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Home My WebLink About15036-zFORM NO. 4 TOWN OF 5OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificnte Of Occupnncy No.. z.1.462.5 ......... Date ......... Ju,LM · 10, ............... 19 ~6 THIS CERTIFIES that the building ......... Aock. ~ddig£on .................. · Location of Property ,.7.% 5 -. .... i. F~quasb .~veaue ............. C~tcho~ue ~. ~.,¥ ..... Mouse tva. Street Hamlet. County Tax Map No. 1000 Section ...I. 03 ...... Block .... 7. .......... Lot ,. 2~.6 ............ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated June .1.8.6 .... 19 .8 6pursuant to which Building Permit No, 35036Z dated ...J. ,u.n.e..2. ~., ................ 19..~.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 ig ......... Deck addition to existing one-family dwelling .77. ....... The certificate is issued to ............. .E.u. ge..n.e..B.u. ¥~,e.r. .............................. (owner, ~,~IfeYoX J~il~x of the aforesaid building. Suffolk County Department of Health Approval N//~ ~/A UNDERWRITERS CERTIFICATE NO .................................................. 1/81 Building Inspector lrO~z NO. Il TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PER/vtlT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 1503~ Z Date ........ ~ .......................... , ...... Permission is hereby granted to: ..... ~~.~,_.....~.:~ ........ I.La.~.~ ...... ~ ,o ............... ot premises located at o...~/..~ ...... J.~P;.~.ff~.....~'~.: ....... ~~....-- ................. County Tax Map No. 1000 Section ...... L..~....~ ........ Block ....... .~..-J, ....... Lot No ..... .~..~.. ........... pursuant to application doted ...... ~.~...]..~.. .................... , 19.~..~..., and approved by the Building Inspector. Rev. 6/30/80 FIELD I.~+S~F ECT ION FOUNDATION {1st) C014~4ENTS FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING 3. INSULATION PER N. STATE ENERGY CODE FINAL FORM NO, 6 TOWN OF $OUTHOLD Building Department Town Hall [~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions in dupl~cate~o A. This application must be filled in typewriter OR ink, and submitted ' ~he Building Inspec.. tot with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property tines, 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, B. For existing buildings (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 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. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $15.0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 Date .......................... New Building ............. Old or Pre-existing Building .... ~. ...... Vacant Land ............. Location of Property...~.~ .~ ................. .~.~.%.~..<t 4. ~'~.. · v~,~, .~. ...... C; ?.~.¢~:7,A~ ~'-- House No. Street ......... /'/amletd Owner or Owners of Property.....~::~ ° ~' .~-z..t~'~-... . ........ ~..'P:..~..~¢~V'. ,. . ....................... CountyTax Map No. 1000Section l~) .'~ Block ~ Lot .~. F. Subdivision ................................. Filed Map No ........... lot No .............. Applicant Permit No ........... Date of Permit ...................... ~. ..................... 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 .... .~.. ~9";",~&.....~.~ ..................... Rev, 10-10-78 76S-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: /~ '~ %'~/ ..... 765-X8~2 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION ZND [ ] INSUL.ATION [ ] FRAMING [~FINAL REMARKS: .... ~/~"- ~r(/~__/~ ,, , DATE C INSPECTOR 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD. N.Y. 11971 TEL.: 765-1803 Approved .-~..7..., 19 ~.(~ Permit No/.%.%.'~)..~.~..~ Disapproved a/c ..................................... Received ........... ,19... ~(J}uddm~l ~pe~tor) ~,' A P P L I C A*T 10N~ Igb~,'R~ ~l ED ,~.. (~ PERIV]IT a. T~s application must be completely filled in by ~pewhter o~ ih, Jh~ a~d submltted to the Bulldog Inspector, with 3 sets of p[aas, accurate plot plan to scale. Fee accordin8 to schedule. b. Plot pl~ show~g location of lot and of build~gs on premises, relationship'to adjoining premises or pubUc streets or areas, and giv~g a det~led description of layout of property must be drawn on the diagram which is pa~ of this app,- cation. c. The work covb)ed by t~s application may not be commenced before issuance of Bufld~g Permit. d~ Upon approval of *his application, the Building Inspector wQ1 issued a Bu~d~g