The URL can be used to link to this page

Home My WebLink About15568-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No .............. Date ........... 19 THIS CERTIFIES that the building d.q c. ~ ,~.d,c~ ~_ .q~ q r~ . Location of Property 5 u e .. ..................... ~l~so ........................... No. Street namlee tyT M N I0005 tie 2~ BI k 3 L 28 Coun ax ap o. ec n.. .......... oc .............. . et ....... .......,.. Subdivision .M,/. o. .A q.u. avie~, .~.ar~. .Flled Map No. 5.6?.] .LotNo. 3. conforms substantially to the Application for Building Permit heretofore ~fled in this office dated D.e.cemb.e~ ~.~.~... , 19 8.6. pursuant to which Building Permit No. 15568Z dated....D.e..c e. robe. r_... ...,.11 ,. .. . ....... 19..8.6, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which tiffs c0rtificate is issued is ......... .Dec. k.a.ddi~.io,n. ~o exist±n~ one The certificate is issued to DREW A. WALKER (owner, ~ )~X ~tYa~ t~ X X X of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE NO .................... .~/.A. .......................... ~/ (.jmffldmg Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, No Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 15568' Z Permission is hereby grront~ed~.~ .... L..~....~.:,......~,~ ........... .~.,?.~ ...... L ~..~. ............... : ....................... ...~..,...~.~.,.,.~.,~,~ ........... ~.~. ~ .~~- .~ ~* ~ ot premises I~ated at ..~ ........... ~.~....~.....~.~,~....~..).~, County Tax Map No, lO00 Section .... ,~:~..~...1 ....... Block ....... ..~. ,...~, .... Lot No....,.~-.,.~. ............. ~urs,ont to o~l~cation doted ~...~,.....Lt ............. , Jg..~.~, ond opprov~ by the Building Inspector. Rev, 6/30/80 FORM NO. 6 TOWN OF: SOUTHOLD Building Department Town Hall $outhold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted .- Immmmmmmm to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with 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. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- 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. For existing buildings (prior to April 1957), Non-conforming uses, or.buildings and "pre-existing" land uses: 1. Accurate survey of p~"opertv showing all property lines, streets, buildings and unusual natural or topographic featu res. 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 buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $1 5.00 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. Updated C.O. $15.00 Date .......................... NewCons truction...~.. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ........................ ~;/2L~. 6/~/~L~.. d .~,l~.0 ..... ~-.~ .-~7.../~.. ~ (~ {. Q ~ House No, Street Hamlet Owner or Owners of Property ~.J~. ~/../~.'. ~f./~.~../~...~. .................................... County Tax Map No, 1000 Section ............... Block ............... Lot ............ Subdivision..~.~.C~F) .~.l?~..~., ...-)/~..~..~.~. ......... Filed Map No.~..(,,0~ J .... Lot No....~. ......... Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building an?/~ i~t,.meets all ~.~i.c/~ble codes and ragu lations. .................... Rev. I0-10-78 OUNDATION (1st) OUNDATION (2nd) ADDITIONAL COMMENTS: OUGH FRAME & PLUMBING ~NSULATION FERN. STATE ENERGY CODE FINAL Z FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Received ........... ,19... Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT Date ................... 19... INSTRUCTIONS a. This application must be co~npletely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildhags on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. e. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever unti~a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEI~,~.,B¥ JvI~DE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone OO~n~n~c~ ~of~il~o~n of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations'~ for the, 'c0fisi~uctifln~, .~ ~. · .of..~ b~uild~a,· .., ~ ~.'additi°ns~ · or alterations, or for removal or demolition, as hereto' described.' The applicant ag[ies t~ ~o~lF i~}fh~g~li~P~.-.