The URL can be used to link to this page

Home My WebLink About15286-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildin§ Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No .... 7~.1.~99.~ ...... Date . .Se..p.~.e.m.b.??..22.: ............ 19 .8.6 THIS CERTIFIES that the budding .... A.c..c.e.s.s. 9 .~.7..e.x.t.e ntz on Location of Property 2.20 0.i.d..[/I.~r.b. or. R.q.a.d .... New Suffolk House No Street Hamlet County Tax Map No 1000 Section . 1.~.7. ....... Block ....0.5. ........ Lot 02 Subdiwsion ........................... Filed Map No ...... Lot No .............. conforms substantially to the Apphcatlon for Building Permlt heretofore filed in tins office dated .S.~ p.t.e.rrtb, e. V. 1.8., .... , 19..8.6pursuant to winch Braiding Permit No.. ~.5.2..8.6 Z. ........... dated . .Se D.~.e.rqb. e F..1.9. t ........ 19..8.6, was ~ssued, and conforms to all of the reqmrements of the apphcable provtstons of the law. The occupancy for winch tins certtficate is issued ts ......... ...A.c.c.e.s..s?r.y...e.x.t. ent:~on to ex:~stzng barn Thecerttficatels~ssuedto Robert & Laurie Whzte (owner, l~obX of the aforesaid building. Suffolk County Department of Health Approval ... .N/fi. ............................. ?end~ng UNDERWRITERS CERTIFICATE NO ............................................. Rev 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT Cf'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Nq ~5286 Z Permission ~s hereby granted to'/~ ..~.?.~../...~.~.. ........................ ,o ..~...~,....~.~~ :~...~....~ .............. county Tax Map No lO00 Sect,o~ .... I,,I ~... . Block ...(~,,.,~,., ..... Lot No...,,~. ? ,.~ ....... pursuant to apphcatmon dated ~.~-~'~q~,lJ"~j4'4~. J...'~l ..... , 19~. ~*., and approved by the Budding 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 A. This apphcation must be filled in typewriter OR ink, and submitted -, ~ to the Building Inspec- tot w~th the following, for new buildings or new use. 1. Final survey of property with accurate location of all buddings, property lines, streets, and unusual natural or topograph lc featu res. 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. Commermal buildings, Industrial buildings, Multiple Remdences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responmb[e for the building. 5. Submit Planning Board approval of completed site plan requirements where apphcable. B. For existing buildings (pnor to Aprd 1957), Non-conform~ng uses, or buddings and "pre-exmt~ng" land uses. 1. Accurate survey of property showing all property hnes, streets, buddings 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 buddings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Cert~hcate of occupancy $5.00 2. Cert~hcate of occupancy on pre-exist~ng dwelhng 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. Updated C.O. $15.00 $15.00 NewConstz'uctzon ...... Old or Pre-ex~sting Building ............ Vacant Land ............. Locat,on of Property..~.0 ..... ~./(2/. ~/.~.~..~...~CJ. ........ ~'~' '~/'J'~ J' ~" H .... House No. am/et Street Owner or Owners of Property .~0 t~)P~/7~...~. }~.~).~-. { ?~......~...~..i..~. .................... County Tax Map No 1000 Sect,on...[. lq ....... Block ...... b. ....... Lot.. · .(~. · .......... Subd~ws~on ............................ Filed Map No ......... Lot No ........... Permit NoJS,~.~ ~' .. Date of Perm,t . .C(.I~ ~./.~.~ .Apphcant .................................. Health Dept. Approval ................... Labor Dept. Approval ........................ Underwriters Approval ................... Planning Board Approval ...................... Request for Temporary Certificate ................... Final Cert~hcate ....................... Fee Submitted $ ........................ Construction on above described bu,ldlng and pF~rmlt meets..~a!l a~ph~_ble codes and regulations Rev 10 10-78 ~ .~c. FIELD INSPECTION DATE I COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING 3. INSULATION FERN. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.. 765-1803 Approved~l~,-~--~J .-'~ Icl, 19 g~' Permit No J ~ ~b ~ D~sapproved a/c ............ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received ........... ,19.. a. This application must be completely filled m by typewriter or in ink 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 buddings on premises, relationship to adjmnmg premises or pubhc sire- or areas, and giving a detaded descnphon of layout of property must be drawn on the diagram which is part of flus app cation. c. The work covered by this application may not be commenced before issuance of Budding 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 avadable for mspechon throughout the work. e. No budding 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 Building Inspector APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Budding Permit pursuant to t Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buddings, additions or alterations, or for removal or demolition, as herem descnbc The applicant agrees to comply with all apphcable laws, ordinances, budding code, housing code, and regulations, and admit authorized inspectors on premises and m budding for necessary mspe~ions ~-- r~ (Slgn~tffre of applicant, or name, if a corporation) ..... .................. .... (mailzng a ess o app ' ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bmlde (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authomzed officer 2 (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 which proposed work will be done House Number Street County Tax Map No 1000Sectlou // 7 Block Hamlet Subdivision ...... Filed Map No Lot (Name) State existing use and occupancy of premlses and intended use and occupancy of proposed construction b Intended use and occupancy .. 3. Nature of work (check which apphcable) New Budding .. Repair ..... Removal ....... Demohtaon 4 Estimated Cost . . ~f ~.~.. 5. If dwelling, number of dwelling units. Addition ~--'~,.. Alteration ....... Other Work ........... (Descnphon) Fee .................... (to be paid on fihng this apphcahon) .... Number of dwelling units 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 Dnnenmons of existing structures, if any Front .... Rear .... Depth. Height ........ Number of Stones Dunenmons of same structure w~th alterauons or addmons Front ........ Rear .......... Depth ........... Height .......... Number of Stones ............... 8 Dunenmons of entire new construction Front .......... Rear .......... Depth ....... Height ....... Number of Stones ................................ 9. Size of lot Front .... Rear ............. Depth .............. 10. Date of Purchase .............. Name of Former Owner .......... I 1 Zone or use district in which premises are mtuated .. 12 Does proposed construction vmlate any zoning law, ordinance or regulation ....................... 13 Will lot be regraded ......... Wdl excess fill be removed 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 withlnl00 feet of a tidal wetland? * Yes ..... No :~'.~: · If yes, Southold To~m Trustees Permzt may be required. PLOT DIAGRAM Locate clearly and d~stmctly all buddings, whether ex~stmg or proposed, andAndtcate all set-back dnnenmons from property hnes Give street and block number or descnpnon accordmg to deed, and show street names and red,cate whether ~ntenor or comer lot. STATE OF NEW YORK, S S COUNTY OF. ............................ bemg duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named He m the ............... (Contractor, agent, corporate officer, etc ) of said owner or owners, and m duly authorized to perform or have performed the smd work and to make and file this apphcation; that all statements contained m this application are true to the best of h~s knowledge and belief, and that the work will be performed m the manner set forth m the apphcatmn filed therewith Sworn to before me thru NotaryPubhc, ...~¢~%~.. ~:...~..g-..~..~... County (Signature of applicant)