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Home My WebLink About15443-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate O[ Occupancy No ZI5317 Date March 3, 1987 THIS CERTIFIES that tile building ., .A.d..d .i.t.i q .n..t.q..a .c.c.e.s..s p.r.y. .................... 125 VILLAGE LANE ORIENT Location of Property ...................................................... House NO. Street .... /t~r~iel County Tax Map No. 1000 Section .. 2. .5 ........ Block . .2. ............ Lot . .9.: .2 ............ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated · O..c.t.....2 .~ .... ! .9 .8.6 ...... pursuant to which Building Permit No. 1 .5 .45.3.~ .............. dated .0..c .t.... 2. 4. .,.. 1. 9. .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 ......... ~..d.~..?...~.~.4, .~}.r.~. ~.. ?., ? .~?.r. k~.~' .~. ?.?.~.~..o Ry' p..~}).d. { ?.~.. ....................... The certifJcate is issuod to E. WILLIAM DAVIS AND OTHERS. (owner,~,~[ ~[r'~CtiAF~t~ of the aforesaid building. Suffolk County Department of Health Approval ...~ ./.A .................................... UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED: N/A Building Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDIHG DEPARTMEHT TOWN HALL SOUTHOLD, N. Y. BUILDING PER'AlT CFHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 15443 Z Permission is hereby granted to: .~.~ ~,~ ....~ ~..~ . . ~ ~...~.~~ ............. ~..: ...................... ~...~. ............................. ;....... ............................... at premises located at ....L;~,:~.......~..~.'~....*~..~ ..................................................... County Tax Mop No. 1000 Section ..... .C~.~. ....... Block. ..... ..C~.....',~.. ........ Lot No ..... .?s..~....~... ........ pursuant to application dated ..... Q~.-.~...~.....,..'~..~ .................. , 19..~..~..,, and approved by the Building Inspector. Building Inspector Rev. 6/30/80 76S.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING ~i~AL ,DATE ~/~//''~ INSPECTO~ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION ZST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [ ] FINAL REMARKS DATE ,NS.CTOR ~~ £~1 BUILDING DEPT. NSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION DATE ~,~,~. INSPECTOR .~~ ~OUNDATION ( I s t ) ~UNDATION (2nd) tOUGH FRAME & PLUMBING INSULATION FERN. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: ....... " ~-' D~'×., ~,' '~' "' :'' FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 TOWN APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted re"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 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 pZOperty 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 occupancy New Dwelling $25.00, Accessory,~t0.00 Business $50.00 2. Certificate of-occupancy on pre-existing dwelling $ 50-. 00 3. Copy of certificate of occupancy $ 5.00, over 5 years $]0.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date ...3./.3. L8.] ................. NewConstruction. %X.. Old or Pre-existing Building ............ Vacant Land ............. 125 VILLAGE LANE ORIENT Location of Property ................................................................... House No, ~ Street Ham/et DAVIS, WILLIAM E. & OTHERS Owner or Owners of Property ....................................... County Tax Map No. 1000 Section 2 5 Block 2o Lot...97.2. Subdivision ................................. Filed Map No ........... Lot No .............. 1544.3Z.. ! .0 / 2.4./..8.6A .CHAR DE .VO. Permit No ........ Date of Permit . . ppticant ......... .L.E.S. ....... E. .......... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $. 10.00 ~/.~..~? Construction on above described building and permit meets all applicable codes and regulations. Applicant..~...,~ ~,,. ,~/, ,W~,, ........................... Rev. 10-10-78 z/Y / FEE: ,~b NOTIFY ~UtLDING FOLLOWING ~N~P~CTIo~: 2 ROUGH F OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFtCAIE ,oF OCCUPANCY ~,lxq '/~"~ l' ¢~ " ?~ooo · FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved . .o..~....o-~-~....,~..~.., 19 .~.b. Permit No./.~.~..~. .~..~... Disapproved a/c ..................................... Received ........... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................... 19... INSTRUCTIONS · 9. This application must be completely filled in by Wpewriter 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 6r 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 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 inspe~ions. ~ ..... ................ (Signature of applicant, or name, if a corporation) ...... ....... (mailing ~tdress'~' ~licant) ..... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Contractor Name of owner of premises...D.A.V.I. $,..141~ .LJ4,X./x~..E:? .&...O.T.H.I~i .RS ......................................... (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. / .~.-~. .... ~.'fl. ~.: ....... Plumber's License No ..... r~. ................. Electrician's License No. . ~..~ i iI Other Trade's License No. l. Location of land on which proposed work will be done .......... 125..v. illage .L~tD.e.. O,r. iep..t ............ House Number Street Hamlet County Tax Map No. 1000 Section 25 Block 2 Lot.. 9.2 Subdivision ................ (i~l'a~g) ................ Filed Map No ............... Lot ............... State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ... Dne. frxmily..dwelJ, ing..& .bars% .................................. b. Intended use and occupancy . . Add. h..o, 1..t.e.r..b~-r~ .............................................. 3. Nature of work (check which applicable): New Building .......... Addition i...X~... Repair .............. Removal .... 4. Estimated Cost.. ,~..~..~ 5. If dwelling, number of dwelling units.. ·.. Alteration . XX ...... ....... Demolition ......... ~ ..... Other Work ............... , (Description) Fee (to be paid on filing this application) ............ Number of dwelling ~nits on each floor ................ If garage, number of cars .~ .................................... ~ .............................. 6. If business, commercial or mixed occupancy, specify nature and extent of each iype of use .............. 7. Dimensions of existing structures, if any: Front ............. Rear ..... I ......... Depth .......... Height ............... Number of Stories .......................... ~ ............................ Dimensions of same structure with alterations or additions: Front .......... , ....... Rear ................ Depth ...................... Height ...................... Number! of Stories .................... 8. Dimensions of entire new construction: Front ............... Rear ...... ! ......... Depth ............. Height Number of Stories 9 Size of lot Front Re ' Depth 10. Date of Purchase ............................. Name of Former Owner ............................. 11. Zone or use district in which premises are situated ............... . ........ ........................ . ...... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ............................ Will excess fill be rem{ .red from premises: Yes No 14. Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No Name of Contractor .......................... Address ................... Phone No ................ 15. Is this property located withinl.00 feet of a tidal wetland? i* Yes ..... No .~.. * If yes, Southold Towa Trustees Permit may be required. PLOT DIAGRAM Locate c early and distinctly all buildmgs, whether existing or proposed, and[ mdmate ail set-back danenmons from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. SEE SURVEY STATE OF NEW YORK, COUNTY OF ................. S.S ................................................. being duly sworn, d~poses and says that he is the applicant (Name of individual signing contract) i above named. He is the .............. C..o.n?.r.a..c ~.o.r. ................................. : .............................. (Contractor, agent, corporate officer, e!c.) of said owner or owners, and is duly 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 manner set forth in the application filed therewith. Sworn to before me this ............. 92..~.f~.~.~-~//,.3~/('~, .... dayof ....... .~.~ .... 19 .~.~.~ Notary Public ...... ~. ~. ?.....~..&..t~..~..... County NOTARY PUgLiC~ State of New Yixk .o, 470?878, Term Expires MBreh ~0, ;~Q ', (Signature of applicant) OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY ~2~q 7'oc, ~/q" * / ' e4xq ?~oPOS~b ZA'/O o'i-