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Home My WebLink About15512-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No .Z.1.5.1.1..2 ......... Date November 19 19 86 THIS CERTIFIES that the bmldmg ...A. qc..e.s.s, qry b. ui..1.d?-.n~ ................. Location of Property .... 6.10.5..W. I .C .K.H..A~...A.V.E.: ...........M~..T T. I..T .U.C.K. ............. House No. Street Hamlet County Tax Map No 1000 Sechon ... 1..0.7 ...... Block .. 4 Lot ..... .2 ........... Subdavision ....................... Filed Map No ......... Lot No .............. conforms substanttally to the Apphcation for Building Permit heretofore filed m ttns office dated · Ra~r, J-.8 ....... ,19 8.fi pursuant to which Bulldmg Permit No.. 1..5.5.1.2. Z. ............. dated .N.°.v.'. 19 ............ 19 8.6, was ~ssued, and conforms to ail of the reqmrements of the apphcable prov,s~ons of the law The occupancy for which this certfficate is tssued ~s .... ·. kace~o~y l~.U%%qtiBcJ, .................................. The certtflcate ts tssued to ...... J.a.m..e.s E: .B.r.q.ck.b.a.n.k ............................. (owner, of the aforesaid building. Suffolk County Department of Health Approval ..... N/.A ........................... UNDERWRITERS CERTIFICATE NO ................ N. / .A .............................. Building Inspector Rev 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) N~ 15512, Z Perm,ssion is hereby gr~nted to' .... ~.:~L,~.:....~...~.~...L.... ...~(/.~.~....~.~.....d~, ......... · .~.~~....~.***.~.*..-.~.!. ~-...~:--~. ~ ,, -~..= ....................... : .......... .~.....~..._....~, ............. ~....:.]. ..... ~ ..~-,.. ..... at premises located ot ...~...~.~..~ .............. ~.~....~ .......... ~V.~~ ....... County Tax Map No. 1000 Section ..... [...O..-J. ....... Block ....... ..~...~. ...... Lot No......~.?. ..... :... , 19..~..~., ond approved by the Budding Inspector. , Fee $...,~.. ~...: ............. Building Inspector Rev 6/30/80 FORM NO 6 TOWN OF SOUTHOLD Budding Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A Thts apphcat~on must be filled m typewriter OR ink, and submitted in duphcate to the Building Inspec- tor with the following; for new braidings or new use 1. Final survey of property w~th accurate location of all buddings, property hoes, streets, and unusual natural or topographic features. 2, Final approval of Health Dept, of water supply and sewerage d[sposal-{S-9 form or equal). 3. Approval of electrical installation from Board of F~re Underwriters. 4 Commercial braidings, Industrtal buddings, Muluple Residences and slmdar braidings and installa- tmns, a certificate of Code compliance from the Architect or Engineer responsible for the budding 5 Submit Planmng Board approval of completed site plan requirements where applicable. For ex~stm§ buddings (p.or to Aprd 1957), Non-conforming uses, or buddings and "pre-existing" land uses' 1. Accurate survey of peoperty showing all property hoes, streets, buddings and unusual natural or topographic features 2 Sworn statement of owner or prewous owner as to use, occupancy and condition of buddings 3 Cate of any housing code or safety inspection of buddings or premises, or other pertinent reforma- tion required to prepare a certlhcate Fees 1. CertLflcate of occupancy $5 00 / 2 Certihcate of occupancy on pre-ex~stmg dwelhng/ land 3 Copy of certificate of occupancy $1.00 use--?pe-Exlstzng C O. $15.00 Vacant land C.O. $ 5.00 New Building ..... Old or Pre ex~stmg Building Location of Property ~./.q.¢7 . .~../cz~hc~z2,/ Hou~ No Owner or Owners of Prope~ . ..~. ~-- County Tax Map No 1000 Section Date ................... Vacant Land ...... street Ham/e; ?. . ................ · Block . ~ . Lot ~ ....... Subdivision . . Fded Map No .. Lot No Permit No .......... Date of Permit Health Dept Approval ........ Labor Dept Approval Underwriters Approval ........ Planning Board Approval Request for Temporary Certificate · .Final Certificate Fee Submitted $ ...... Construction on above described building and p6°r~mt meets all apphc.~.at~des and reJ~la.t40'~ OUNDATION (1st) OUNDATIO~ (2nd } OUGH FRAME & FLUMBING ZNSULATION ?ER N. Y. STATE ENERGY CODE FIliAL ADDITIONAL COMMENTS: ¸%. FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLDoN.Y 11971 TEL.: 765-1803 )~approved a/c kpproved~-}¢*4~, lfil, 19~{'. Permxt No. /.