The URL can be used to link to this page

Home My WebLink About15174-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy o ~?~ Dar Au. gust 1.2. THIS CERTIFIES that the building Ac ce s.s o.r~ Bu~ld~n LocataonofProperty 2.00. H..orton Ro. ad Southold, N.Y. ~l~u$~ '1~o. ' ........ Street Hamlet County Tax Map No. 1000 Section ............ Block ............... Lot ................. Subdivision ............................. Fried Map No ......... Lot No ...... conforms substantially to the Application for Building Permit heretofore f~lcd in this office dated .Au. gu..s.~..~,, ......... , ]9 ,~..Spursuant to which Building permit No....1.5.1,7. ~..~ ............ dated . .~.u.~ u, .s .C..~. & ................ 19 ,~,~,, was issued, and conforms to all of the requirements of the applicable provisions of the law The occupancy for which this certificate ]s issued is ......... Accessor~ Bu:cld ~.n~ Lauren Krug The ¢~rt~cat~ is ~su~d ~o ...................................................... · .. Suffoi~ County Department of HeaRh Approval ............ .N./.A. .................. N/A UNDeRWRITeRS C~RT~F~CAT~ NO .................................................. R~v. 1/81 Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDIHG P EP-JA I T (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 15174 Z Date ............................. , 19. Permission ~s hereby granted to' , at premises ,ocoted ot ......~**.~ ...... ~.....~**~.. ........................................................... ~o.n~ ~a~ Mop No ,ooo SeC~~) ° ~. pursuant to opphcotlon doted~*'~'~' Oul[dlng Inspector Block .... ..~...[ ........Lot No. · ~ ...... , 19~.~ , and approved by the 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 Thru apphcat~on must be filled in typewriter OR ~nk, and submitted m ~ to the Building Inspec- tor with the following; for new buildings or new use' I. 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 dmposal-(S-9 form or equal). 3. Approval of electrical mstallat~on from Board of F~re Underwriters. 4. Commercial buddings, Industrial buddings, Multiple Residences and similar buildings and installa- tions, a certificate of Code comphance from the Architect or Engineer responmble for the building. 5. Submit Planning Board approval of completed rote plan requirements where applicable. For exmt~ng buddings (prior to April 1957), Non-conforming uses, or buildings and "pre-exmtlng" land uses: 1. Accurate survey of p~operty showing all property lines, streets, buildings and unusual natural or topograph m featu res. 2, Sworn statement of owner or prewous owner as to use, occupancy and condition of buildings. 3, Date of any housing code or safety inspection of buddings or premises, or other pertinent informa- tmn required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5 00 2. Certificate of occupancy on pre-exmtmg dwelhng $15.0 0 3, Copy of certificate of occupancy $1 00 4.Vacant Land C.O. $5.00 / .~ .~./..(.9.~.~,. 5.Updated C.O. $15.00 Date ...~.~['~, .. NewConstructIon .. Old or Pre-exmtlng Budding .V~'.. ....... Vacant Land ............. ,ocat on of Property .... ..... Hous~ No. Street Ham/et o rtv Owner or wnersof Prope ....................................................... County Tax Map No 1000Section ..~Oq;' ...... Block ...(7/ ......... Lot ..~.°~. .......... Subd~wmon ...................... Fded Map No ....... Lot No ........... Health Dept Approval ..................... Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ............... Final Certificate ....................... Fee Submitted $..~. ).c~.c[~.. .............. Construction on above described budding and ~er/llit'~ets 911 appHc~e codes and regulations Applicant ~.~.~ ................... Rev 10-10-78 FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & FLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIOn;AL COMMENTS: 7 7GS-~802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [~~TION []FRAMING [(-.]"FINAL REMARKS DATE Dmapproved a/c FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL e..OUTHOLD, N.Y, 11971 TEL.: 765-180:2 ,19~[' , 19~. Permit No/.h-./ '~t :~ (Budding Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS ~LDG. DEPT. TOWN OF SOUTHOLD Received ........... ,19.. , a. This apphcabon must be completely filled in by Wpewriter or in ink and submitted to the Bulldmg Inspector, w~tb sets of plans, accurate plot plan to scale. Fee according to schedule b Plot plan showing locatmn of lot and of buildings on premises, relationship to adjmmng premises or pubhc stre, or areas, and giving a detmled descnphon of layout of property must be drown on the d~agmm whmh ~s part of this ap!: catnon. c. The work covered by this apphcat~on may not be commenced before issuance of Buildmg Permit d Upon approval of th~s apphcat,on, the Bmldlng Inspector