Pemit to the app~c~t. Such pemit shall be kept on the pr~mises available for ~spection throu~out the work. e. No bulldog sMQ be occupied or used in whole or in,p~t for any purpose whatever until a Ce~ificate of Occup~cy shall have.been granted by the ~uilding Inspector. APPLICATION IS HEREBY MADE to the Building Dep~tment for the issu~ce of a B~lding Pe~nit pumuant to the ~uilding Zone Ordinance of the Town of Southold, Suffolk'County, New York, ~d other applicable Law% Ord~ces or Regulations, for the const~ction of bulldogs, addidons or alterations, or for removal or demolition, as here~ described. The applicant agrees to comply with all app~cable laws, ordinances, bufld~g code, hous~g code, and regulations, and to admit authorized inspecto~ on premises and ~ bulldog for necessa~ inspections. (Mailing ad~lress of applicant) State Whether applicant is owner, lessee, agent, ~rchitect, 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. ' (Name and title of corporate officer) - Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Othci Trade's License No ......... .. ............ 1. Location of land on which proposed work will be done~ ~ ......................................... .t..sS .... ....... A .......... 5 .......... House Num bet ~\ Street Hamlet County Tax Map No. i000 Section .... /. ~..~. ........ Block ...... .'~ .......... Lot .... 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 and occupancy... ~ X*~ ~* ....................................................... b. Intended use and occupancy t t 9,cYw~ }o,~ t2 ,*i ,w~ ............................... ','h'~* ,'~.~ ~,~k .~ F;;, ~ . ,;.~, .,~c .................. 3. Nature of work (check which applid.!able): New Building ..... ' ..... Addition ...... Alteration .......... Repair .............. Removali .............. Demolition .............. Other Work ............... . ' (Description) 4. Estimated Cost ............................. .~..~? Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling uniis ............... Number of dwelling units on each floor ................ If garage, number of cars ....... ; ................................................................ 6. If business, commercial or m~xed oqcupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, it'any: Front .............. Rear ....... .. Depth ............... Height ............... Num ber~~ 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 Ylt~nth Height ............... Number, of Stone. s, I ~i ................................................ 10. Date of Purchase ......... .~{~).~ · · ;. q ~~*er Owner ............................. 11. Zone or use district in wh~ ~r~i[~ t ~. ~[~.~ .................................. 12. Does proposed constructi~5'a~o~ ~ ~~'~ulation: ............................. 13. Will lot be regraded ...... ,.~ .~O. ~..t ~ ~il excess fill~e removed ~om premises: Yes 14. Nme or Owner or premises ~ ~, ~ ~ss. 66 ~ ~uq ~.~,~q~hone No..7~q. :.¢& t~ .. of Contractor 15. Is chis property ideated ~I 5[~et of a t~dal w~e~and? *Yes ..... ~ .... · If yes~ Southoid Tom Tru~r~ s ~erm~C maybe requSred. PLO-T DIAG~M Locate clearly ~d distinctly ~I b~:fld~gs, whether existing or proposed, and. indicate ~1 sqt-back d~ensions from property. . ~nes. Give stre6t and block number~ or description accord~g to deed, and show street na~es and red,cate whether interior or corner lot. [ , ~ NOTI~ BUILDING DEPARTM~T AT ~ " 766-1802 9 AM TO 4 ~ ~ THE ~ FOLLOWING tNS~C~ONS: 1 FOUNDATION ~O REQ~RED FOe ~OUREO 2 ROUGH ~RAMING & ~UMBING ~ 3. INSULA TIO~ x .... 4. FiNAt. CONSTRUC~ON MUST ~ ~l - '~ [ AL' CO"STRUCTION ~A~ MEET .... THE REQUI~MEN~ OF ~ ~ATE CONSTRUC~ON & ~GY >TATE OF NE~Y9~K,~ ~ ~ ~ COD~, NOT ~N~E ~R 20U~ 0~~ ...... ~'9 ~ES~N OR C~.TRUC~ON ~RORS. ....~J~~¢-J~ ......... ~ .................. being duly sworn, deposes and says that he is the applicant / (Nam of fndividual signing contract) [hove named. le is the .................. ~ ........................................................ , (Contractor, agent, corporate officer, etc.) ~f said owner or owners, ~d is duly ~uthodzed to perform or have perfomed the said work and to m~e and file t~is :ppilcation; that all statements contained, ~ this application are true to the best of his knowledge and belief; and that the york w~l be perfomed in the m~ner set forth ~ the application filed therewith. ;worn to before me this .................... 19 ~67~'~T~ CounW ~ (Si~a~ure of applicant)