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Home My WebLink About14990-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..~.1.4.5..2.9 .......... Date June 18 ., 19.8.6. THIS CERTIFIES that the building Accessory Location of Property ....... 2. 2. .0.4.0..~.a.i.n...13.o,a.d' ....... Orient House No. Street Hamlet County Tax Map No. 1000 Section ... 1.. 7 ....... Block ...... .6 ........ Lot ..... ]~/.o...9.,. '... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated · .dT.u.n.°...~ 7 ............. 19 .8.6. pursuant to wbfich Building Permit No.. ~..4 ~ .5.q Z. ............. dated ...G.u.n.e...1.7 .................. 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 is ......... Accessory building. ~-: The certificate is issued to .... .e.i.l. 1...M.u.J:r. ............................................ (owner,~'~ ~,'z~X of the aforesaid building. Suffolk County Department of Health Approval .................................. N/A ....... UNDERWRITERS CERTIFICATE NO ................................................. Building Inspector R~v. 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) 14990 Z Permission is herebt granted to: ...... ,...~...~..~.~...~.....~.~.~-4...~' o,,,~,~,,~,~ ........ ~.....~..~ ....... ~~...~ ........................... pursuant to application dated~ ............ Z..~ ........... , 19~, and approv~ by the Building Inspector, Rev, 6/30/80 Ao FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted ~a ~ 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, sti'eets, 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: I, Accurate survey of p~operty 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. 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 CoO. $5.00 5. Updated C.O. $15.00 $15.00 .~ New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property .... .~...~.. ?..~..-~. .... ,~..~. ~,?.~..~...~- .~..~. ................. House No, Street Hamlet Owner or Owners of Property ............................................................ County Tax Map No. 1000 Section ... ,... ......... Block Lot Subdivision ................................. Filed Map No ........... Lot No ...... .. ....... P e rmit No ./.Y.~. ~Z~. ~. Date of Pe rmi ~/~../?~i~..App licant ~~~'.. ,~. ~ ;~ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Cortificate ....... ~ ............. Final Certificate .... ~ ............ Fee Submitted ~.~.~ .~...~ ..................... Construction on above described building an~permit r~eets all applicable c~es and regu~tio~ns.~ ., Rev. 10-10-78 , IL. 0 'FC~RM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL 8OUTHOLO, N.Y. 11971 TEL.: 765-1802 Examined~./7, 19~.C Approve~,~.../. 7.., 19~"Pennit No../..~. ~...~.~. ,Z.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS TOWN OF SOUTHOLD a. This application must be completely filled in by Wpewriter 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 pre,.mises available for inspection throughout the work. e. No building shhll be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the 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.. :0~' '~-' '~' ~inspe~tions. ,/1o .~. '~ '(~' '~'' ~' ~'~'''~/' //~,~ ,//~Z~ ~?/ // - ' ' '~'z'~ /J~Signature of app)lcant, or ¢'~r!//e, if a corporatio.n)~/ (Mailing address of app~itcant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... ........................................................................... Name of owner of premises...~L. {~ . .//~...~../..~.. .g'C'" ?"'~ ' ' _.~ If applicant isa corporation, signature of duly authorized officer. ~ ~ ~ ~y: ,.,~, ~/~ '~OTI~ ~ OEPARTM~ AT .............................................. 7~1~ ~AM ~ 4 ~ ~0~ ~ (Name and title of co,orate officer) · ~NG ~8~C~ON~: ~u~]det'~ ~i~ens~ No ................. ~ ~ED ~ON~~: P]umbeffs ~icc~se No ......................... 3. ~SULATION 4. ~AL CO~ ,~ "~ "~' ~ Electrician's License No ....................... ~ OOMPLE'~ ~ ~,O~ r A~ CONS'r~h '~ ,m~, -;~[. MEET Oth=, Tr~dCa Li~ns~ N~ ...................... THE REnU~'' :' "~', OP THE ~T~. Cc~t,,;, ~ ~,<.~Cr~(}N & ENERGY 1. Location of land on which proposed work will be done ~ ~ ..~,. ~..,.~,,~,.~,: ~,~.,,,, ~_~,~ ..... House Number Street Hamlet Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use ann occupancy..~ ~? ~> ~' ...... ............................... b. Intended use and occupancy .................................................................... 3. Nature of work (check whf~lj ~pplicable): New Building .. ~'. .... Addition .......... Alteration ..... epmr ~l~"! ~ ' ' Removal ....... Demohhon Other Work ............... ~ : C~/ (Description) 4. Eii.imated Cost/% .O'~:?:.~.~.~..i ......... Fee ..' ' ' v. ,e ,.. { ~ (to be paid on filing this application) 5. If dwelling, number of dwelling ufiits ............... 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 ..................... D~menmons of ex~stmg structures,lffany: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dhnensions of same structure wttl3 alterations or additions: Front ................. Rear .................. Depth Height Number of Stories · 8. Dimensions of entire new construction: Front .......... . ..... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9 Si ' pth · ze of lot: Front ............ . .......... Rear ...................... De ...................... 10. Date of Purchase ............ ; ................ Name of Former Owner ............................. 1 1. Zone or use district in which premises are situated ................................................... 12. Does proposed construction violatle any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded .......... ; ................. Will excess fill be removed from premises: Yes No 14. Nmne of Owner of premises .... ; ............... Address ................... Phone No ................ Nmne of Architect ........... ~ ............... Address ................... Phone No ................ Nmne of Contractor .......... ~ ............... Address .... : .............. Phone No ................ 15. Is this property located within 300 feet of a tidal wetland? *Yes ..... No ..... · If yes, Southoid 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 m mber or description according to deed, and show street names and indicate whether interior or corner lot. 3TATE OF NEW YORIC- . ~ oF. g ........ ' ~ff~' ~ .............. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) xbove named. teis the... ~TZ--ff;.. ~Z/ ................................................. (Contractor, agent, corporate officer, etc.) )f said owner or owners, ~d is duly authorized to perform or have perfomed the said work and to m~e and file t~s tpplication; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the york will be perfomed in the intoner sot forth ~ the application filed therewith. ;worn to before me this ...... XT.~ ........... d~v of..~..~;. 19~ lota~ Public,~~. ~. ~ ~.. ~ / LINDA F. K~WALSKI ~ _ NOTARy PUBLIC, State of New Yo~ . No. 52,45247it (Si~ature of .......... : Qualified Commission Expires~