will issued a Building Permit to the apphcant Such peru shall be kept on the premises available for mspectmn throughout the work e. No budding shall be occupied or used m whole or m part for any purpose whatever until a Certificate of Occupan shall have been granted by the Bmldmg Inspector APPLICATION IS HEREBY MADE to the Bu,ldmg Department for the msuance of a Bmld]ng Permit pursuant to t Bmldmg Zone Ord,nance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances Regulahons, for the eonstructton of buildings, add~t~ous or alteratmns, or for removal or demohtaon, as herem descnb, The applicant agrees to comply w~th all apphcable laws, ordinances, budding code, housmg code, and regulabons, and admit authorized mspectors on premises and m budding for necessary inspec~ (Signa'tlSre of applicant, or name, if a co[~r~5~at]on) ................ ?.' ............... ct ...... (mazllng ~tddress *of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, gen~ra] contractor, electr~mn, plumber or build~ Name of owner of premises L ~ CL P..~.--~ . . n the tax roll or latest deed) If applicant is a corporanon, signature of duly authorized officer 2 (Name and title of corporate officer) Builder's L~cense No ..... Plumber's L~cense No Electnman's License No ...... Other Trade's Lmense No Location of land on which proposed work will be done House Number Street County Tax Map No 1000 Section J ~c.~ Subdivision (Name) Block . 0 I Filed Map No · Lot ·. Lot State ex~stlng use and occupancy of premises and intended use and occupancy of proposed construction a. Ex~stlng use and occupancy ~ ~c,~ ~_. ~ ..... b Intended use and occupancy ~ · 3. Nature of work (check which applicable) New Building ...... Addition ........ Alterataon Repair Removal ...... Demohtlon ......... Other Work .~.~C. '~.'(~ii i ~ .~ ,,- ~ (Description) 4 Estnnated Cost . cl ..d-2~.. :.'~.. ~ ................ Fee .~..~.: ......................... (to be prod on filing this apphcatlon) 5. If dwelling, number of dwelling units ............ Number of dwelhng umts on each floor ............ If garage, number of ca~ .......................................................... 6. If business, commercial or m~xed occupancy, specify nature and extent of each type of use ............... 7. Dimensions of existing structures, if any. Front ........ Rear ............. Depth ............ Height .......... Number of Stones ............................................... Dwaenmons of same structure with alterations or additions Front ............ Rear ............. Depth ............... Height ................. Number of Stones .................... 8. Dmiensmns of entire new constructmn' Front .......... Rear ............ Depth .......... Height ....... Number of Stones ...... 't ..................... ~ ............ 9. S~ze of lot Front . . .~,5~.' ........... Rear...~.~. .............. Depth . ,*o.O ............. 10. Date of Purchase ............... Name of Former Owner ..................... 11. Zone or use dmtnct m wluch premmes are mtuated .............................................. 12 Does proposed construction wolate any zoning law, ordinance or regulation- . ........................ 13. Wall lot be regraded ..................... Will excess fill be removed, from premises. Yes ~ 14. Name of Owner ofpremmes ~,0~j4C*-J... ~.. ~. Address ~£:~ ~/D. o2:C,e-~/.~/,). Phone No..2.~.,{ -2s7(~3.. Name of Archxtect ............. r,/ Address ................ Phone No ........... Name of Contractor .................... Address ............. Phone No ....... 15. Is this property located withznt00 feet of a tidal wetland? * Yes ..... No '.~..~ · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and d~stmctly all buildings, whether existing or proposed, and. indacate all set-back dimensions fr, property hnes. Give street and block number or descnptmn according to deed, and show street names and md~cate whetl interior or corner lot STATE OF NEW YORK, S S COUNTY OF ....... (Name of ~nd~vldual mgmng contract) above nmned APPROVED AS NOTED IOTi~ BUI~tNG DEPA~TM~ AT ~5.1802 9 AM ~0 4 ~ ~ THE r-OLt OWING FOUNDA*[ON ~ REQUIRED COR ~URED ~ON~ETE ~ ROUG~ ~RAMING & ~UMBING ~ FtNA[. CoNSTRUCTiON MUST g~ COM~ ~[ FOR C O ALL { :ONSTRUCTtON THE REQUIP~MENTS STA~ CONS~UC~ON & ENERGY CODES ~OT ~t~ OR ~NS~ON ~RORS, · being duly sworn, deposes and says that he is the applic* He is the .... (Contractor, agent, corporate officer, etc.) of smd owner or owners, and is duly authorized to perform or have performed the said work and to make and file t apphcation, that all statements contained m thru application are true to the best of Ins knowledge and behef, and that ! work wdl be performed in the manner set forth in the apphcatmn filed therewith Sworn to before me thts ....... ~/ . , ...day of .... ~ ......... 19f~