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Home My WebLink About15338-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Z15474 D.e .c.embe r 9 19 .86 Date ............................. , . . THIS CERTIFIES that the building .A.d.d.i.~. 5~9p. . Location of Property ......2.4.0..D. 9.n.n.a' .Dr. . .: Ma~ctituck Mouse No. Street Hamle~ il5 3.4. ' County Tax Map No. 1000 Section ........... Block .. 15 . .Lot .... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated .... .89~..~.: 23 ,19 .8.6. pursuant to which Building Permit No. ~..5 .3.38 g. dated.....~?Pt.._....................' 27 198..6.,wasissued, andconformstoalloftherequirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... .... .S.c.r..e.e.n.e.d...p.o.r.c.h. addition to e. xi.s.t, ing. one family .d. we.l.l.~.n.g~. The certificate is issued to .. JAMES & LILLIAN ROGERS row. er, ffftx of the aforesaid building. Suffolk County Department of Health Approval ........ .N/.b: .............................. UNDERWRITERS CERTIFICATE NO ................ .~./.b: ............................. . Rev. 1/81 Building Inspector FOIL~ 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 THE WORK AUTHORIZED) 15338 Z Permission is hereby granted to: ....T~.~...~...~...o..:~. .............................................. .../~~~....~.:.~.,....!...L ~.~:..;~ ...... ,o .......... at premises located at ..~.~..O..._!.~.~J_4~., ....... .~~ ................................. County Tax Map No. 1000 Section ........ J.l..,,~'.. ...... Block ..... ~....~.. ......... Lot No.......-~....~. ............. pursuant to application doted .~~...~.'~-. .......... , 19.~...~, and approved by the Building Inspector. Fee $.., .~**...'.....'~**. .... Building Inspector Rev. 6/30/80 FIELD INSPECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE ADDITIONAL COMMENTS: 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 aa ~ 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 Amhitect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. For existing buildings iprior 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: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1,00 4.Vacant Land c.o. $5.00 5. Updated C.O. $15,.00 NewCons tz"uc t ion ...... Old or Pre-existing Building Location of Property ...c~.z./.O..,...~...~.~,~.~...'...~.F-. ,. .... House No. $15.00 Date l ........... ............ Vacant Land ............. Street Hamlet Owner or Owners of Property ,'~,~,'~5 ~- ~ /./~-~ ......... Block ..... ~ ....... Lot...~,~ .......... County Tax Map No 1000 Section .(/.~ .. Subdivision ~ p H~LF ~E~ Z~- ' '- .... ~ ~;'~,..-~ ~ ¢.~ . .Filed Map No. ~ .... LotNo..~ ......... A ~ ~ ~s ........ Permit No. Z~-~3.~ ~. ~. Date of Permit ~.??.'.~..Applicant .......... .[, Health Dept. Approval ........................ Labor Dept, Approval ........................ Unde~riters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ .... ~ ,~ .................... 7G5-1802 BUILDING DEPT. INSPECTION [ ] FRAMING REMARKS: [ ] FOUNDATION 1ST []ROUGH PLBG. [ ] FOUNDATION 2ND []INSULATION []FINAL DATE INSPECTOR TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1803 Appr~)ved~..~'.'?.., 19~..{°. Permit No./~.~..~.?..~. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19.. Date . ~. · ·...'~.~. ...... , 19 .~.C. INSTRUCTIONS a. Tins 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 penni! shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole ct in part for any purpose whatever until a Certificate of Occupancyy 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 o~ Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described The applicant agrees to comply with all appl~cable laws, ordinances, j0a, ilding codj~lhous~g code, and r~gulations, and tc admit authorized inspectors on premises and in building for necessa~ n e ' s. · .............. (Signatu~of applicant, or name/if a corporation) (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-. O/~. A $...X~.. t.~.'q ........................................ (as 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 .... ,X-..~-..;% ................ Plumber's License No ......................... Electrician's License No ....................... Otlier Trade's License No ...................... Location of land on which proposed work will be done] ................................................. ttouse Number Street Hamlet County Tax Mai) No. 1000 Section ..../.?.~. ........... Block ..... ./..6~. ......... Lot....,~..~(. ............ Subdivision ,Zg/i~...~../.~.o.~Z .~e'Z...~4;A~. ~.6'.~. '..~.5' ...... Filed Map No..4(.."{'.2~. G ........ Lot...~..~ ......... (Name) ::"' , State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . ././9. ..... ,/5~/~ ~e ,(,~; ............... ,t v Dco LL,,oc oo'}Ty ._q I266 o 0 . ........... b. Intended use and occupancy ............... z ................................. Nature of work (check which applicable): New Building ...... Addition Repair .............. Removal . ~. ,.~ ............ Demolition ........ Estimated Cost.. (to 9. 10. ......... Alteration ....... .... Other Work ~g.g.'g.. (Description) e paid on filing this application) If dwelling number of' dwelling units Number of dwellin uhits on each floor If garage nnmber of cars If business, commercial or mtxed occupancy, specify natu, ret and extent of each type of use ................... Dimensions of existing structures, if any' Front . ~ q Rear ....g..~.. r. ..... Depth ,~.? ' Height ............... Number Of Stories ........... /. .............. ~ ............................. Di i of with alt ' ations o additions F ~ Rear mens ons same structure er r : rent .......... i ....................... Depth ...................... Height ...................... Number bf Stories ................... Dimensions of entire new construction: Front .~ .o..' Rear ~..o ' Depth Height ~ '. Number of Stories ./ Size of' lot: Front /./.o. ' Rear //q t '. Depth /2,A ~ Date of Purchase ............................. Name of Former Owner l ........................... 11 Zone or use district in which premises are situated ' 12. Does proposed construction violate any zoning law, ordinance or regulation: i · 13. WilIlot be regraded .......................... ' ' ' .. Wdl excess fill be remo?ed from premises: Yes 14. Name of Owner of premises .4-'~,e.s. ~./~.~-.~G.S.... Address .~Y.?.~ff~.~. &. ~fl..t~.~.e.t'Phon~ No.~.~ .g:-~.~..~.7. .... Name of Architect ........................... Address ......... [ ..... Phone No ....... Name of Contractor ~rJ~.~] .~..~.~.s~9.~5..,~.~. .... Address7?~. ~.o.~ fro/../~.~..7~ ~ f~'~ ph~,,,~ 15. Is this property located within 300 feet of a tidal wetland? *Yes 22:7~"'~;"'.~ ........... · If yes, Southold Town Trustees Permit raaybe required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate ail set-back dimensions fro, property lines. Give street and block number or description according to deed, and shrew street names and indicate wheth~ interior or corner lot. 17-*-- STATE OF NEW YORK, S.S COUNTY OF ................. · . · ~ ..... .~. ..... ' ............................. being duly sworn, deposes and says that (Nm~e of individual signing contraqt) above named, he is the applican He is the ..... ~ .......................................... i ............................ (Contractor, agent, corporate officer etc.) of said owner or owners, and is duly authorized to perform or have performed theisaid work and to make and file thi application; that all statements contained in this ,application are true to the best of his knowledge and belief; and that th work will be performed in the manner set forth in the application filed therewith. , Sworn to before me this , Notary Public, .._ ........... ~~ ...... County 'z~"~l./~/] ://~'//: ] / / / , ( / , , / .. / .... , "~~~F -,/ .[ / (Signatu~o f appl,cant: I0 J USE I$ UNLAWFUL ~!~THOUT CERTIF~ u~, OCCUPANcy lC4TE II Post ~' ~ 18X24 ~MJM;