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Home My WebLink About15135-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..g.:l,..4.7.0.1. ......... Date .... ~..u. ~¥..2.4. ..................... 19.86.. THIS CERTIFIES that the building ........ D.~..o.k .................................... Location of Property ... 3.1.2.0..A.~.b. 9.~.~.s.q .n..~.a.n. ? ........... ,G. ree.n~ort House No. Street Hamlet County Tax Map No. 1000 Section ....0.5.2. ..... Block ... ,0.4 .......... Lot 03_ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·..G..u..ly..2.1. ........... 19.8..6pursuant to which Building Permit No. 15J-.5~5$ .............. dated .... gu. .17..2.4 ................ 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 ......... ...r~eck..a40i.~.~.cm. ~q..a.n..e.x..~.s.~.~.n.g.p.n.e., .f.a.m. ~..~y..d.w..e.~.~.~.n. %. ................... The certificate is issued to ....... P..~.U.L..C. 9.R~...g' g..I.Ixl. I...I .I,.I ............................... (owner, le~X~O~) of the aforesaid building. Suffolk County Department of Health Approval ....... ~../.3. ................................ UNDERWRITERS CERTIFICATE NO ............... IxJ../.A ................................ Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILOIHG I~E~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15135 Z County Tax Map No. 1000 Section ....... ..(~....~..~.,..~,,... Block ...... .(~..~. .......Lot No ...... ?.....~ ........... ...~.~. ~v'" 10 ..~...~., approved by the pursuant to application dated ........... [ ....................... , ... and Building Inspector, Fee $...,~.....:.~... Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPL~CAlqON FOR CERTiFiCATE OF OCCUPANCY Instructions Bo 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 natu rel 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, {ndustria~ buildings, Multiple Residences and simitar 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 survev of p;Coperty 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 anv housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 $15.00 4.Vacant Land C.O. $5.00 .~/.~. /~.~. 5. updated C.O. $15.00 O~te .... /. .......... Newconstruction ...... Old or Pre-existing Building ............ Vacant Land ............. House No. Street Hamlet Owner or Owners of Property . z ~z ~, County Tax Map No. 1000 Section ... ~ O 5' ~- Block V Lot . Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ...................... Underwriters Approval ........................ Planning Board Approval .................... Request for Temporary Certificate ..................... Final Certificate ...................... Fee Submitted $ ............................. Construction on above described building an~eT~plicable codes and regulations. Rev. 10-10-18 ~ ~ 765-t802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND[ ] INSULATION [ ] FRAMING ~ [ ] FINA,~,,~. _~ ~- . REMARKS: DATE ~///~/~ I NSP£CTO"/~(~~ tiDATE II OO'h'~,,~t$ FOUNDA'TION (1st) FOUNDATION (2nd) ROUGH FRAME & ?LUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 ', TEL.: 765-1803 Examined..~..,~ .;~t~..., 19~.~. 1, . .permit Disapproved a/c ..................................... ............. (Buildih~ APPLICATION FOI: INSTRUCTIONS /~ece±ved ........... ~19.., 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 16cation '0f lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed descriptioh 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 !aws, ordinances, building co..d~-ghousing code, and regulations, and to admit authorized inspectors on premises and in buil4ing for necessary in~pe'cti9~.~ /f/] ~ (Signature of applgcant, of/~ame, if a corpomtio, n) X ...... (Mailing address of applicant) State whether applicant is_owner lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... .~..~/~( .~. .................................................................................. Name of owner of premises .../.62.~ ~ .k~.·. .~..~. ~2~ ~.,W./...4'.~ ........................................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) . Plumber's LicenseNo ......................... Electrician's License No ....................... Other Trade's License No ...................... I. Location of land on which proposed work will be done .................................................. ...7/. z. ...... .e': .................. : ............................ House Number Street Hamlet ~" .~... t' .... 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 ........... T' ....... ~" 't~, .. ~ ,,d ............... b. Intended use and occupancy 3. ~?re o~f~work (check which applicable) New Building . ' Addition ~... Alter 'an ~* .' I ............... atl ............ Kepa~r .............. Removal .... Demolition Other Work ' I' ~ t ~ ~.~z./ (Description) 4. ~E~timated Cost .... ~ ~.~, ~ ..................... Fee ~ (to be paid on filing this application) ~ "' 0fd 5. If d~lhng, number of dwellin units ............... Number welling units on each floor ................ If garage number of cars 6. If business, commercial or mix ~d occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing stmcturbs if any: Front Rear Depth Height ............... Number of Stories ........................... D~ensions of same structure With alteratio~ .............................. [additions: Front ............ Rear ........ Dep~ ....... · ~, [[ ............ Number of Stones .................. m ............ ~" ~ '~s ' ' .......... Di ensigns of entire new co~o~h~ .~ Rear ............... Depth.. ~ : ~ ~ .............. ......... . ........ 9. of o : .. ...... :: .... .... 11.1°' Date oePurchase ~ --~- ~.~5~,~)~: a;~ ;[~ .... A .......... ~ ......... }~ '~~i~s~ "TM omer uwner ............................. 12. Does proposed construc~~~nance or regulation. ' - " 13. Will lot be regraded .... ~~1~.~.. Will excess fill be removed from premises~ ' ' ~i ' ' No 14. Nme of Owner ofpremise~.~. ~: ...... Address ................... Phone No ................ Nme of Architect ....... ~ .~ ........... Address Nme of Contractor ...... ~fi. ..... ' .................. Phone No ................ ........... Address ·: ........ Phone No...~/ ....... 15. rs thSs property located iw~thSn 300 face of a t~dal wetland? ~s 2 .... No ..~. ~Zf yes, Southold To~ trustees Permit maybe required. . ~ PLOW DIAG~M ...~- Locate clearly ~d distinctly ~1~ bufld~gs, whether existing or proposed, and. indicate ~1 set-back d~ensions from~ property fines. Give street and block]number or description accord~g to deed, ~d show street names and indicate whether* inte~or or corner lot. 1 FOU~OATION TWO REQUIRED FOR POURED CONCRETE STATE OF NEW YORK, COUNTY OF . . . S.S 2 ROUGFt ~:RAMiNG & PLUMBING , ' 4. FINAL CON~iTRUCTION MUST ............................. ; ................... being duly sworn, d~[~o~l~lt~l~¥Esl~lFl~~ the applicant (Name of individual signing contract) ALL CONSTRUCTION SHALL MEET above named. i THE REQUIREMENTS OF THE N.Y ~'ATE CONSTRUCTION & ENERGY : i (Contractor, agent, corporate officerg~ltt~N OR CONSTRUCTION ERRORS,' ' of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his 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 ............... ~.f~. ..... day of i .... ~ .......... ,19 ~l~~'~j / (Signature of applicant)