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Home My WebLink About15583-zFORM NO. 4 TOWN OF 5OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy N $ D December 23 19 o. 15534 ate ........................... THIS CERTIFIES that the building A d.d L ~ i o~ ' 26875 'MAIN ROAD '. O..RIENT, Location of Property ......................................... .. . . . ... ... .... . · · House No. Street Hamlet County Tax Map No. 1000 Section .. 0.1.8 ...... Block .. 0 ~ ........... Lot ... 0·1.7. ......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated Dec. 9 ,198..6 pursuant to which Building Pennit No. 155.8.3.z .... dated ...q ~ ~ .- ._.~ ~ ................. 19.8. 6., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued i~ ......... The certificate is issued to ...... M I C HAE L. K.O.R E L L ..................................... of the aforesaid building. Suffolk County Department of Hea~th Approval ....... ~./..A ................................ UNDERWRITERS CERTIFICATE NO ............... ~/6 ................................ Rev, 1/81 TOWbi OF $OUTHOLD BUILDING DEPARTMEbiT TOWN HALL SOUTHOLD, bi. Y. BUILDIbiG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15583, Z Date ...J~ ....................... , .... Permission is hereby gronted to: ~ /3 - ....~. .~ ~ ~.:z. ....... ..... .cb~.....~.:..':t..:.....I./..~. .~'t..7. .................. .... ~'"~,...O~J.-.. _ ._ _O ' , .'T).. ' ~ ..... :..,~.=.=~ =..m..,,......o,-~......~....~.....; ...................................... located at.. ~...~...~.. ~ ..~.........~......0~.......~...q(. .......... ...(~...~... ~ .: ...~., .................... County Tax Map No. 1000 Section ....... ..C~...L.~.. ...... Block ....... (~..~ .... Lot No....~..!...~... pursuant to application doted ~~.~..J....~.'~.. ........ , 19.~..~., and approved by the Building Inspector. Fee $..~,.:.~.. 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 ink, and submitted ~ ~ 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 prt)perty showing all property lines, streets, buildings 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 buildings or premises, or other pertinent informa- tion required to prepare a certificate. 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 $15.00 Date .......................... New C OhS truc t i on ...... Old or Pre~existing Building ............ Vacant Land ............. Lo,at,on of Property. House No..~.~..~.~./..~_~Street ~rnlet Owner or Owners of Property .../~./...~'~./~.../~. ............................................ County Tax Map No. 1000 Section . ~.~/~ :.~).q... Block . ~)~.-,0.~ ..... Lot .~. ~ .~.'.0.0.(~. .... Subdivision ................................. Filed Map No ........... 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 and permit meets all applicable codes and regulations. Applicant.. ~~ ........... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL gOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined '~'~...%~., 19 ~..~ Appr~...~.~.., 19~. .~. Permit No. 1 .~ ~ BEg I 5 Received ........... ,19... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS (Name and title of corporate officer) Builder's License No .......................... Plumber's License No .............. - ........... Electrician's License No ....................... a. This application must be completely 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 buildings 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. c. 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 until a Certificate of Occupancy shall have been granted by tho Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws. Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary insvectiop~s. .~ .-.q ~ .~ :-f?.Z .................. (Signa~~ a corporation) .... r:.8.2. ..... ......... .... . . ;. ,... (mazlzng address or appxzcant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........................................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. / ¢~/~,~ .~ Other Trade's License No ...................... 1. Location o f l.a~d on which proposed ~w/grk w~Lt~done. ............... ........... iii iii i i" House Nmnber Street Hamlet County Tax Map No. 1000 Section ~)/.~..' .0[?..O. ........ Block . .~.~: 19~.~. ........ Lot..~./. ¢..~.~..d) ....... Subdivision ..................................... Filed Map No ............... Lot ..: ............ (Name) 2. State existing use and ~ccupancy ~f premises and i-jP~qnded use and ~ccupancy ~f pr~p~sed c~nstructi~n: a. Existing use and occupancy ~.'~. · .~¢ ............. ,7'"~/"Z ...................... b. Intended use and occupancy .................................................................... 3. Nature of work (check which applicable): New Building ..... i.... Addition . ~.. ...... Alteration .......... Repair .... ' .......... Removal .............. Demolition ............ Other Work ............... (Description) 4. Estimated Cost ........... ; .......................... Fee ........ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of c~,elling 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. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure With alterations or additions: Front ................. Rear .................. Depth .................. ;... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear . ../Q.: .t./.tg. ~.... Depth ............... Heighten. ~ ./O.: ........ Nu!mber of Stories .. (~/V~ ................................................. 9. Size of lot: Front .... .. ....t ............ Rear ...................... Depth ...................... 10. Date of Purchase .. ~.,~/~. .................. Name of Former Owner ~,~./.~..~...~/t~..7'O. ~ ....... 11. Zone or use district in whfch premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ....... t ~ ......... ,. z ........ Will excess fill be removed from prem.~ets;. Yes No 14. Name of Owner of premises /f/r/'~_//d~..t,-....~.E>..~..~. Address .~t~.r.. (~.~. ~./.~hone~.~$.,~.~.-.~.~g'ff.... Name of Architect ........ , .................. Address ................... Phone No ................ Name of Contractor ....... ! .................. Address ................... Phone No ................ 15. Is this property locate~ withint.00 feet of a tidal wetland? * Yes ..... No .~... · If yes, Southold Town T~ustees Permit may be required. PLOT DIAGRA~ Locate clearly and distinctly ~l buildings, whether existing or proposed, and. indicate M1 set-back dimensions from prope~y Hnes. Give street and block number or description according to deed, and show street names and indicate whether i~tedor or corner loL STATE OF NEW YORK, S.S COUNTY OF ................. ................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dgly authorized to perform or have performed the said work and to make and file this application; that all statements coqtained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manoer set forth in the application filed therewith. Sworn to before me this ............. .~. ......... day Of ...... .~. ~ .......... 19~.~.. Notary Public ...... ~.~-(....~'....~g.~..~...¢~-.... Coun~7~/~¢/~.. . Ko. 4707878, Su~olk ~Ql~ ) (Signature of applicant)