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Home My WebLink About15299-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Ofhce of the Building Inspector Town Hall Southold, N Y. Certificate Of Occupancy No Z14997 Date October .1.5, ............... ........................... 19 86 THIS CERTIFIES that tile building D e c k a d d z t z o n Locatlon of Property 380 Flatt Road 0r~ent. N.Y. H~'s'e No: ...................... 'S't~'e~i ..................... /tamle~' County Tax Map :No. ]000 Sect]Eon .0.%$ ...... Block . .q~ .......... Cot .... 2..0 .......... Sub&vision ............................. Filed Map No ......... Lot No .............. conforms substantmlly to the Apphcatton for Building Permtt heretofore filed tn this office dated S. ~, p3.e.m..b9 ?.. ! .0 ~ ....... 19 8.6. pursuant to wluch Braiding Permit No. ,, ! .5.2,9.9,..Z ........... dated September 21 , 19 86, wastssued, and conforms to all of the requirements of the apphcable prowstons of the law The occupancy for which tlus certtficate ts tssued ts ......... ,, p.e.c.k., ,aAa. z' .~.<o.n...~.o..e.x..~.s.~,~ n. 5' .%?..c.a ~. ~..~y. fi.¥?,~.ZAn..~ ........................ The certificate is issued to A n n H o p k · n s (owner, I~r~t ~xO~r~n~z X of the aforesaid budding. Suffolk County Department of Health Approval ......... N.../.A .............................. UNDERWRITERS CERTIFICATE NO .................................................. Rev 1/81 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) N? 15299 Z Permission ~s hereby granted to' County Tax Map No 1000 Sect,on . O/..~... Block ...(~.'~..'~.. ...... Lot No....~q....~... Budding Inspector Fee $ '~''~' / 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 m typewriter OR ink, and submitted m ~ to the Budding Inspec- tor w~th the following; for new buildings or new use' 1. Final survey of property w~th accurate location 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 electrical installation from Board of Fire Underwriters. 4. Commercml buildings, Industrial buddings, Multiple Remdences and mmilar buddings and mstalla- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buddings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operty showing all property lines, streets, buildings and unusual natural or topograph m 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 mforma- t~on required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancv 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 NewConstruction ...... Old or Pre-existing Building $15.00 // Date.. ~... ~'.~,~.~...cP.? // ............ Vacant Land .......... Location of Property ,., ~.~". ?.,., P~/rF ~- .~? ./~. .~.~' / .~.,,~...7~'. House No. Stmet Ham/et Owner or Owners of Prope~y ............. ~ ~ ~ ~,~4~ ~. ...................... .... CounW Tax Map No 1000 Sect,on ... ~ ........ Block ...~ .......... Lot...~ ,V ......... Subd~ws~on ................................. Filed Map No ........... Lot No .............. Permit No/~.. ,2~..~. ~ Date of Permit .~/?/~..~'.C. Apphcant ~ .... .......... /¢.....-./j/....-C. Health Dept Approval ........................ Labor Dept. Approval ................... .. ... Underwriters Approval ....................... Planning Board Approval ...................... Request for Temporary Certificate .................... Final Certificate ....................... Fee Submitted $ ......................... Construction on above described budding and permit meets all apphcable codes and regulations. Applicant...~,. ~/~.. ................. Rey 10-10-78 r'/~'/,~ ,*/o, Iz o$188 F1ELD INSi~ECTION COMMENTS FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE ADDITIONAL COMMENTS: 765-180Z BUILDING DEPT. INSPECTION [ ] FRAMING REMARKS: [ ] FOUNDATION 1ST [ ]ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FINAL DATE INSPECTOR Approve~rJ'~ [~-~ ~.[ Disapproved a/c .. 'FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N Y. 11971 TEL.. 765-1803 ,19 (Budding Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BLDG OFPr TOWN OF $OUTHOLD Recexved ........... ,19. Date 5~,e~.at- ...... , / a. Tins apphcatlon must be completely filled in by typewriter or in ink and submitted to the Bulldmg Inspector, vat~ sets of plans, accurate plot plan to scale Fee according to schedule b. Plot plan showmg location of lot and of bufldmgs on premises, relationship to adjoining premises or pubhc stre or areas, and glvmg a detmled description of layout of prope_rt4~nust be drawn on the diagram which is part of flus ap cation. c. The work covered by tins application may n.