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Home My WebLink About15195-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ...... 1.4.~..3.8 ....... Date .. ?.u.g .u.s.~..2.6~ .................. 19~.~. THIS CERTIFIES that tl b ldi Accessory Shed le Ul ng ................................................ Locahon of Property . .~9.S.q .~,o.~.b.~. 99.k.L.a....a...~J.5. y..z.c.k..~..d.. ..... .~.aA~. ~..~.u.c.k.,..~ House I~o. Street Ham/et' 113 06 015 County Tax Map No. 1000 Section ........ Block ............... Lot ................. Subdiws~on ............................. Fried Map No ......... Lot No .............. conforms substanhatly to the Application for Building Permit heretofore Fried in this office dated .fig. gu..s .~..2. ! ~ ......... 19.8..6 pursuant to which Building Permit No.. ] 5.1.9.~ ~ ............. 86 dated .....Augu.s......................t 26, 19..,wasissued, andconformstoalloftherequirements of the apphcable provisions of the law. The occupancy for which this certificate is issued iS ......... Accessory Shed The certificate ls ]Ssued to .. Donald F. Shaw & Dorothy R. Shaw (ownerd~,~ flIRtRIl~R~ x of the aforesa:d building. N/A Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO .................. .N./.~. ........................... Buildlng Inspector Rev FOII~ NO. Is TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. N°. BUILDING PERM. IT fi'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) i519~ Z Date ~~.~....~..~ ............ , Permission is hereby granted to' ~ '"'~' ' ....--~..~.. s-~ .9. ...... at premises I~ated at .]..~..S.~ ...... ~.~ .~......~~ .............. County Tax Map No 1000 Sect,on.;.,...~-- -.. Block .................... Lot No ................ pursuant to apphcat,on dated .(/--~~ *~'.~ ...... Jg~.~., and approved by the Building Inspector. Building Inspector Rev 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Bu dding Department Town Hall Southold, N.Y. 11971 765- 1802 ,. I J J, I1J I',' APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcation must be filled in typewriter OR ink, and submitted m ~a~r.m to the Building Inspec- tor w~th the following; for new buildings or new use: I. Final survey of property with accurate location of all buildings, property hnes, 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 certihcate of Code compliance from the Architect or Engineer responsible for the building. 5. Subm ~t Planmng Board approval of completed site plan requirements where app licable. For existing buildings (prior to April 1957}, Non-conforming uses, or buildings and "pre-existing" land urns: 1. Accurate survey of p~operty showing all property lines, streets, buddings and unusual natural or topographic f~atures. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any houmng code or safety inspection of buildings or premises, or other pertinent informa- t~on required to prepare a cert~ftcate. Fees: I. Certificate of occupancy $5.00 2. Certffmate of occupancy on pro-existing dwelling 3 Copy of certifmate of occupancy $I.00 4.Vacant Land C.O. $5.00 5. Updated C.O- $15.00 $15.00 ..... ..... Date ? / -- Newt ohs truct zen ...... Old or Pre-existing 8uddmg ............ Vacant Land ............. Location of ProperW . ~ .[.~.~0. ...... ~ .............. House No. Street Hamlet Owner or Owners of Property .... ~.P, ,~A ./~/. ~',,. ,~¢4gr4.. ,~2~.¢¢..~.A.~... ¢/~, ?,~..~/¥. , ,, ........... County Tax Map No. 1000 Section .... //. ~,, ....... Block ..... .~.g, ....... Lot,. ?./..~. ......... Subdivision ................................. Filed Map No .......... Lot No .............. Permit No .......... Date of Perm.t .......... Applicant .... .~..d¥/.~//.~t/. ..~.'.~.~ · .~... ....... . Health Dept. Approval ...... /;/j.//~J' ............ Labor Dept. Approval ........................ Underwriters Approval ...... /~./,~ ............ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate .... ~ ................ Fee Submitted $ .~.~.~.O. ...................... Construction on above described building and permit meets all applicable codes and regu{atlons. Applicant ........................ Rev lO-lO.7a co 'iELD -i-.S," r FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: v , ~',.. ,, FORM NO, 1 ~ · "*" ['t'~0~P TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y 11971 TEL.. 765-1802 Examzn ~V ~ ~, ~9~ ~ Disapproved a/c (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS O'IOH.t.nOS 40 N/~AO.L' Received ........... ,19... Date ~'~ 3./ . , 19 .