~.e~zl~l~ laws, ordinances, building code, housing code, and regulations, and to admtt authonzefl h~st~e~ }~fl~ an3r ih l~Uildmg for ~te~es~ary mspe~bons. , ' (Signature of applicant, or name, if a corporation) , ........................ (ma±J_±ng address or appJ_±canr) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............. ~..~/% ....................................................................... Name of owner of premises , ~.~.'~..~.&' .~'. · ././~./.C./t'~.~. j~... ~. :...~.. ~...~. ................................. (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 .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ...5.0. S ................... ~ .o-coz....~g:.~. ~../-.u.,0... ......... ,F.,~.,s.. T....A4 ~&t.c~ .~. ................ House Number Street Hamlet county Tax No. 1000 Sectio,, .... .......... lock ...... ......... Lot .... ........... · , ............ ....... Subdivision./~(~/~LCt.lJ [~.Od . k Filed Map No. :.~. ~:~../ Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~ .~ 5 I ~).~. N.C. ~. b. Intended use and occupancy ..... .~).~-.~..~...- ..................................................... 3.i Nature of work (check which applicable): New Building .......... Addition ...... Alt ration .......... Repair .............. Removal .............. Demolition ... '. .......... Other Work ............... --~ ~---,i~i (Description) 4. Estimated Cost.../.....~.... .......................... Fee...~..'-~..:,..."~'~.. ........................ i (to be pard on fihng this appheatlon) $. If dwelling, number of dwelling units .... .DT/~. ....... 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 Dim sion of i ting structures if any Fr nt Rear ' Depth Height Number of Stories ) ...... I ......... Dimensions of same structure with alterations or additions: Front ..... i ........... Rear .................. Depth Height Nffmber of Stories 8 Dimensions of entire new construction: Front Rear ' Depth Height ............... Number of Stories ...................... i ................................. 9 Size of lot: Front Rear i Depth 10. Date of Purchase ............................. Name of Former Owner ............................. II. Zone. or use district in which premises are situated ........ '"""''" 'i ....................,-,...-.... ... 12. Does proposed construction viola, to any zoning law, ordinance or regulatioO: ...'79 ~. ............... ~, .' ....... 13, Will lot be regraded ...... :. ~,tl 0..., ............. Will ex_tess fill be t'emoved frompreornises: ,Y, es 14, Name of Owner of premises DR ,~,W..A..~d.~...~,/~.' .~.. Address,,~..OX,~/fl~T~..~, · Name of Architect ..... .%?[&... ............ Address ' . Phone No .............. Name of Contractor ·':iltt-'''' . Address ' ' %. ...... ~ ........ . Phone No. '~' 15. Is this property located withinl,00 feet of a tidal wetland? * Yes ..... No ,~... · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. OCCUPANCY 0R USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY STATE OF NEW YORK, COUNTY OF., S.S (Name of individual signing contract) . above named. APP OVg AS NOTED , NOTIFY 8OILDI~¢ OECA~T~[NT AT 7BB-1802 9 A~ rO ,~ PM ~fl THE FOLLOWIN(~ {NSPECTIONS: FOONBA'~tO~~ ~O ~!(I~RED flO[iG. ~g~dNL~ & pLUmBING ,%., INSULA i'ffl~J [ BE c;O~v,~ E~E ~OR C,O, ALt CONST~iUCTION SHALL ~EET THE REQUI~&~ENTS ~ ~HE N.Y STATE CONSTR[JC~I~ & ENERGY COD~ NOT ~$~NS~E ~R m~IGN O~ CGi~STRU~ION ERRORS. being duly sworn, deposes and says that he is the applicant 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 this application; that all statements~ contained in this application are true to the best of hi~ knowledge and belief; and that the work will be performed m the manner set forth zn the application filed therewith. Sworn to before me this ~ .: ........... /.;... .... ~..day of ...................... 19 Notary Public, . ..... ~ ........ .e<..~..~--... Count , DAYJE~ HAP OF-j::)ROPEIZ1-Y 8UP..VEYED FOI.~ P-.iChtAP.:D 0,, DP.E'x,v'A,WALtZER E&ST' TOWN OF ~OUT'HOLD~N,Y, hI,Bg°ST~Q"E. 5OUTHEP._N 125,1< 125,C BOULF_.VAf~D NOTE.- LO¥ NO'5. SHO'vCf'-I I~EFE~ 1"O"MAP OF AC4U&VI E¥¢ PAP,.14,,'I ON ,Fl LE IN THE SVFFOLK COUNTY CLEP. K'5 OFFICE ~,5 i'""~P NO, ~24. SCALD 5O" 1" ® : PlPll GUAI;~,NTEED TID THE T3TLE GUARANTEE C. CiMDANY AN.I) T'~ THE SOUTH ,,,,, VAR TUYU,%.)N ',1