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Home My WebLink About15060-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. ~146.05 Date July 8 ................................................ 19...86 Accessory garage TI{IS CERTIFIES that the building ................................................ Location of Property 1350 GIN LANE SOUTHOLD h3~s3 ~iol ....................... 's't/eJi ....................... County Tax Map No. 1000 Section 8 8 ...Block 3 . . .Lot 16 Subdivision. BA.Y HA.y~N ...Filed Map No. .Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated .J .u.1X 7 8.6. t5060Z ................ , 19. pursuant to which Building Permit No ..... dated July 8 19 86. 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 ......... bccessory garage, The certificate is issued to . .GEORGE & DORIS BROWN (owner, of the aforesaid building. Suffolk County Department of Health Approval .......... .N/?. ............................ UNDERWRITERS CERTIFICATE NO ' .N/A. Building Inspector Rev. 1/81 TO~VN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 15060 Z Permission is hereby granted ........... · ..~.~ ...........~ ......... .~ ............... at premises located at ..]...~.~..'~.. ........................................... County Tax Map No. 1000 Section ...... ..~....~....~.. ..... Block .... ..~.....~ ........ Lot No ...... J..~ ............ pursuant to application dated ...... ...~...~....~. ....................... , 19..~....~.., and Building Inspector. Fee $.~......~.....~'.......'~. approved by the Building Inspector 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 This application must be filled in typewriter OR ink, and submitted m ~ 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 sifnilar 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 property 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 5ccupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. Updated C.O. $15o00 $15.00 Date ....................... New Bui(ding ............. Old or Pre-existing Buiidingp ~..~.. ..... Vacant. Land ............. Location of Property lYu~.~e .N.o~?. . ....... ' '~" ~' '. ' '~t ......... ~ {~ ~ ~ ~e~ Owner or Owners of Property . . ~~..~ /. ~: . ~~ ..................... . ......... ........... .............. Permit No ........... Date of Permit .......... Appl;cant ..... /~;..., ,,... .... ~.. ; ~. Health Dept. Approval ........................ Labor Dept. App¢oval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and p,erl~it msets al, l-ap~licable codes aj~ r~ulations/ Applicant . . ~ , . ~ ....... )Z .l o U; -rr C) ,( 'iELD INSFECTION OUNDATION (1st) COMMEN TS OUNDATION ( 2nd ) OUGH FRAME & PLUMBING NSULATION PER N. Y. STATE ENERGY CODE FINAL 'FORM NO, 1 ,/ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved ., 19~..(P. Permit No../.-'~'~...~'.q .~.. Disapproved a/c ..................................... (Building Inspector) BLDG, DEPT. TOWN OF SOU'i'HOLD Received ........... ,19... APPLICATION FOR BUILDING PERM IT '~/ Date .................. I9 : a. This application must bg~y~4,[n~y~j~rllt,~rj~,~ and submitted to the Building Inspector, with 3 sets of plans, accurate plot locatiqn%~,~t ~o~6~l~relationship to adjoining premises or pubSc streets b. Plot plan show~g or areas, and giv~g a det~led de~ o~t ~[,~t~'must be drawn on the diagram which is pa~ of this appli- cation. /" .,~[~ ~ ~ c. The work covered by t~s ~~a~c,O~ced before issuance of Bufld~g Permit. d. Upon approval of this appli~, ~.~ ~ffctor will issued a Bufld~g Pe~it to the appficant. Such pe~it shall be kept on the pr~mises avaflab~ ~K ~roughout the work. e. No bufld~g shhll be occupie~ used in whole or in p~t for any purpose whatever until a Ce~ificate of Occup~cy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to ~e Building Dep~tment for the issu~ce of a B~iding Pe~it pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, ~d other applicable Laws, Ordh~ces or Regulations, for the construction of buildhgs, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all appUcable laws, ordinances, bufld~g code, hous~g code, and regulations, and to admit autho~zed ~specto~ on premises and ~ build~g for necessa~inspec~ ~ ~~ wm , (Mailing address of applicant) State Whether applicant is owner, lessee, agent, architect, engineer, general contractor, electhcian, plumber or builder. ..................................... ,',:- ..... . ....;~' 'V. 'g: '&,', ........ If applicant is a corporation, signature of duly authorized officer. '"- 4. * g{"¥~, f~ .~'~ ~'O 4 ~,~ F~ .............................................. i gOt~,~Oa'e~O~ T~'¥Q x (Name and title of co~orate officer) - =0~ ~OO{~gl~ ~( ~C~E f~ Builder's' License No .......................... ~ Plumber's License No ......................... ~ COM~ET~ TH~ ~EQO~P~MENT~ OF ~E Electrician's License No ....................... ~'A~ CONff~RUC~ON & OH~er Trade's License No ...................... ~IGN OR CQN~ff~U~ON ~O~S, 1.Location of land on which proposed work will be done .................................................. ... .... ............. ........ ............ House Number Street Hamlet ..... ......... ............. ........... SubdMsion...~...~. ........................... ~fled ~p ~o ............... ~ot ............... (Name) State existing use and occupancy of premises and intended use and occupanc~ of proposed construction: a. Existing use and occupancy ..... .~'~..~.~./~.-~~~.~ ~ b Intended useandoccu anc ~ ~ / ' ~~ · p Y .............. ~ ~ ~-~...~ .......... ~~. ............... 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... Alteratign ...t ....... · : ............. Removal .............. Demolition .............. Other Work .,~"]~ Repair ' ~.,I ~ ~ ;~ ' ~' 4. Estimated Cost .... ~...~f~...:..~....?...,fi~..?T.'~'...r'~'4~... Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Numb,,er pf dwelling un[ts on each floor ................ If garage, number of cars .......... ~ .......... '~. [ .'.~.. ,¥/... ~..,.f~..... .......................... 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 construChon: Front ......... ...... Rear ............... Depth ............... Height ............... Number of Stories . :'. ............................... ;~ .............. 9. Size of lot Front ?.0'1~ r. .. . Rear ~.'cr0 10. Date of Purchase ............ ....~ .~. ~ ,~ ........ Name of~o~r~me,~r Owrjer . ).'.'~...~.tT.. 11. Zone or use district in which premises are situated ........... /./,.~ .....,~,~,~,~,~,~,~,~,~.4: ............................... 12. Does proposed construction violat'e any zoning law, ordinance or regulation: ....~ ......................... 13. Will lot be regraded ....... .,,..,. ..... ,:4 .......... Will ?~_,x~ess fill be hemoyed from premises: Yes No 14. Name of Owner of premises .~ f.~-~.~...~".~-'~.. Addre~.~/~l Name of Architect ......... ~......~"~... Addrd~· };'~*~' ' ....... Phone No ................. Name of Contractor .......... ~ .... < 15. Is this property located wSthin 300, *If yes, Southold Town Trustees Perr~i't; Locate clearly and d~stinctly all buildings, whether property lines. Give stm~t and block ndmber or description interior or corner lot. ~TATE OF NEW YORK, s.S ?OUNTY OF ................. i (Na u ng contract) tbove named. ' Phone No. · · :2 ........... .~.;. No .~. all set-back dimensions from [icate whether / being duly sworn, deposes and says that he is the applicant is the .... ..................... ............. 't; ) ......................... i a officer, etc. said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this tpplication; that all statements containbd in this application are true to the best of his knowledge and belief; and that the york wili be performed in the manner set forth in the application filed therewith. ;worn to before me this .............. ~ ....... day of..,...~. ~ .......... 19~.'~ 4otaryPublic ....... ~'f'~'~'" "//'~"l~"~"~-~"'"C°unt [ ~ (Signature of applicant)