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Home My WebLink About15296-zFORM NO 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Date October 8, 86 THIS CERTIFIES th Deck at the building ......................................... Location of Property . ~ 4.5 ~.o.l.o..n.i.a.1...R.o.ad ................ S..o.ut.h.o..1.d. ............ House No. Street Hamlet County Tax Map No. 1000 Sechon 0.7.9 ...... Block . 0.6. ......... Lot 26 Subdivision ..................... Filed Map No ....... Lot No .............. conforms substantially to the Apphcahon for Building Permtt heretofore filed in this office dated S el~.t. 21 .8.6p .................. ,19. ursuant to wluch Bmlding Permit No. 15296Z dated ...S .ep.t ... 2.1 ............. 19 8.6, was ~ssued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for wluch ttus certfficate is issued m ..... ... pe.q~..ad.d.~..t.~o.n..%9..e.x.i.stAn, g. d.w.e..~.~i.n.% ........................... Butch, S~dney & Rhoda The certfficate is issued to .Bul:~k ~ . O'grae..s..C.r.~eg..& .M.a.rs.h.a .................... (owner, ~ ~,~X l~]~[~ilX of the aforesaid building. Suffolk County Department of Health Approval ..... ~I [/k .............................. N/A UNDERWRITERS CERTIFICATE NO ............................................ R~v 1/81 FOB,.M NO. · TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF: THE WORK AUTHORIZED) Permission is hereby granted to County Tax Map No 1000 Section . .I;~/.OJ Block ...~)...~. ..... Lot No......'.'~....~. ..... 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 A. This application must be filled in typewriter OR {nk, and submitted m ~ to the Building Inspec- tor 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 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 F~re Underwriters. 4. Commercial buddings, Industmal buildings, Multiple Remdences and similar buddings and instaila- tions, a certificate of Code comphance from the Architect or Engineer responmbJe for the building. 5 Submit Planning Board approval of completed site plan requirements where apphcable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of pZoperty showing all property lines, streets, buddings and unusual natural or topographic 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 buildings 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-existing dwelling 3. Copy of certificate of occupancy $1,00 4.Vacant Land C.O. $5.00 5. Updated C.O. $15.00 New C cms truc t ~on ...... Old or Pre-existing Budding $15.00 Date ..................... ............ Vacant Land ............. House No. , Street .~.,it~73~._.~ Hem/er Owner or Owners of Property'..~/~..~.~...~4/~/.d).~,~f.~.~.~o .~..~...~.. V/~*~,.~/~ifi u, ........... Coun~ Tax Map No. 1000 Sect, on ... ~.~.f. ..... Block .... ~ ....... Lot .Z.~/ ........... Subd~wmon ......................... Fded Map No ......... Lot No ............ Permit No/.~..2-.q.~...Z:. Date of Permit . .Apphcant C~/~.../.'~.~;..../~... < .~..... Health Dept Approval ........................ Labor Dept. Approval ........................ Underwmters Approval ...................... Planmng Board Approval ...................... Request for Temporary Certificate .................... F~nal Certificate ....................... Fee Submitted $ ..................... Construction on above described budding and per ~ meets all applicable de d regulati ns. ,. Apphcant.. ~.,:r¢-~_.~, ,~.< '~~..:~ .............. FIELD INS~ECTION COMMENTS FOUNDATION {1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE Ym FINAL ADDITIONAL COMMENTS ,T L I B EI:?.'I'~' - L " , M~GAP_J~Y G MAP OF PlTOPEITTY s. UP..VE','ZP FOP.. JOHNCLINDA BEP..TAN,,! TOWN o? .GUAID,,AN'r'~ED TO 1"HE. A.IVlEITJC. AN TITLE ~NSUI:~ANCE ,CIO. ~ V~N TUYUSON- ' -; ...... ~ - -4"-:,:~,Y-'".: , 765-1802 BUILDING DEPT. INSPECTION FOUNDATION XST []ROUGH PLBG. FOUNDATION 2ND []INSULATION FRAMING []FINAL REMARKS:~ BUILDING DEPT, ~-~/~/7~ INSPEI TIO FOUNDATION ~ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSU~TION [ ] FRAMING REMARKS: FINAL FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 D~sapproved a/c [2LDG DEPT, SOUTHOLO Recexved ........... ,19. (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .......... 