -- .~l'~J~'~ APPLICATION IS HEREB~~~ment for the issuance ora Bmldmg Pe~,t pursuant to Bmldmg Zone Ordinance of the ~'~ ~~o[k County, New York, Regulat,ons, for the constmc~on bf ~d{~ons or ~teratlons, or for remova or demohtlon, as hereto described The apphmnt agrees to comply wi~',a~ ap~cable laws, ordinances, budding co~e, housing code,~d reg~ahons, and to admit authorized mspecto~ on preml~ ~d m b~dmg for necessa~ ~nspechon~ . ...7'"7 .. (Signature of apphcant, or name, ~f a corporahon) i¢ ; .... : .... ..............' State whether apphcant is owner, leaee, architect, engineer, gener~ contractor, elecmcmn, plumber or Id N~e of owner of premises .... /~o~ ~,. ~ (~on thc tax roll or latest deed) If apphcant ]sa corporation, signature of duly authorized officer (Name and title of corporate officer) Builder's License No. F'/* .t~, I. ¥ Plumber's License No Electrician's License No Other Trade's License No Location of land on which proposed work will be done House Number Street County Tax Map No 1000 Section ...... Subdivision ~E~IY F t E ~ . . (Name) 2 State eximng use and occupancy of premises and intended use and occupancy of proposed construction a. Existing use and occupancy b. Intended use and occupancy ~OdTt'40 aD ('.f Hamlet Block ..... Lot.. Filed Map No . ~O ~. !.'~ . Lot ~ .... 3. Nature of work (check which applicable) New Bufldmg .. . Addition ...... /~ltemtlon . Repmr ...... Removal ...... Demohtlon ......... Other Work .... ~' ~ O O Sc ~ ' 'f '~:5~'c_J (Description. 4. EsmnatedCost . . ."7..00. .,~-~c~ .............. Fee ............................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............ Number of dwellmg units on each floor ........... If garage, number of cars 6. If business, commercml or mixed occupancy, specify nature and extent of each type of use 7. Dunenslons of ex~stmg structures, if any Front Rear ............ Depth . . Height .......... Number of Stones ..... ;. .............. Dkmenslons of same structure with alterations or additions' Front ............ Rear ........... Depth ............. Height .......... Number of Stones.. 8. Dimensions of entire new construction' Front ........ Rear ............ Depth .......... Height ......... Number of Stones ..... Sizeoflot Front ..f 5-O ...... Rear... ./i~.~..ii.il..ii'i'~);~t~ ''~..~.' .. Date of Purchase . .,~ .............. Name of Former Owner Zone or use dlstrlct ,n which p~¢m,aes ale s~cua[ed .. Does proposed construction violate any zomng la'#, ordinance or regulation ...... ~ Y ............ Will lot be regraded . :-.X~-' . ...... Will excess fill be removed from premmes Yes Name of Owner of premises .~'~: .?.d~ ~:q (% ..~../:~ 5~dress ........ ~ Phone ?~&..?r C/~. Name of Architect .... [ WT. ...... Address ..... Name of Contractor ..... :r7 . ...... Address ............ Phone No ...... 15. Is this property located withinl00 feet of a t~dal wetland? * Yes ..... No ..... · If yes, Southold Town Trustees Permit may be requmred. PLOT DIAGRAM 10. !!. 12 13. 14. Locate clearly and dlstmctly all bufldmgs, whether exmtmg or proposed, and indicate all set-back dmnenslons fr property hnes Give street and block number or description accordmg to deed, and show street names and mdmate whet interior or corner lot STATE OF NEW YORK, S S COUNTY OF .. a o-rec £ . ...... (Name of individual signing contract) above named He is the .... ../~ Q .~ t' 17 .......... · . being duly sworn, deposes and says that he is the apphc. (Contractor, agent, corporate officer, etc ) of smd owner or owners, and is duly authorized to perform or have performed the said work and to make and file apphcation, that all statements contamed m this apphcatlon are true to the best of his knowledge and belief, and that work will be performed ~n the manner set forth m the application filed therewith Sworn to before me this ......... r ' '~' .day of )/~rt/ ,19..~ Notary Pubhc,j~e~-4~,c ~''___..#l!l~tl~ A~)~'' ~/~'' i~Z C23~ty .. ~/ (Signature of appl;J~