~'~") ~,~. (Budding Inspector) APPLICATION FOR BUI LDING PERM IT Application No ..... INSTRUCTIONS a. Tins apphcation must be completely filled tn by typewriter or tn ink and submitted to the Building Inspector, wt ~'ts of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of braidings on premises, relationship to adjoining premises or public sir r areas, and giving a detailed description of layout of property must be drawn on the diagram which ts part of tins atioa. c. The work covered by this alll~r~tion30ay not l~ commenced before issuance of Building Permit. d. Upon approval of this a~p~ll~.~o'~ld~t~nl~pector will issued a Braiding Penmt to the app~cant Such per ~ be kept on the prem:sek~b~s~q~ou~lout the work· ~aH have b~n gr~te~~~~~, ',~dMg Zone ~ ~ ~ . ~n~'~, Suffolk County, New York, ~d other apphcable ~ws, Ordm~ces legations, fo~ ~ [ddmons or alteratmns, or for removal or demolmon, as hereto descfib 'ge applier agr~ ~ ~M~lmab[e laws, ordmance~ddmg code, ho~g code, ~mns, and ;~ ~-~ bmldmg for necessa~ m~pect~ons ~~ ~ -~/ ~gnature of applicant, Or name, ~ a corporatmn) (Marling address of apphc~t) ;tale whether apphcant ts owner, lessee, agent, architect, engineer, general contractor, electnctan, plumber or build~ 4rune ofownerofpremtses ,..'~t722.~'~: -~. ~ ?'¢:vF~z~::~29 ~ (as on the tax roll or latest a~t~J~OV'~'~l;} ~k$ No~}- f applicant is a corporation, signature of duly authorized officer ,.~,TE: M.//?/fb B,P # /~'~-/l~ i .q (Name and htle of corporate officer) Builder's License No .... Plumber's License No. . . Elecmctan'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 Sectmn ./'.O ~ ..... Block NOTIFY i~9tLD]N6 OFPAffTMENT AT 76~-1802 9 ~M TO 4t $WI t:OR THli FOLLOWING INSPECTIONS, FCIUNDA'qDN "P. NO REQUIRED FOR POURED 2ONCPE T~ ROBGr, SRAMING ~ ~.UMBING 4, rlN.'~t ct ,~Is'rR{w'I'iON MUCdT Hamlet ·.. Lot '~ Subdivision .............. Fded Map No .... Lot (Na~) State existing use and occupancy of premises and lnt?ded usfl and occupancy of proposed construction da. Existing .use and occupancy ..... ~/' ~'~/ .......... b. Intended use and occupancy .................... ,. Nature of work (check w~ch appi;cable) New Budding . Addition .......... Alteration Repazr ....... Removal ...... Demolmon .......... Other Work ... Esttmated Cost .............. If dwelling, number of dwelling units. (Description) ...... Fee ........................ (to be pald on Filing thru application) ...... Number of dwelhng units on each floor ........... If garage, number of cars ................................................ If business, commercml or m~xed occupancy, specify nature and extent of each_type of use ......... :, ..... Dimen_~lOnsofex~stingstructures, ifany. Front .~d~. . . Rear ...a:~ ..... Depth ~.t~' ...... HeigWi ......... Number of Stones ...... ~ ........................... Dunenmons of same structure with alterations or addmons Front . '.' 'ff~ ~i ' ' Rear .......... Depth ................ Hetght ............ Num~;~o f Stones ........... Du'nansions of enttre new construction Front ........... Rearff/ ..... Depth .... Height .............. Number of Stones ..... // ................... Size of lot: Front .............. Rear. . /-.~' . . Depth ............. Date of Purchase .............. Naive of Former Owner ................ Zone or use district m which premises are situated .. ,~ .~ ............................. Does proposed construction violate any zoning laws o*rdmance or regulation ........ Will lot be regraded ............... ; ,~ .... Will excess fill be removed from premises: Yes No Name of Owner of premises ......... /~<'.... Address ........... Phone No ........... Name of Architect ............. /~. ....... Address ................ Phone No ......... Name of Contractor ....... ~ ...... Address ............... Phone No ....... PLOT DIAGRAM Locate clearly and distinctly all buddings, whether ex~stmg or proposed, and. ~ndicate all set-back dm~enmons from ~perty lines. Give street and block number or descnptton according to deed, and show street names a,n~l mdfcate whether enor or comer lot. ,TE OF NEW YORK, JNTY OF. ~. Og:/~'~/~ ?~.. S S ..... !ff.../P_~.~ 5 ~'... '~,~'0.. ..¢/¢ .r~...'4'M. .~. ' . being duly sworn, deposes and says that he m the apphcant (Name of individual mgnmg contract) ~e nmned. the .............. .............. (Contractor, agent, corporate officer, otc ) aid owner or owners, and ~s duly authorized to perform or have performed the said work and to make and file this lcation, that all statements contained ~n thru apphcatlon are true to the best of his knowledge and behef, and that the k w,ll be performed ~n the manner set forth m the apphcatton filed therewith rn to before me this ...... /. ...... day of .... ~"' UNOAJ. COOleR // (S,gnature of apphcant) mrm ,~,ptres Deo~mber 31, 19.L.~o