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Home My WebLink About15178-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall 5outhold, N.Y. Certificate Of Occupancy House No. Street Hamlet County Tax Map No. 1000 Section . 1.4.6. ...... Block ... O3 .......... Lot ..... .0.2. ......... Subdtvtsion .............................. Filed Map No ......... Lot No .............. conforms substantially to the Applicatton for Building Permit heretofore filed in this office dated A.u.~u..s .t..5. ~ ........... ,19.8..6pursuant to which Building Permit No ..... ].5. ! .7.8.Z ........... dated .au.~u..s .t. 6 ~ .......... t98.6. ., was ~ssued, and conforms to all of the requirements of the applicable provisions of the law The occupancy for which this certificate is issued is ......... The certificate ~s issued to ...F?.a. nk..& W.a. 1.te.r...C.z.e.n. sk~ ............................... of the aforesaid budding. Suffolk County Department of Health Approval ...................................... UNDERWRITERS CERTIFICATE NO ....................... ~/3. ...................... Rev 1/81 FOEI~ NO. II TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. N°. County Tax Map No ,000 Secn/~o.~....).4~..~. . Block. .... ..C)......~. ....... Lot No..C~....2'..... ....... pursuant to application doted '~ .... , 19 ..{~,, and approved by the Budding Inspector 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 This apphcation must be filled in typewriter OR mk, and submitted m~ to the Building Inspec- tor with the following; for new buildings or new use: 1. Final surv0V 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 budding. 5. Submit Planning Board approval of completed site plan requirements where applicable. For existing buildings (prior to Aprd 1957), Non-conformmg 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 condmon of buildings. 3. Date of any housmg code or safety inspection of buddings or premises, or other pertinent reforma- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-ex,sting dwelhng $15.0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.C. $5.00 v 5. Updated C.C. $15.00 Date .......................... NewtOns ~'uc t~]~on ...... Old or Pre-existing Budding ............ Vacant Lend ............. ......... · ................................ House No. Street Hamlet Owner or Owners of Property ....................................................... County Tax Map No. lO00 Sect,on.,/. ,Z~-., ,q~, ...... Block...~. .......... LOt.....~.. ......... Subdlwslon ................................ Fded Map No ......... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ....................... Labor Dept. Approval ..................... · · · Underwriters Approval ........................ Planmng Board Approval ............ Request for Temporary Certificate ................... Fmal Certificate ....................... Fee Submitted $ ............................ Constructmn on above described buddmg and:~j;mt meets all apphcableA.odes and regula, tions. Applicant ............. 7 ..................... fiELD I~ .... FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) 3. INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 0 2 AS NOTED b*~UILDING DEPARTMENT AT 1802 ~ ~ TO 4 ~ ~R THE *tWO ~ECIUIRED C~ tNSTRUCTION MUST SHALt MEET REQUIF'~'tENT$ OF THE N.Y ENERGY NOT HESPONSIBLE E~RORS t FL0, ork ~o~,s I" I ..-} I ~1~/8co 765-1802 BUILDING DEPT. INSPECTION [ '] FOUNDATION IST [ ] ROUGH PLBG. [ ] F~H~DATION 2ND [ ] INSULATION [~-J~RAMING [ ] FINAL REMARKS: ~ Dmapproved a/c ..... ,o,=.o., ,.v. vowN o. SCUT.OLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y 11971 TEL.: 765-180:3 ,19a'6 APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Rece~.ved ........... ,19.. a Tins appllcat~on must be completely filled m by typewriter or in mk and submitted to the Budding Inspector, with sets 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 pubhc sire. or areas, and giving a detmled description of layout of property must be drawn on the diagram which is part of this apr cation. c The work covered by flus application may not be commenced before issuance of Buildmg Permit d. Upon approval of this application, the Building Inspector will issued a Budding Permit