19. INSTRUCTIONS a Tins apphcat~on must be completely filled m by typewriter or in ink and submitted to the Bufldmg Inspector, wit sets of plans, accurate plot plan to scale. Fee accor&ng to schedule b Plot plan showmg locatmn of lot and of buddings on premises, relationship to adjommg premises or pubhc sire or areas, and gwmg a detailed description of layout of property must be drawn on the diagram whmh Is part of this ap cation. c. The work covered by tlus apphcation may not be commenced before issuance of Budding Permit d. Upon approval of this apphcatlon, the Bmldmg Inspector will ~ssued a Bufldmg Permit to the applicant Such peri shall be kept on the premises available for inspection throughout the work. e. No budding shall be occupied or used m whole or m part for any purpose whatever until a Certfficate of Occupm shall have been granted by the Budding Inspector APPLICATION IS HEREBY MA~DE to the Bufldmg Department for the issuance of a Building Permit pursuant to Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable laws, Ordinance- Regulahons, for the construction of buddmgs, additions or alteraQons, or for removal or demohtlon, as herein descnb The applicant agrees to comply .w~th all apphcable laws, ordmances, bufldmg code, housing code, and regulations, and admit authorized inspectors on premises and m bufldmg for necessary mspec~ns. . ~,0/Sfi (Signature of applicant, or narfie, If a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bmld Name of owner of premises ~ ~1/,~/ '~../~fO c"t/.~q g~,~.¢~. .. (as on the tax roll or latest deed) If applicant IS a corporation, signature of duly authorized officer (Name and title of corporate officer) Builder's License No .~/0~... ~ Plumber's License No Electrician's License No Other Trade's License No County Tax Map No Subdivision Location of land on which proposed work will be done 3 ... /ed, House Number Street 1000 Section 7 ~ Block .. . ~ Filed Map No Hamlet · Lot. (Nan~e) State existing use and occupancy of premises and ~ntended use and occupancy of proposed construction a. Existing use and occupancy b Intended use and occupancy 3. Nature of work (check which applicable). New Budding . .. Addition .~" .. . Alteration .... Removal ........ Demoht~on .... Other Work ........... Repmr . ~$.~ . '¢4/~ .0. (Description) 4 Estunated Cost ....................... Fee ................................ (to be prod on fihng th~s application) 5 If dwelhng, number of dwelhng umts ....... Number of dwelling units on each floor ......... If garage, number of cars ...................................................... 6. If bus~ness, commercial or m~xed occupancy, specify nature and extent of each type of use ............. 7. Dtmens~ons of existing structures, if any Front . . . Rear .......... Depth... Height ...... Number of Stones .. Danenslons of same structure with alterations or addit~ons Front ........... Rear .......... Depth ......... Height .............. Number of Stones .............. 8. Dimenmons of entire new construction Front ......... Rear .......... Depth . . Height ..... Number of Stones ......................................... 9 Sxze of lot Front ..... Rear ................... Depth ........... 10. Date of Purchase ................... Name of Former Owner 1 1 Zone or use dxstnct in which premises are situated ....................................... 12 Does proposed construction violate any zoning law, ordinance or regulation . /~'.~.. ......... 13 Will lot be regraded .... ~ .... //~4'~' "~'/-~ Will excess fill be removed from premises Yes 14 Name of Owner of premises ~-,~,~,~ ~, C,y~.rm~4~a,~,~ess,...~/e /.,~ (. ~. ~.. Phone No. ?~.~ S-~. Name of Architect ..... A~r~ess ............. Phone No ......... Name ofContractor~'x~,<,.,~,~, b/L~,~./~'~7~ . AddressJZ.¢4~. J~./~Y,t~,~e. ~)Z Phone No ~. ~J'*~?,/..7 15. Is th:Ls property located w).th:Ln :LO0 feet o£ a tidal wetland? * Yes ........ · If yes, Soughold Town Trustees Perra±~may be required. PLOT DIAGRAM Locate clearly and dmtmctly all buildings, whether existing or proposed, and, indicate all set-back dimensions fro property hnes. G~ve street and block number or description according to deed, and show street names and mdmate wheth intenor or comer lot STATE OF NEW YORK, S.S COUNTY OF. a )4. '3,2 (Name of individual sl~lng contract) above named He ~s the g 0 ~ ~ ~ c~O ~ .... (Contractor, agent, corporate officer, etc ) of said owner or owners, ~d ~s duly authored to perform or have perfomed the smd work and to m~e and ~e appbcatmn, that all statements contained m th~s appbcat~on are true to the best of h~s ~owledge and behef; and that work will be perfo~ed in the m~ner set forth in the apphcatmn filed therewith. Sworn to before me th~s PA~IOIA ~ ~UR~A~ ' ' (Signature of a--l:'-Ppica ~ta~ Pubhc, State of N~ OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY APPROVED AS NOTED NOT'~ BUILDING DEPARTMENT AT 7~5-1802 9 AM TO ~ ~ ~R THE FOLLOWING INSPEC~ONS: FOUNDATION ~0 -/