~mfl~n.e~ lss~ce of Bmldlng Permit d. Upon approval of this application, the l~t~i[/~kl~h~pe, ct~s~.~ll~'~g Permit to the applicant. Such pen shall be kept on the premises available for e. No budding shall be occupied ~.~s~'~tl~ ~,vlimle~~['~]~]l[i~un~'l~ose whatever until a Certlflcat e o f Occupa! shall have been granted by the Building'~J~.~.~. APPLICATION IS HEREBY MADE t~'~l~u, ll~[~ k~0 art~fo~the issuance of a Bmlding Permit pursuant to Building Zone Ordinance of the Town of Sb.u{~ 'l~l~]~ew York, and other applicable Laws, Ordinances Regulations, for the construction of burld~&flt~t a~,a~r*atlons, or for removal or demohtion, as herem descnb The apphcant agrees to comply with all appl~c'a~[e 1~ Ol~dTnances, budding code, housing code, and regulations, and admit authorized inspectors on premises and m ~i~dmy ?or necessary inspections (S~gnature of applicant, or name, if a corporation) (MaIImg address of apphcant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electnclan, plumber or build Name of owner of premises (as °n the tax r°ll °r latest d~e~,\3 ~ B.P If applicant is a corporation, signature of duly authorized officer D ~TE' ................ NOTIFY BUILDII~IG DEPARTMENT AT (Name and title of corporate officer) 765.1802 9 ~,M TO ~t PM FOR THE FOLLOWING IN%PECTIONq FOuNOA3'ION TWO ~-QU1RED FOP Builder's hcense 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 1000 Section / ~. Block . 3 INSUL~ rIOt' THE REQLtlP5 ~FNT5 ~A~ CONsTwUCTtON Ham]et 2 Subdzviszon. ...... Filed Map No .... Lot . (Name) State exzstlng use and occupancy of premises and intended use and occupancy of proposed constructzom a Existing use and occupancy ~/--~. ~ ~, ~ ~, .., ............. : ~'* '" b. Intended use and occupancy $...~ .~ . . /.2._.~ y C.. ' · ' ' .' ' "~, 3. Nature of work (check which applicable) New Building · Addition ...... Alteration /. ...... Repmr . . ~ ~ .q~q~ . Removal ...... Demolition ......... Other Work . .~...~.. (Description) 4 Estimated Cost .~.~o.o...o..~. ............... Fee ................................. '~ (to be paid on filing this apphcation) 5. If dwelling, number of dwelling units .. / ...... 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. Dunenslons of existing structures, if any Front... Rear ........... Depth Height ........... Number of Stones . /i~.~' . ...... Dimensions of same structure with alterations or additions Front .. y C. .. Rear .. ~' .~. .......... Depth . ,Z. ~ '. .. Height ... ~. 9' . ...... Number of Stones .... /.. ',~.~-.. 8. Dimensions of entire new construction Front ..... /.~ .. Rear ............. Depth Height ...... Number ~t e. 9 Size of lot Front ........ Rear ................ Depth .............. 10. DateofPurchase ............. NameofForm_erO,wne. r ~ >~ .................. 1 1. Zone or use district in which premises are situated ,~9 L .......... 12. Does proposed constructmn vlolate any zomng law, ordinance or regulatlon' .. ~ 13 WdI lot be regraded ~. .......... WflI excess ~l be removed from premises' Yes 14 Name of Owner of premises ~ ~. . Address . .C> ~ .... Phone No .......... Name of Architect ................. Address .... Phone No Name of Contractor ,~..,~ ...... Address o--~.:_ ..dT.I ...... PhoneNo ~'~-3 ~'?~'~' PLOT DIAGRAM Locate clearly and distmctly all buddings, whether existing or proposed, and. mdicate all set-back dnnenslons fro property hnes. Give street and block nu~mber or ,de,cnption accordmg to deed, and show street names and indicate wheth 2 interior or corner lot. STATE OF NEW YORK, S S COUNTY OF ........... (Name of individual signing contract) above named. ·. being duly sworn, deposes and says that he is the apphc; He is the ............... (Contractor, agent, corporate officer, etc ) of smd owner or owners, and ~s duly authorized to perform or have performed the said work and to make and file t application; that all statements contained m this application are true to the best of his knowledge and belief; and that t work wflI be performed m the manner set forth m the application filed therewith. Sworn to before me this ....... [0. .......... dayof ~ ..... ,192g NotaryPub,,c, .~ .~.- ..~.2-- .L,/..~-w_....' County