to the apphcant. Such pern shall be kept on the premises available for inspection throughout the work. e. No bmldmg shall be occupied or used in 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 Bmldmg Department for the issuance of a Bmldmg Permit pursuant to t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of bmldmgs, additions or alterahon% or for removal or demolition, as herem descriN The apphcant agrees to comply with all applicable laws, ordlnances/15hfldmg code, houmng~ode, a~ulations, and admit authorized mspectors on premises and in buildmg for necessarl/·(/S~lg t~%nt, or nair/sntctl°ns . . . . ./X,~/ . n~e'~~. ,/' · .,'ff~'~./...'7...-?:. ,. 4.... (mailing addres~ of app_l:tcant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, ~ or build, ' 25/ ' i' :i:;o¢'&':. .......... Name of owner of premises (as on the tax roll or latest deed) If applicant is a corporation, mgnature 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 Location of land on winch proposed work will be done House Number Street ,,.-¢qZ ,,e Lot. County Tax Map No 1000 Secbon .. Block ...... Hamlet Subdwlston .. . Filed Map No Lot (Name) State existing use and occupancy of premises and intended use and occu/pancy of proposed construchon a txlstlnguse and occupancy ~0~ m ~ ~ /-~/O/~/~-'~ ....... ': ......... b Intended use and occupancy ...... ':/ ,-=~?-JAr~ . ~ 3. Nature of work (cheek which applicable)' New Building ..... Addition .......... Alteration ...... Repmr ...... Removal ............ Demohtlon ............ Other Work ......... (Descrlptlon 4. Estimated Cost -'/'r/~ O o (to be paid on filing this application) 5. If dwelhng, number of dwelling units ..... Number of dwelling units on each floor .......... If garage, number of cars .................................................. 6. If business, commercial or m~xed occupancy, specffy./~/a~._~r~ and extent of ea~ I2v~e of use ....... ~., ~... 7. D~menslons of existing structures, if any Front ~"TwO .... Rear . .~r..~ ........ Depth..C~.~.... Height ......... Number of Stones .. ~. ........................ ..~ .~. !¢, ~eg~hnslons~!.~estructurewlth~}teeg~onsoraddltions Front· N'umljoedkof/S~oi~;sRear/~(-j 8. Dimensions of entire new construction Front ........... Rear .~.1~t ...... Depth ./~ ..... Height ......... Number of Stones ............ / .................. ~ .~./ ..... 9. Sizeoflot Front .., .7._~. ( ......... Rear .... ......... ...... 10. DateofPurchase ~J(~ 'F..... [ .<'/.').~[ ....... Name of Former Owner ...{~.Icg:...g.4. ......... I 1. Zone or use district in which premises are mtuated .......... .. ......f~/; ~ ................. 1 2. Does proposed constructtqn violate any zoning law, ordinance or regulation' . ...................... 13 Will lot be regraded .~. O. ..... _- -.~r ...... Will excess fill be.,~emov~l from premlses:.,,r-<~ 14. Name of Owner of premises/,~)~L~'.~ C~e~. ?(/Address /.O~. ,J/'/~/t/de-tq~. Phone No.<~. 7.D. 7.~..~.~. A Name of Architect . ~ ..... ~ .... Address .~. ....... ~ .. Phone No ........... Name of Contractor,~/~q~J.(.-(~7.~. L,)~.ff. QQ... Address ~..td//J~ .../'f/5(~... !.. Phonemi~...N ........... 15. Is this property located w~thinl00 feet of a tidal wetland? * Yes ..... N~_~... · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buddings, whether existing or proposed, and, indicate all set-back dimensions fr, property hnes. Give street and block number or descnptlon according to deed, and show street names and indicate whetl interior or comer lot STATE OF NEW YORK, S S COUNTY OF ......... (Name of ~ndlwdual signing contract) above named. · being duly sworn, deposes and says that he is the applic~ He ~s the ............... (Contractor, agent, corporate officer, etc ) of smd owner or owners, and ~s duly author]zed to perform or have performed the said work and to make and file apphcation, that all statements contained m this apphcatlon are true to the best of his knowledge and belief, and that work will be performed in the manner set forth m the application filed therewith. Sworn to before me this ........... .~.... day of.. ~ .... ,19. Notary Pubhc, .~-~-~-/ .T- ~. ~. ~J..0.~..0#111/!~ ~l~li~.K~ ~l[l~l~ l~dt ..... Coun~ . . .~... ~ *1~ 4/07~?a,~.~'1 (Signature of applica