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Home My WebLink About15216-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ..... ~ J .5.0.5 ? ..... Date ....0.q ~ ? .b.e?.. 3..0., ................ 19~.~. Deck addition , THIS CERTIFIES that the buridmg ............................................. Loeation of Property 10105 Soundvzew Av~enue Southold House No Stree~ Hamlet County Tax Map No. 1000 Sect]on . 0..5~ ....... Block . 08 . .Lot 05 Subdivision ............................. Fried Map 5Io ......... Lot 51o .............. conforms substantially to the Apphcat~on for Buriding Permit heretofore fried in this office dated 6 .ug.u.s.t...~.2., .......... 19.8.6. pursuant to wtuch Bmld~ng Permit No.. ~ 521.6 g dated ...~.u.~u. s..t..2.9, t ............. 19 .Sfi., was issued, and conforms to all of the requirements of the applicable provisions of the law The occupancy for wluch this certificate is issued is ......... ... p.e.c..k .a.d.a. <¥q .n .a.q .~..x<s.t..~.n~..o..n.e..r.a .m.<¥...~w.e3.! ~.n.g ..................... The certificate is issued to ........... p,.l~,¢ e. t~rlg~,l.qqlg ........................... (o wnerd~e~ ~kt~rke~{~ X X Of the aforesaid building. N/A Suffolk County Department of Health Approval ....................................... N/A UNDERWRITERS CERTIFICATE NO .............................................. Rev 1/81 lrO~K~ NO. ~ TOW'N OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N, Y. BUILDING PER~.4.1T (THIS PER?v~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Z County Tax Map No lO00 Sect,on . .C~ ~;,,~"~ Block ...... ..~....~,. ........ Lot No. ~J ~ pursuant to apphcation dated' . .~-~~ [ '~ .., 19 .~. ~., and approved by the Budding Inspector Building Inspector Rev 6/30./80 FORM NO. 6 TOWN OF SOUTHOLD Bu tiding Department Town Hall - Southold, N.Y. 11971 765- [802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A This apphcation must be hlled in typewriter OR ink, and submitted m I~=a~=~ to the Buildlng inspec- tor w~th the following, for new buddings or new use: I. Final survey of property w~th accurate Iocatmn 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 electrmal installation from Board of Fire Underv~riters. 4. Commercml buildings, Industrial buildings, Multiple Residences and s~m~lar buildings and installa- tions, a certificate of Code comphance from the Architect or Engineer responsible for the budding. 5. Submit Planning Board approval of completed site plan requirements where applicable. For ex~sting buildings (prior to April 1957}, Non-conforming uses, or buildings and "pre~ex~sting" land uses: 1. Accurate survey of p~operty showing all property lines, streets, buddings and unusual natural or topographm features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buddings. 3 Date of any housing code or safety inspection of build,rigs ar premises, or other pertinent informa- tion required to prepare a cerbfmate. Fees: 1. Certlhcate of occupancy $5 00 2. Certificate of occupancy on pre-e×istmg dwelling 3. Copy of certificate of occupancy $1.00 4.Vacan% Land C.O. $5.00 5. Updated C.O. $15.00 $15.00 Date . . .1.0./. '~ 9/.8. f~ .............. NewCons tructton ~ .... Old or Pre-exmtmg Building ............ Vacant Land ............. Location of Property1.©1(~ Soun,dylew ?vqn. ue Southol. d,. N.,.~. Hou-~, No. Street Ham/et Owner or Owners of Property Alzce Knobloch .............. County Tax Map No. 1000 Section 05/~ Block .0,8 Lot... 0.5 , Subd,z~s~on .............................. Filed Map No ........... Lot No .............. Permit No15215Z Date of Permit Applicant Kevln Knobloch Health Dept Approval ....................... Labor Dept. Approval ........................ N/A Underwriters Approval ........................ Planning Board Approval ................... ... Request for Temporary Certificate .................. Final Cert~fmate Fee Submitted $ .... 5, .OD .................. Construction on above described budding a~ Rev 10 10-78 latmns. Apphcan .......................... FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL !!DATE ADDITIONAL COMMENTS: i 765-1802 BUILDING DEPT. INSPECTION DATE FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N Y 11971 "-TEL.: 765-1803 Exam,ned%t4~r ~[.~, 19~O Approved ~,.~,,~.~td,~' ~),~, 19~0 Penmt No t ~'~0;g~' D~sapproved a/c ............... (Budding Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date g~(~ [1 ...... 