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Home My WebLink About15118-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupnncy No..Z .1.4.7. 8..9 .......... Date .... .A.u.g.u..s .t..1.2. .................. 19..8.6 THIS CERTIFIES that the buildLng A'ddit ±on Location of Propertynot, se"' ' .5..5..5.tvo..P.y.t....R.d.: ...#.10 .(.B.r o..w.n.s..l;t.iJ..l,~ 1 ...... O;c. ie~t .... ~--/o~ Sout~lew D~'~e ' Street County Tax Map No. 1000 Section . . .-~ ......... Block ........ 3 ...... Lot ...... 8 ......... m. Subdivision ....................... ........ Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·..J..u.ly..2..1 .......... , 19. ~.6pursuant to which Building Permit No. , .1,5.1. ~l.8.Z ............. dated .... J.~t~Ly..22 ................ 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 ......... Addition--tool shed to exis~cinc[ dwelli o.. ........................... The certificate is issued to .... .A.N..N.E...M%.¢, .KAY. ........................................ [owner,~;~ of the aforesaid building. Suffolk County Department of Health Approval ......... .N/.A. ............................. N/A UNDERWRITERS CERTIFICATE NO .................................................. Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTNOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 1511g Z Permission is hereby granted to: .... ~.~ ....... ~.:~..,. ................................... ro ..',~...~':'~....'~..'~. ,,',., ..,.~...--...,~'.~ ........................................................ I'" ~ ........... at premises located at ..~..~..~,..,...C.,.~......./......~l......-.~-..~....-~.... .......... ..~..~ ..................... County Tax Map No. 1000 Section ..... ~-...~ ...........Block ...... ..~......~. ...... Lot No ...... .,0.....~. ........... ~s~ont to o~p,,ca.o~ dot~ ....... ~.~..~.t ..................... , ,~.~_~,, and oppro~O b~ ~e Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions ~o,O ~ c~-/ A, This application must be filled in typewriter OR ink, and submitted. IIila~l to the Building Inspec~ tor with the following; for new buildings or new use: 1. Fina~ survey of property with accurate location of a~l buildings, property lines, streets, and unusual natural or topographic featu res. 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:Coperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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 $15.00 3. Copy of certificate of occupancy $1.00 .vao t ,. nd c.o. $5.00 5 .Updated C.O. $15.00 Date ........ / ..... NewC ons truction ...... Old or Pre-existing 8uiJding ............ Vacant hand ........ ~ .... Location of Property ...... ¢ ...... ~T' ~P ~¢ O&l~l' House No. Street ~ o ~ ¢ ,~am/et ~c ~ ~ . ~ Owner or Owners of Property ....... ~,~. ~~ County Tax MapNo. 1000 Section .,.J'~, ........ BIock...~% ......... Lot..~ ........... Subdivision ................................. Filed Map No ........... Lot No .............. 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. ....... .................... Applfcant 765-18~2 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [] FOUNDATION 2ND [ ] IN/SU~TION // []FRAMING ["]'FINAL REMARKS: DATE./~//~/~ INSPECTOR F1ELD INSPECTION FOUNDATION (1st) FOUNDATION (2ndl ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE tiDATE It ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined...~/ ~-~' .,19..~. Approved '~' 'l~i; '.1-i i., 197.~. ?ermit No. l.i~.l/.~..~-... Disapproved a/c ..................................... .L.~TOWN Or SOUTHOLD ..~ Rece:[ved ........... ,19. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS 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 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 inspections,, ~ ............ ............ (Signature of applicant, or name, if a corporation) .... 0. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises...~. ~.~.4~ ...... [~/~ ~. ~ ...................................... (as on the tax }oll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No..:~. ·... 1 .~. ~. ............ Plumber's License No ...... ~ .0.~.~. ............. Electrician's License .No .... ~.0 .~.~. ............. Other Trade's License ~4o~. ~'. ? .............. House Number Street Hamlet County Tax Map No. 1000 Section ..... ~.-~;,~. ......... Block ...... ~ .......... Lot .... .~. ............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ... '~..k?.~. ~.~.. ......................... : .... :: ........ .. ............... b. Intended use and occupancy .. i .T..(~.c)..~-~-...~.~. t;~. ......................................... 3. Nature of work (check which applicable): New Building ..... ' .....Addition ..... Alteration .......... Repair .............. Removal ............ Demolition .... ,. .......:... Other Workt'l .............. 4. Estimated Cost .... '~ ......... Fee..~.~.~;~. ~. ' (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling uni(s on each floor ................ If garage, number of cars ............................................ ~ ............................ 6. If busmess, ommerc~al or m~xed occupancy ~ecffy nature and extent of egeh type of use ....... u~ ............. 7. D~mens~ons of~x~st~ng structures, ~f any F~ht...,. ~. '> Rear ~ ~ ..... Depth. ~. .......... Height ...1~ ......... NumberofStories...[.[.~...~.[~.~ ........ i .............. D~eBsio~s ~f same structure with filter~'tions~ ~fliti6~s Pr~ont ~, e, ~$ Dep~ ...................... He~t ....... :. · ·::..~; ......Number of Stones .............. --~. D~mens~ons or entire new construction Front...~ ..... ..,. ~eat ~. ~ ~ g~¢}h, Height . . .~ ........... Number of Stones . . .} ......................... ~ ............... ,/ ........ v · · 9. Sizeoflot: Front ::./?~O ............. Rear .... j.iQ ............. iDepth ...~.~. ofeu m ... ................... of Own, ............................ 1 1. Zone or use district in which premises are situated ...................................................... '12. Does proposed construction violate any zoning law, ordinance or regulation: .~ ........................... 13. Will lot be regraded ............................. Will excess fill be removea from premises: Yes No 14. Nme of Owner of pre~ises l{~B~.. ~... Address ~.q~ 2~..~ ~L~.~.. Phone No. Nme of Architect.,..~ ............ : · ......~... Address . . i Phone No . . Nme of Contractor gh~%~..~O~ ...... Address ~*~. ~~Phone $o~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. inaicate all set-back dimensions from property lines. Give street and bld¢~ rfuh/l~er~t descrip~i6n,~ ,'aEc6rdi~ i~,~ed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ................. S.S ................................................. being duly sworn, deposes (Name of individual signing contract) above named. and says that he is the applicant' He is the ............................................................. (Contractor, agent, corporate officer, etc.)l ............. ' .............. of said owner or owners, and is duly authorized to perform or have performed the s~id work and to make and file this application; that all statements contained in this application are true to the best of hi~ knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ............. ........ or ...... ......... Notary Public ......................... County : (Signature ~f applicant)