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Home My WebLink About15333-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Z.15.4.7..8 Date D.e.cember 9. 19 8.6 THIS CERTIFIES that the building .A.d.d. 5: .t i,o.n.. . Location ofProperty/:/~d 16649 New Suffo'lk Rd. New Suffolk s3 ........................................................ Stree, County Tax Map No. 1000 Section 1.17. .... Block 04 .Lot .. 031 . Subdivision ............................... Filed Map No ......... Lot No .............. confonus substantially to the Application for Building Permit heretofore filed in this office dated 15333Z .... .S.e.R.t.:' .2.4. .......,19..8.6pursuant to which Building Permit No ...................... dated . .S cPk... 2 5 ................. 19 8..6., 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 ......... The certificate is issued to ..... ~¢t;c~..gk~.t.~¥ ......................................... (owner, ~,~q2~)K~sXtX~ of the aforesaid building. Suffolk County Department of Health Approval ............ Iq.. [.A. .......................... UNDERWRITERS CERTIFICATE NO .................... .N/.A. .......................... ~IKuil lng Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDiHG PERMIT CrHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15333 Z Date ...... ~;~......~ ............. , 19..~..~' granted to: Permission is hereby .~~~i'~' '"~'~'/'~'~'i~C'"~/( ,ooo ....... 2., ......... Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD 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 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 featu res. 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 n~tural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of bu ildings. 3. Date of an,/ hous{ng code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of o~cupancy on pre-existing dwelling $15.00 3. Copy of certificate of occupancy $1.00 5.Updated C.O. . $15.00 Date .................. NewConstruction ...... O Id o r~~. ~).~'.C./.~.... Vacant Land ............. Location of Property .. ~'~.~..~. ........... House No. Street Ham/et Owner or Owners of Property ............................................... ~..~.~. ~.,t~.~./~'~ County Tax Map No. 1000 Section .......... Block ........ Lot...E~.~./. ........ Subdivision ................................. Filed Map No ........... Lot No .............. PermitNo. ,~',J'-.~.~..~'~. Date of Permit .~.~?/~'...Applicant Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters/~pproval - '" Planning Board Approval Request for Temporary Certificate ..................... Final Certificate ..... . .~... ............. Fee Submitted $ . /~333 ~ 7GS-t80Z BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. 2ND [ ] INSULATION [ ] FOUNDATION [ ] FRAMING ~FINAL REMARKS:~ -- FIELD INSPECTION FOUNDATION (1st) COMMENTS FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N. STATE ENERGY CODE Ye FINAL ADDITIONAL COMMENTS: 17/. OCCUPANcy OR USE IS UNLAWFUL' WITHOUT CERTIHCA TE OF OCCUP, qiVC¥ /0 / FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~,-~,;~,,,.l~'4~u COUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined . ... ., 19 . · 6 Ap proved~..~:~--~...., 19~.~Permit No./~..3~...~ ~ Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PER,tIT ~.~.~.~. Date .......... 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 Buildh~g 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 9 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) .... ...... - - (r~z~l~i~ add-~ess of/applicant) ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner ofpremises..~.6~..~~(a~ ................................................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 ..... .~.o~...~.. .............. 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 Hamlet County Tax Map No. 1000 Section /../. 7..~...~. ....... Block .Q.~..D..~. ......... Lot..~...7./..~')..~..~. .... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 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 applicable): New Building.; ' ~'~itio~..,~-~ AIt~--,:~- ', Repair Removal . D em olition ~-~-.~-~'~ 'i ....... ' ' .................. ~ .......... i' ' ' umer WOrK ......... .... :. ' ' ~ ~ (Description) 4. Estimated Cost .... ~.~] . .t~..,.O.O. ................ i.., ;,.. Fee fff~f~ - ~ , ' / (to be ~md on fihng th~s apphcat~on) 5. If dwelling number of dwelling units Number of dwelling unit~ on each floor If garage r~mber of cars .............. : ~ . 6. If business, commercial 'or mixed occupancy, specify nature and extent of each tyEe of use ..................... dc7. Dimensions of existing structures, if any: Front ............... Rear ....... ~ ....... De ....... ....... ~. ight . pth He ............... Number of Stories ............................. ; .......... ~ ~ D~ensions of same structure with alterations or additions: Front ............ ; .... Rear .......... , ....... Dep~ ...................... Height umber of Stories ............... 8..Dimensions of entire new construction: Front ....... ; .. ...... ' Rear ........ [ ...... Depth ............... : Hight '. . ~:~, ~ e ........... Number of Stories -~ff~ Size of lot: Front ...................... Rear ...................... ~epth ...................... ~ Date of Purchase ............................. Name o~ Fo~er Owner .; ............................ ~l. Zone or use district i~hich nremises,~re s ~',',~ - ' . Dges proposed construction violate any zonin~ law ordinance ...... ~-~:~-. '~ .......... 13 Will lot be regraded . un,, ......... ' . ......................... ~lil UX~SS IlU O~ removan, trom premises: Yes No '14. N~e of Owner of premises .................... Address .......... ~ Phone No ................ Name of ~chitect ....................... Address . · . Phone N~e of Contractor ~r~ ~ff~ -~ "~f- ''; ...... i'" No ...... ~ ........ . 15. Is thLs property located wit~nl.00 feet of a.tidal wetland? ~ ~e; .VT~'~ No ..... ' .... ~ If yes, Sou~hold To~ Trustees Permit may be ~equired. PLOT DIAG~M Locate clearly ~d distMctly ~1 bufldMgs, whe~er existing or proposed, ~d. indicate ~1 set-back d~ensaons from property ~es. Give street and block number or description accoMMg to deed, and sOow ~ indicate whether ifitefi6r or corner lot. :TATE OF NEW YORK, ',OUNTY OF ................. S.S ........................................ being duly sworn, depose and says that he is the applicant (Name of individual signing contract) bore named. is the ................................................... (Contractor, agent, corporate officer, etc.) said owner or owners, and is duly authorized to perform or'have performed the said work and to m~ke and file this ~plication; that ,all statements contained in this applicatio'n are true to the best of his knowlddge and belief; and that tile ork will be performed in 'the manner set forth in the application filed therewith. v~om to before me this ............ ~qo . .day of. 19 ..~ ~ otary Public, ' · ' ~ County ~ ~r- (Signature of applicant)