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Home My WebLink About15150-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hail Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building ....r.ep.l.a.c.p.m.e.n..t..o.f...ap..a.c..c¥....b..1.al.g,....i.n..r.e..a.ryard. Location of Property ..... 9.5..5... Soundview Avenue Ext:. Southold House No. ' .................. 's'tie31" ...................... County Tax Map No. 1000 Section ..... 5.0. .....Block ....... 2, ....... Lot ....~.~ ............ Subdivision ...... X Filed Map No. .X Lot No. X conforms substantially to the Application for Building Permit heretofore filed in this office dated .... ~..u..~z..2.8. ,..1.~. 8..6... pursuant to which Building Permit No ...... ~ .5.1.5.0. g. .... : .... dated ....... ~Tp.],.Lz..2p.,.. 3 .9.8.6. ..... 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 ......... .... ~ep3.~gem.e. nt. ~.c.~e~ ~.o.~.y.b.t~.~. O.~.n.g. $.n..t.h..e. ~e.~..~. ~.a.~.~.. ................... The certificate is issued to ............. ~Tg~l]~ .~,..~.~ggp,~.~ ! S .......................... of the aforesaid building. Suffolk County Department of Health Approval ................. .I~/.~. ........ . ............. UNDERWRITERS CERTIFICATE NO ........................ ~/.~ ...................... PLUMBERS CERTIFICATION DATED: N/A · Rev. 1/81 TOWN OF $OUTHOLD BUILDING D£PARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDIt4G PERJ~IT (THIS PEP. MIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15150 Z Date Permission is hereby granted to: .... .......... .... ....~..ff...¢.~...~.u..~....~..:..~Z ..... ~..~.~......~.:~.:...u..~.zt ............ ~,~....c~.....~,~.....~..~ ........ ~ ............................................................ ak~)t premises Iocoted at ....~.....~.'.~.......~.~,.~...~.:,....~..-...~:. ...... ~.. County Tax Map No. 1000 Section ,.L..C~..~.... ....... Block ...... .~.....'~... .... Lot No ....... !,! ............... Building Inspector. approved by the Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building De~=rtment Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ~I 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 Hea~th 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 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: Additions $25.00 1. Certificate of occupancy New Dwelling $25,00, Accessory'i$10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C,O. $ 20.00 5. Updated C.O. $ 50,00 Date...~.~..~:.5].~.~.] ....... NewC°nstructi°n ...... Old or Pre-existing Building ............ Vacant Land ............. House No. Street Ham/et Owner or Owners of Property .... .~. 9.~-~.~...~'...-~. ~ .q'.q .~./~,t(.. ¢.~ ......................... County Tax Map No. 1000 Section .............. Block .............. hot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Perm it No. ~.~. ~.~..~..~. Date of Permit ~.(~l ~'~'' .Applicant.. >.~..~..~../~....~J~-:~.. ?..~.~% % '.~ ..... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate .... ~ ............... Fee ......... Construction on above described building an~t__ .. pCmit/~neets ~l/applicaJ~'e.codes and regulations. TOWN OF $OUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 To Whom This May Concern, We are unable to complete your Certificate of Occupancy because .of the following reasons. /Z/ An application for Certificate of Occupancy is not on file. /~ No Underwriters Certificate on file. /_~ The check is(~/not on /~/ No Health Dept. Approval on file. /5/ No final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. Building Permit # _~ ~ ]_ ~ O Z Building Dept. ***/5/ No Plumber Solder Certificate on file. ( all permits involving plumbing being issued after April 1,1984 ) Occupancy or use is unlawful without a Certificate of Occupancy. Clear up this matter as soon as possible so that le§al action does not have to be taken. Thank you for your prompt attention. FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: ,~/~ BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. FOUNDATION [ ] INSULATION ZND FRAMING [ ] FINAL ,il ''~: > ~ 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined. ,_.