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Home My WebLink About15298-zFOflM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N Y. Certificate Of Occupancy No Z-15672 Date .. Ap.r i.!:, .2.1,, .!987 THIS CERTIFIES that the budding ALTERATION.. .. . .... & REPAIR. .. . ..ACCESSORY. .. ...,....BUILDING... LocatmnofPmperty . 2,05. Map. le .L.a.n.e ..... M.a.t. tz.t.u.c~: .N.e~...Yo.r.k ......... House No. Street Hamlet County Tax Map No 1000 Section .I 0 7. ..... Block . 2 .Lot I 0.2 Subdlvimon .............. Filed Map No ..... Lot No .......... conforms substantially to the Apphcahon for Budding Permit heretofore filed in this office dated September 9, 1986 pursuant to wtuch Building Permit No 15298 Z dated S.e p..t e mb. e..r 2...1, ..... 1986 was issued, and conforms to all of the requirements of the applicable provm~ons of the law The occupancy for Much tins certificate is issued is ...... ALTERATION & REPAIR TO ACCESSORY BUILDING MARK & BEVERLY ROLLINS The certificate ~s issued to ........ ~&,&r, l~K:~t~g X ................ of the aforesaid braiding Suffolk County Department of Health Approval .. N /A N/A UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED: N/A Building Inspector Rev 1181 I~O~M NO. ~ TO~N OF $OUTHOL~ BUILDING D£PARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERJ*,41T (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N9 1529g Z County Tax Map No ]000 Sect,on . /,0.'~... pursuclnt to (:ppJlcotlon doted Building inspector. Fee $;, .,~, - .,~. .. Block . ~- Lot No.../...~., ' ~ Building Inspector Rev 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 ~OWN OF $OUTH0U) APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This apphcation must be filled in typewmter OR ink, and submitted i~ to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of properW with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. F~nal approval of Health Dept. of water supply and sewerage dlsposal-(S-9 form or equal). 3. Approval of electmcal ~nstallat~on from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildmgs, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the bullring. 5. Submit Planning Board approval of completed site plan requirements where appbcable. For existing buildings (prior to Aprd 1957), Non-conforming uses, or buddings and "pre-existing" land uses: 1. Accurate survey of p~operty showing all property hnes, streets, buddmgs and unusual natural or topographic features. 2 Sworn statement of owner or previous owner as to use, occupancy and condition of budd|ngso 3. Date of any houmng code or safety mspectlon of build~ngs or premises, or other pertment i~farma- tion required to prepare a certificate. C. Fees: 1. Cert{flcate of occupancy New Dwellzng $25.00, Accessory ,$10.00 Business $50.00 2. Certificate of-occupancy on pre-existing dwelling $ 50.00 3. Copy of cert[ficate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O.- $ 50.00 Date ........................ Locat,on of Property ...... .c~. ¢..~. ........ . , .~...¢.t...~/c~?....~..~ .......................... House No ~Street ~larnle* Owner or Owners of Property , .'-~,,. ¢7~,<..~... ,//~.. ~..~ .................. County Tax Map No. 1000 Section /¢P 7 Block ~- Lot., Subd~ws~on .............................. Fded Map No ........... Lot No .............. Perm,t No./¢..'~..~-.f.¢c..2~. Data of Permit..¢~.//.J~..Applicant. ~~. ./. Health Dept. Approval ..... /?. ~.~. .............. Labor Dept Approval UnderwrltersApprova, ...~/~/.~/~.,/ ............. PlannlngBoard Approval....~../~.. Request for Temporary Certificate ..................... F mai Ceruf[cate Fee Submitted $ .... ,~,~.,, ,~. ,E~. ................. Construction on above described building and perm~kmeet~al/happhcable codes and regulations. Apphcant -<~.~ .~. ~.'-~--~--~-~ .*-- Rev 10 10-78 FIELD I~SFE2~TION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION FERN. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: Approve~ ~h..] Disapproved a/c FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD. N Y, 11971 TEL,, 765-180:3 , i9t% Permit No.l a'l 3 (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ,, 19 INSTRUCTIONS a. Tlns application must be completely filled m by typ~i~r or, t ink ar/,~'tubm~tted to the Building Inspector, wit sets of plans, accurate plot plan to scale Fee according 11 b Plot plan showing lo at,on of lot and of bmkd~ on ~ , r~a~p to adjmmng premises or public st~ on the dmgmm which ~s pan of this ap or areas, and g~vmg a detmled descnphon of layo~ c. The work covered by tNs apphcatm~6t ~ ~e msu~ce of Building Permit. d Upon approval of th~s apphcano~~ ~a Bmldmg Pem~t to the applicant. Such per sh~ be kept on the premises available f~i~gn~ >>~ ~,~.. e. No building sh~l be occupmd or~e~oI~l~ hy purpose whatever untd a CeNfficate of Occupm sha~ have been granted by ~e Building Insp~ ~ ~PLICATION IS HEREBY MADE to ~e~m~ ent for the msuance of a Bmldmg Pemit pumuant to Building Zone Ordinance of the Town of Southo~ County, New York, ~d other apphcable Laws, Ordm~cet Regulatmns, for the constmctmn of buildings, add~ s or alterations, or for removal or demohtion, as hereto descnb The apphcant agrees to comply w~th a~ apphcable 1~ , ordinates, bufldmg c~e,~oumng code, ~d regulabons, ~d admit anthomzed mspectom on premises ~d m b~dmg for neces~~s ~~~ (Sl'gnStuie ;~a~pli-lam~ ~ na~e, ,f a ~or~ora~,~) ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build (as on the tax roll or latest ~eed) x/ ~ If apphcant ~s a corporahon, s~gnature of duly authorized officer ~F ~ ~BY' ~' ~ ~ ,t, ~OTJ~ ~UILD!NG OEPARTMENT AT (Name and title of corporate officer) Budder's License No .g.g.g.g.g.g.g.g.g.~¢..wt.oA-? Plumber's L~cense No Electrician's L~cense No Other Trade's License No Location of land on winch proposed work will be done . ~ House Nmnber Street County Tax Map No 1000 Sechon [ O .~ Block .. "t, 61802 9 ~,M TO a PM FOR THE FOci OWING U~i%PEC'rtoN.q ~ ~OUREU CO~,,~(iP~ ~ ROUGH ~RA~IN[. · ~dMBING 3, INSULATIOr~ 6F COM~TE FOR ALL CONSTRUCTION SH~LL THE ~EQUI~MENT5 ~ THE N,Y ~i~ CONS~UC~ON & EN~GY ~D~ NOT ~S~E ~IGN OR CC~S~IO~I E~RORS, Hamlet · Lot Subd~vlszon. Filed Map No Lot (Name) State ex~stmg use and occupancy of premmes and intended use and occupancy of proposed construction a Exmtmg use and occupancy b Intended use and occupancy 3 Nature of work (check which applicable) New Bmldlng Add~bon .... Alteration .. /.5. . Repmr . "/N .... Removal .............. Demohtton ............. Other Work ~ (Description) 4. Estimated Cost ~ ~ .~. ~.o. ?.~.~ ................ Fee ..~. ~ · ~ (to be paid on f'flmg this application) 5. If dwelhng, number of dwelling units .......... Number of dwelhng units on each floor .......... If,Rarage, number of cars ... 6 If busmlss, commercial or mixed occupancy, specify nature and extent of each type of use 7 Dlmenstonsofexlstlngstructures, lfany. Front... P'~ . .Rear .-J...O ...... Dept'h'..'~{~i~/" Height I .~ .... Number of Stones ~ ..... Dnmenslons o~f~_ame structure with alterations or add]~ons Front '' i~-.~., ii l~;ar' i ii' .~i .~.' i Depth . . ~*r. ............ Height ....... ~.c~ Number of Stones... P-- ........... 8. Dimensions of entire new construction Front ........ Rear ....... Depth ......... Height .......... Number of Stones .................................. 9. Size of lot' Front ....... Rear ............. Depth ,... z-- ..az ....... 10. Date of Purchase l.~/.O~ .. Name of Former Owner Bk~x~'..~/..'~..WLr...~. ...... 11. Zone or use district in which premises are situated ......... ['. 12. Does proposed construction v4olate any zoning law, ordinance or regulation' 13 Will lot be regraded .k~..~ .......... Will excess fill be removed from premmes' Yes 14. Name of Owner of premises ............ Address .......... Phone No ........... Name of Archxtect .... Address ......... Phone No ............ Name of Contractor ................. Address ........... Phone No. 15. Is th~s property located withintO0 feet of a tzdal wetland? * Yes ..... No .X~: ..... · if yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and d~stmctly all bufldmgs, whether ex,sting or proposed, and indicate all set-back dimensions from property hnes Give street and block number or descnptlon according to deed, and show street names and indicate whether interior or corner lot TATE OF NEW YORK, S S 'OUNTY OF ..... ........... bemg duly sworn, deposes and says that he ts the apphcant (Name of individual signing contract) bore named. is the (Contractor, agent, corporate officer, etc ) smd owner or owners, and ts duly authorized to perform or have performed the smd work and to make and file this ~phcatlon; that all statements contmned m this apphcatlon are true to the best of his knowledge and behef, and that the ork will be performed tn the manner set forth m the apphcabon flied therewith. ~/orn to before me this ....... ~. ..dayof. ~ ...... ,19.~.~ .... '~ ~ ~E ¥'OE ....... 1~ Afb' ~, ';t,,~e of N~ ~ (S~gnature o f applicant)