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Home My WebLink About15346-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No Z15477 Date December 9 19 8..6 THIS CERTIFIES that the building Addition · Location of Property ...3205 .M. innei~aha .Bi. yd.: ..... Southold House No. Street Hamle~ County Tax Map No. 1000 Section .0. 8..7 ........ Block . .Q $ ........... Lot..~ ~ ............. Subd,v,s,on .~..V..o.f. .......... Filed Map No..9. .1.7...Lot No....3.6. ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... .S.~p.L.:..2.7 .... .. ,19.8.6. pursuant to which Building Permit No. ...15.34.6.7,. . . ........ . dated Sept. 27 19 86 ............................... , was issued, and conforms to aU of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued i~ ......... p.eck a.d,d.i.t, io.n. to an .exist.in~ one family dwelling. WILLI,A~I. & P.A.T. RtCIA HUM.B,U. RG The certificate is issued to .................................................... of the aforesaid building. Suffolk County Department of Health Approval ..... .N./.A. ................................. UNDERWRITERS CERTIFICATE NO ............. .N./.A. . ................................ . ; ~lding Inspector Rev. Z~tt~ NO. ~ TOV/N OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PE P~,~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 15346 Z Permission is hereby granted to: ... ...~.~.~....~.~.~ ............................................... ........... at premises located at ...~...'~....o..~........~.~.......~...~....-.~..-q~..,...~/~f~... County Tax Map No. 1000 Section ....... ..~....~...~ ....... Block ..... .~..~ ....... Lot No.....~..~. ............ pursuant to application dated ......~..~..~gr~(~,.,.~.,~ .......... , 19..~.~, and opprov~ by t~e Building Inspector. 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 ~ 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 natura~ 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. Fees: 1. Certificate of occupancv $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 $15.00 Date .... /.~./~.,d~./('~.~: ...... NewC°ns%ruction. ~_. .., Old or Pre-existing Building,_ ............ ,Vacan~,'L-a~d .~ .......... / cat,on of Property ............. ./~,~./Z~'/~/~..~... .... · ~Street Owner or Owners of Prooertv .. County Tax Map No. 10'0~'~:c;,:n ..' '~'r,.,~....':: Bloc: .... ~. ...... ':Y~:~.. '" '~".~,..'... t Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ..................... Fee Submitted $ ~J ~'~ Construction on above described buildirf~-~mlt-Yneets~all applicable codes and regulations. Aool ca~... ..... ~'~'~ .... ............................... LD INS~ECTION COMMEN TS IDATION ( 2nd ~ ;H FRAME & PLUMBING 3LATION PER N. sTATE ENERGY CODE FINAL ADDITIONAL 'COMMENTS: 0~.. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 I{3WF,~ OF SOUT~O/. D Approved Disapproved a/c ..................................... ................................ .... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... Date .................. , 19. INSTRUCTIONS a. This application must be completely tilled 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. Pl0t 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 M~aDE 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 ali applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildin~.~_~__~/~~-' '-' :' ' ' ' ' ' ' ' ' ' · ' · · · ' ': · '~' "~-~--ZS'~ph'cant, or name, if a corporation)' (mailing address of applicaftt) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............. ..................................................................... Name of owner of premises....~../. ]~.~./.../~.. d:..~...,.~.~.., .~..~... ~....~.~-~,~..~.,.../~...~..~.~..~.,.. (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 Plumber's License No. Electrician's License No ....... ~ .............. Other Trade's License No. ~- 1. Location of land on which proposed work will be done .................................................. House Number ........................ ~ir~;i ' ' ~t.. ;~n'l&i ................. County Tax Map No. 1000 S~ection ..... g'7 ......... Block .... ~ ........... Lot..~.. ~::;~ ,6 .~.~.. Subdivision..~..~...~... ]../~.(.N~.a?m/.f).~.~...~..~t~. Filed Map No.. '~'~'~)'7''' Lot ......... 2. ~tate existing use and ~ccupancy ~f premises and intended use and ~ccupancy ~f pr~p~sed c~nstructi~n: a. Existing use and occupancy .~...~..~.~/~;*ee , ............... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ...... :... Repair .............. Removal .............. Demolition .............. Other Work. ,~'-I~ ~ ..... ; (Description) 4. Estimated Cost ........................... Fee ................................. ..... , J/~ (to be paid on filing this application) 5. If dwelling, number of dwelling~ units, ...... f~.~ Number of dwelling units on each floor,.. ~,/~ If garage, number of cars .... i.. ~./~ ........................................... j ............. 6. If business, commercial or mixdd od'cupancy, specify nature and extent of each type of use .... .~/~ ............. 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth .'..~...~O..~ ....... Height ............... Number of Stories ........................................................ Dimensions of same structure With alterations or additions: Front ................. Rear .................. Depth .................... i... Height .............. : ....... Number of Stories ...................... 8. Dimensions of entire new const'ructlon: Front ............... Rear ............... Depth ............... Height ............... Number of Stones .................... v .................................. 9. Sizeoflot: Front ..... ~'//.! ............ Rear ...... ,~/~,~.~ ........ Depth ../,~../.:~.O ............ 10. Date of Purchase .... ."P'.//~.~.~. ............ IXJame of~Fonner Owner .../Z~-~.7'~.. ~'¢4~,~ .,~. ..... 1 1. Zone or use district in which p~e{n{ses are situated... ~'~"t'.t~'~./~r~, ...... ; ~, ......................... 12..Does proposed construction viqla~e any zoning law, ordinance or .regulation: .... ~..' ...................... 13. Will lot be re~raded ..... ~. ~ ................ Will excess fill be removed from premises: Yes No 14. Nme of ~{~e~$~¢~..~ ~ Address ~.~O~ .~, ~o~ne No. ~.~ N~e of Architect ~ Address ~ Phone No Nme of Contractor ........ .~ .................. ~ Address ....... ~ .......... Phone No... ~ ........... 15. Is th~s property iocated~wSth~ni;O0 feet of a t~dai wetiand? ~ Yes ..... No ..... * If yes, Southold To~ Trhstees Permit may be required. ~ ~'~0~ PLOT DIAG~ ~, ~ Locate cle~ly ~d distinctly ~1 bufld~gs, whether existing or proposed', ~d. indicate ~1 set-back d~ensions from property ~nes. Give street and bloc~ number or desc~ption accord~g to deed, ~d show street nines and indicate whe~er interiororcornerlot. ~,~ h~ Blvd. ~&k 3, c~n~ l~ - ~e~ ~*le~ ~ot~e~ OWA t 0 STATE OF NEW YOgK, I COUNTY OF .... ! S.S (Name of individual signing contract)" above named. ...... being duly sworn, deposes and says that he is the applicant He is the .' , (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dilly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the mantlet set forth in the application filed therewith. Sworn to before me this .... >~' ..... /.?~L-'' '/f: .day of ...... 19 i~ ot~i~ t~..g.-* } ~'~... i?.... .... $~f.~.~l[<.