~ .~,,.c~.., 19~.(t' Approved .~..&.c~.., 19~.~. Permit No. 1..~.]..~..'~...~: Disapproved a/c ..................................... Received ........... ,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 appl~z 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, build~g code, hous~p.g code/')and regulations, and to admit anthorized inspectors on premises and in building for necessary inspec~(~ns.~[ ,-~,-~ ........ ./:l. : .X. ....... (Si¢/.,,ure of ap. plicant, or name, if a corporation) - .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .... .'75.°..~'..~. · · · PT.~ · ·.~. ?-'. .~>. · .O. .K- .~. ~. · \ '>- ...................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. Builder's License No. ~ ...... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed wore will 'be done ............. .¥..: ................................ House Number Street Hamlet County Tax Map No. 1000 Section ...... .(~.. ~ ..... Block ...... .~.~ ...... Lot .... ~.,f ............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State ex/sting use and occupancy of premises and intended use and occupanc~ of proposed construction: a. Existing use and occupancy ...... ~.~..~....~.. [-~ .K~..~...~.~-~..-~L~.I ...[~...~...l~..e4 ~.,~- f~'..'('~x.. b. Intended use and occupancy .................................................................... ' 9. 10. 11. 12. 13. 14. 15. *If yes, Southold Town Trustees Permit maybe required. PLOT DIAGRAM Nature of work (check which applicable): New Building .... Addition . ~ ........ Alteration ......... Repair .............. Removal .............. Demolition .......... [... Other Work ............... .~.~..~...~. T/.' .' .' .' .' .' .' .' .'~'.. (Description) E tim d Co Fee s ate st ....... ~ ...................... , ...................... . (to be~ paid on filing this application) If dwelling, number o f dwelling units ............... Number of dwelling units on each floor... '...' ..... :.-..: If garage number of cars If business, commercial or mixed occupancy, specify lla.ture and extent of e~,cb ty~pe of use l~;~'h' '''~..I Dlmenmons of e.xist~ng structures, if any: Front .... 3. 7 .t:~, ...... Rear . .c~ .-. O. ....... '!i ..... Height .... ~?..Z..'~ .... Number of Stories ....~..'.~.~--~ ................. ............... Dimensions of same structure with alterations or additions: Front ........... i ...... Rear .................. DD;mP!h~ ..... ;lc ..... ,nle .... ~ 't~ 't~:~r ........... ';:~>?}:: 'I~' 'rN.U.~.~. ?.fo~!?.';s.: ' ' 'p't~ ........... sions o ntire w co s c ont ..... I.t;>. ea De . .~ x.-.~:5>? ..... Heig ..~.--.~ .... Number of Stories .... t~P.*~-X~-, .......... . . ...... .............: Size oflot: Front ...................... Rear ...................... ~ Depth ..................... Date of Purchase .... .'7'1 \7l ~ ................... Name of Former Owner i. ~O.b-~ ............... Zone or use district in which premises are situated ...................... .... . Does. proposed construction violate,z>any zoning law, ordinance, or regulation. .... 1 ............. r,",'~ ~ ti *. St~(;~ ...... ~o ,~ q/Iff.a w:_ Will lot be regraded ......... ~. ................. Will excess fill be removpd from premises: Yes No Name of Owner of premises ~.~-~I.~.t4~1-$..;; ..... AddresS~.~..~.~.~. ~ ./j~. ~0.~. ~Phone No."}6 ~.* .~.'g.~.~'. .... Name of Architect Address Phone No Name of Contractor .... ~.~,~.~-~kqt~ ....... Address ~.~. ,~o~£ g/i~.~,.L .~.hone No.'l.6,~.'.~.Z, .4-~.. Is this property located within 3(~ feet of a tidal wetlandV ~ e z"°r' ~ ~' '' Locate clearly and distinctly all buildings, whether existing or proposed, and. ihdicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and ~ndlcate whether interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF ................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the (Contractor, agent, corporate officer, etd.) 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 tha. t the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this I i