19~~ a. Tlus apphcat~on must be completely filled m by typewriter or ~n ~nk and submitted to the Building Inspector, w~th sets of plans, accurate plot plan to scale. Fee according to schedule b Plot plan showing locatmn of lot and of buddings on premises, relatmnsMp to adjoining premises or pubhc stmc or areas, and giving a detmled description of layout of property must be drawn on the d~agram which ~s part of flus app cation. c The work covered by tbas apphcatzon may not be commenced before ~ssuance of Budding Permit d. Upon approval of tbas apphcat~on, the Bmldmg Inspector will ~ssued a Bmldmg Permit to the applicant Such peru shall be kept on the premises avadable for inspection throughout the work e. No buddmg shall be occupied or used m whole or in part for any purpose whatever untd a Cerhficate of Occupan, shall have been granted by the Budding Inspector APPLICATION IS HEREBY MADE to the Budding Department for the issuance of a Buildmg Permit pursuant to t Bud&ng Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances Regulabons, for the construcbon of buddings, ad&tmns or alterations, or for removal or demohtion, as hereto describe The apphcant agrees to comply w~th all apphcable laws, ordinances, building code, housing code, and regulatmns, and admit authorized inspectors on premises and in budding for necessary znspectmns ..... (S~gnatur~ of apphcant, or name, ~f a corporation) .... .,?'... . ..... /.-.e.c. . m .,.'r. . . State whether apphcant is owner, lessee, agent, arcMtect, eng~ ge,neral contractor, electnman, plumber or~ud_d~ ... ..... AuPta0V i.0 .¢.¢ NOT£ (as on the tax roll or latest deeded-6, ~, BY ~' ~' /''-' FEE __ '. I If applicant is a corporation, signature of duly authorized officer NOTIP¢ BUILDING DEPARTMENT AT (Name and title of corporate officer) Builder's, L~cense No..~~cc .'~. . . Plumber s License No x.~ . . Electriman's,L~cense No . ~ .... Other Trade s Lxcense No - - · "h - - - 1 Location of land on which proposed work will be done House Number County Tax Map No 1000 Section Street Block 765 1802 9 ~,M TO I rqvt flOR THE FOL' OWING INBPECTIONS' 2 ~OUG~ g~AMING e pLUMBING 4 F~ ..... O.*~STRUCT)ON MUST BE COfJ, D EI~ FOR C,O ALL CONSi ~dCrlON SHALL ~EET T~ BEQUIVEMFNTS O¢ THE N Y ~ CONSTRUCTION & ENERGY CCO~ I~T R~NSI~E FOR Hamlet . Lot SubdiwsIon Filed Map No Lot (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construct]on a. Existing use and occupancy ~') c k Uc-.~C~ ~?..r~x4& ........... b Intended use and occupancy . 3. Nature of {york (dheck which applicable) New Bufldmg ........ Addition ...... Alteration ...... Repmr ....... Removal ........ Demolition ......... OtherWork. P. 2'-. ..... e~.~ ~/ ck.~.~ ~,,~,~t~--~- (Description) 4. EstmaatedCost . /o~. ~.~q'.~'. ................. Fe .e~...~..~e~....~. ..... (to be prod on filing thru apphcat~on) 5. If dwelling, number of dwelhng units ......... Number of dwelling units on each floor ............. If garage, number of cars ..................................................... 6 If business, commercaal or mxxed occupancy, specify nature and extent of each type of use ............... 7. Dimenmonsofexistmgstructures, lfany Front ..... Rear ............. Depth ......... Height ........ Number of Stones ................................... Dnnenmons of same structure with alterations or additions Front ............. Rear ............ Depth ........... Height .......... Number of Stones ............... 8. Dtmenmons of entare new constructmn Front ........... Rear ............. Depth ......... Height ......... Number of Stones .......................................... 9. Size of lot Front .............. Rear ................ Depth .............. I0. Date of Purchase ................ Name of Former Owner .................... 1 1 Zone or use district in which premises are situated ................................... 12 Does proposed construction violate any zoning law, ordinance or regulation' . ......................... 13. W~ll lot be regraded .................. Will excess fill be removed from premises Yes t 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 withinl00 feet of a tidal wetland? * Yes ..... No ..... · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and &stmctly all buddings, whether exmtmg or proposed, and. indicate all set-back d~rnenmons fro property hnes. Give street and block number or descnptmn according to deed, and show street names and re&cate wheth intenor or corner lot STATE OF NEW YORK, S S COUNTY OF ......... (Name of individual mgnmg contract) above named. · being duly sworn, deposes and says that he is the apphcm He is the ......................... (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 tlr application, that all statements contamed m this application are true to the best of his knowledge and belief, and that tl work will be performed in the manner set forth m the apphcation filed therewith. Sworn to before me thru ....... f.,2-., . . .day of . ....... , Not .... ount