~'~. a. This apphcatmn must be completely filled m by typewriter or in Ink and submitted to the Buildmg Inspector, with- sets of plans, accurate plot plan to scale. Fee according to schedule b Plot plan showmg location of lot and of buddings on premises, relatlonsh~p to adjoining premises or pubhc street or areas, and giving a detmled descnphon of layout of property must be drawn on the diagram which is part of this apph cabon. c. The work covered by tins application may not be commenced before Issuance of Bmldmg Permit. d Upon approval of thxs apphcanon, the Building Inspector will issued a Budding Permit to the apphcant Such portal shall be kept on the premises available for mspecnon throughout the work. e. No buIIdmg shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupant., shall have been granted by the Building Inspector APPLICATION IS HEREBY MADE to the Budding Department for the ~ssuance of a Building Permit pursuant to th. Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of bulldmgs, addlhons or alterations, or for removal or demolition, as hereto described The applicant agrees to comply with all apphcable laws, ordinances, budding code, housing code, and regulations, and t, admit authorized mspectors on premises and in bmldmg for necesla7 inspectlons~. (/.I ~ (Signature of apphcant, or name, if a corporahon) (Marling address of apphcant) State whether apphcant ~sow~ lessee, agent, architect, en~neer, general contractor, electrician, plumber or budder mame ofownerofpremmes Dt~t'Ad/d /zr ~ .gQ.~P~Q~-k6~/. /r~.,. (as on the tax ro~yor latest deed) If applicant is a corporanon, szgnature of duly authorized officer 2 (Name and title of corporate officer) Builder's License No Plumber's License No Electncmn's Lzcense No Other Trade's License No .... Location of land on wluch proposed work will be done /o o . House Number Street County Tax Map No 1000 Section /_.. 7~/J:~ /,~ u?~OBlock Subdw~slon .... Fried Map No (Name) Hamlet ........ Lot ...... · . Lot .. State ex~st~ng use and occupancy of premises and intended use and occupancy of proposed construction a Exlstmguseandoccupancy ~/ ff--~.'~, c'l't~.7? .............. b. Intended use and occupancy .. .~' .... 3. Nature of work (check which applicable) New Budding .... Addation ....... Alteration ..... Kep~r Removal ........ Demohhon ....... Other Work ..... ~ (Description) ...................... 4 Estimated Cost .2..D. Fd. _,6,~. Fee. (to be prod on filing th~s apphcat~on) 5. If dwelling, number of dwelhng units ......... Number of dwelhng umts on each floor ............. If garage, number of cars ................................................. 6 If business, commercial or mixed occupancy, specify nature and extent of each type of use ................ 7. D~mensions of existing structures, ~f any Front ... 7 ...... Rear ....7. ....... Depth . l_~ ........ Height ~ ..... Number of Stones .. ! ............................. D~rnensions of same structure with alteratmns or additions Front ............. Rear ........... Depth ............... Hmght ........ Number of Stones ........ 8. D~menmons of entire new construction' Front ....... Rear ............. Depth ...... Height ........... Number of Stones ........................................ Size of lot Front .... /.$ ¥, ff.. l .~ .... Rear ...... 7.,f, ~ .... Depth .. ctr~ 2,~..,~ ..... Date of Purchase .... /'J4z-f~.. ;g 5.. J.q 71t . Name 9f Fg~'rrner Owner ~A/.~'..,~. Md.. $4'.~c,Z.~ tr'.... Zone or use district inpam ses-' ag situated.. .......................... Does proposed construction wolateV any3omng law, ordxnance or regulatlon - ~ ....... ~ .x ..... Will lot be regraded ..... ~ .......... Will excess fill be remo~j~d~fro~ premises'/,////'/ Yes Name of Owner of premises ~)~tttt/f//ze]/~'r~>./'~¥R.,f/~dress ffl~;~ .,~/g ~ .J, iy, do6~Phone No .7.q.~/'7. Name of Architect ..... /~//~ ............. Address ............ Phone No ....... Name of Contractor . . ,fi////.fg ............. Address ............... Phone No ........ Is this property located within 300 feet of a tidal wetland? *Yes ~. No ..... *If yes, Southold Town Trustees Permit maybe required. PLOW DIAGRAM I0 11 12. 13 14 15. Locate clearly and distinctly all bmldmgs, whether existing or proposed, and. mdmate all set-back dn'nenmons fro property hnes. Give street and block number or descnptmn accordmg to deed, and show street names and indicate wheth interior or corner lot. STATE OF NEWYORK,., ~. ~.~.~, ~ ~ - - COUNTY OF. ~zd'Tf~-4~5~<~.. · ...... ~..~PI~ ./(t../'.~' ~'~ -- .~/'lq ..'ff~ .......... being duly sworn, deposes and says that he is the apphca (Name of ~nd~wdual mgnmg contract) above named He m the ......... ~. (.4Z./I.~. ~/~ ........................................ (Contractor, agent, corporate officer, etc ) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file ti apphcatmn, that all statements contained m this apphcahon are true to the best of his knowledge and behef, and that tl work will be performed in the manner set forth m the application filed therewith. Sworn to before me this .... ~/.4~ ......... day of .~_~.~,4x~-/~ ....... 19 No. 4822563, S~tm~c ~:oumY..~ Term Expires December 31,1 (Signature of apphcm