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Home My WebLink About15039-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ....... .Z.lfi.~. 9 .~ .... Date ....... ~..u~7' ?.3. .................. 19.8.6. THIS CERTIFIES that the building ...... s. 9.P.e.e.n../>.q~. 9 ~..&.. d..e.c.k. ................... Location of Property ,... ~ .~,~ .............. ~. 9 9.d.q 1. ~ .f .f..D.p.: ............ .H.a. ~..~ .~.~.u.q .k ..... t~ouse tvo. Street Hamlet County Tax Map No. ] 000 Section ..... .1.0.7....Block ...... 7 ........ Lot ..... 2. .3 .......... Subdivision .......... X. .................... Filed Map No ..... X....Lot No ..... .X. ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... 4t~¢.e..1.~ ....... ,19 .8.6. pursuant to which Building Permit No .... ~. 79.3.9. z. ........... dated ..... ~.q~..2.7. .............. 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 is ......... .~9 r.e.o.~, p.qp.c, i~..a, qd...d.e, qk., p.n,..~.n..e.x. ~..s.~.5_.n.g..o.n.q.: .f.~.m.5. ~y..d??..3_~.~n.g: ........... The certificate is issued to ................. g A.R.Y...&..~.~.~. 9.a.~..~..~.~p.~. ................... (owner, I~e~[ ~(a~ of the aforesaid building. Suffolk County Department of Health Approval .............. J~/.. b ........................ UNDERWRITERS CERTIFICATE NO ...................... .~/.g ........................ Building Inspector Rev. 1/81 l~O]B3& NO. 1~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PEP. AAIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 15039 Z Permission is hereby granted to: .............. ..~......~...~.~ ............................................................. ~o ~ ,o .~...~....~.~..~...~.~..~.....~...~.~ ....... ............ ,. ..................................... Ot premises Iocoted at ....~.~...~.....,~,,~..~.~.'~.~...~..t~:.: ....... ~.~ ...................... County Tax Map No. 1000 Section ....... I...O...-J. ........ Block ...... .0.,.']. ........ Lot No..,.~.,~ ............. pursuant to application doted ..... ...~..~.)....~ ....................... , 19..~..~,., and approved by the Building Inspector. Fee $.,,..t .................. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Bu ilding Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY (nstruct{ons 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 unusua~ 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 "pie-existing" land uses: 1. Accurate survey of p~L"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: ~. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 $15.00 Date ............... New Building .~. .......... Old or Pre-existing Building ..... ~ ...... Vacant L, and ............. Loc t,onofProperty... .¢. :... ..... ........... Owner or Owners of Subdivision ................................. Filed Map No ........... Lot No .............. Heahh Dept. Approval ........................ Labor Dept. Approval ........................ Unde~riters Approva~ ........................ Planning Board Approval ...................... Reques~ for Temporarv Certificate~ .................... Fina~ Cer~ificate~ ..................... Construc~on on above described building andpermh meets~ll applicable codes and regulations. PP · · · ..................... FIELD INS£JECTION FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE .%. FINAL COMMmNTS ADDITIONAL COMMENTS: At~pl~OV£~ AS ~0~~', ~$TI~ BUILDING,OEPAflTM~T A1 ~,65-1802 R AM TO ~ PM ~R THE ~tJST A, LL ~O~ ~HALL MEET ~ O~ V~E CODES · ~ FOR FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 76~1802 Examined....~., .~.~ ..... 19~.~. Approved ...~ . ..~.~. .... 19~.b.. Permit No.]. ~.~..~.~..~.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No .................. i d35 1 Date..6/1!:8.6 .............. 19.., INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with ~ 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 street 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. TI~ 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 penni 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 Occupanc~ 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 o: 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 tt admit authorized inspectors on premises and in building for necessary inspections. '' i~;f'~~' 'am'e: 'i~ ~ 'c~;~a'tio'n') .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................... q~.~,~ ....................................................................... Name of owner of premises ..... .G.g..R.Y....S... fi...IyI.E.D.O..Re.. ~: . .H.~.R.D.Y. ....................................... (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 I. Location of land on which proposed work will be done .... 5.4.5 .~'~p.o. clc~.;LJ~.~ .9~c.5,v.~ ....................... ............................................... M~tti~n.~k,. N...¥ ............................. House Number Street Hamlet County ;Fax Map No. 1000 Section ...L07 ............ Block ...... .7 ........... Lot....2.3. ............. 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 . OT~e..~.m.5,1. y..d.w.e..l_.l.J_.n.g. b. Intes)ded use and occupancy ...... s.a..ra9 .... Rep'air · · .'f'~Y~ 7 · .~'?~'YT..~oval ............ Demolition .............. Other Work ............. Estim ~?ll! /j I .. (Description) 4 ...... 'i"~ ................... Fee ...$.7.5.00. .......................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... 1. ......... Number of dwelling units on each floor ............. If garage, number of cars ' 6. If business, commercial or mi~ed occupancy, specify nature and extent of each type of use ................. 7. Dimensions of existing stmctu'res, if any: Front $1~c. 3,T~.¢H$.D R~I~t.R.VEY .... De-th ...... Height ............... Number of Stones ........................................... Dimensions of same structure With alterations or additions Front .~.E.E ~I~iT.'ACH~'I~ S(~P~I~gY '' ' D. pth .. ................ r... He,ght ...................... Number of Stones ............. 8. D~mens~ons of entire new construction Front ~ ........ '-; f-' ' ~ ........... ~x~ar . . meptn .1,~. ~ .4¢... Height N~mber of Stories 100 I Rear 100 1..3.5 ). Size of lot: Front ................................... Depth ]. Date of Purchase .... 5/2.1/~81 ................. Name of Former Owner RoSanf[ .S. &..Elizabeth. ~L .' I. Zone or use district in which premises are situated..".15'.'..r.e..s/,a.~r..i .......... Sh.e.r.w.o..o.d .............. 2. Does proposed construction viblate any zoning law ordinance or regulation: IxJO t..Will lot be regraded ............................ . Will excess fill be removed from premises: Yes lx ~. Name of Owner of premises ~qar~e..a$. ob. qv.e .... Address ................... Phone No..299:-.8.8.5[t... Name ofg. rchitect ' Address Phone NoP.r. 323 2500 Name of Contractor ........ . .................. Address ................... Phone No PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions fro~ · operty lines. Give street and block number or description according to deed, and show street names and indicate wheth~ terior or comer lot. 'ATE OF NEW YORK, )UNTY OF... SUZ'.EQLK ...... S.S GARY S. HARDY (Name of individual sighing contract) ~ve named. being duly sworn, deposes and says that he is the applican O~NER is the ..................... (Contractor, agent, corporate officer, etc.) said owner or owners, and is duly authorized to perform or have performed the said work and to make and file thit Dlication; that all statements contained in this application are true to the best of his knowledge and belief; and that th~ ,rk will be performed in the manner set forth in the application fried therewith. 'om to before mc this /~ June 86 ...................... day o~ ...................... 19... .... s.?. ¥ ....... NOTARY PUBUC, State :al Now Yorll (Signature of applicant) NO. 52.4655242, Suffolk County Commission ~pires March 30, 1~ ~"~