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Home My WebLink About14728-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building ........ .d.e.c.k...a.d.d.~..~ .~.o.n. ........................ Location of Property .... ¢ 9.0..134 .~.~.s.. $..~ ?.e.e..~ ~ .............. C.u. ~ 9.h.qg .u.e.,..~ .e.w..Z.o..v .k... House No. Street Hamlet County Tax Map No. 1000 Section . .1.3.7. ....... Block .... 5. .......... Lot..~ .~ .............. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .gpr.t.2..3, ............ 19 .8.6. pursuant to which Building Permit No..q.6. 7..2.8.z. ............. dated .&pr J-J-..2, .................. 19..8.6, was issued, and conforms to ail of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... .d.%q 1~ addition The certificate is issued to ..... J~.c.K. ~i~a.l.q r~ .~ ......................................... (owner, ~,~ ~I~ of the aforesaid building. Suffolk County Department of Health Approval ................. ~ [.A ...................... N/A UNDERWRITERS CERTIFICATE NO .................................................. Rev. 1/81 Building Inspector FOEM NO. ft TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 14728 Z Date .0~ ...... ~ ....................... , 19...~..~ Permission is hereby granted to: ,~,,,~..,:,.....~..~.~.~ .......... ...... .~/...~.......~)..~......~.....~ ..................... ..~~..~..;.~.:~..:..!.!.~..~.~.-.. ........ , ........ ~ ............ ~.....~. ....... ~.~.~ ............................ ot premises located at ......:~,.o...'..O.......'~.--'~......~.~....~, ......... ~~~ ...................... ~.....~...~...~.~ .............................................. .... .................................................... County Tax Map No. 1000 Section ..... l..,~.,--J. ........ Block ....... ,~ ............ Lot No ...... !..~. .............. pursuant to application doted ......~.~..~.,.~ .................... , 19..~...~, and approved by the f~uilding Inspector. Fee $.~:..~ ..... Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall $outhold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANC' 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 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. 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 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.Oo $5.00 5. Updated CoO. $15.00 NewCons t~uction ...... Old or Pre-existing Building $15.00 / /r Date ..... {/. ...... T ,/% ......... ............ Va;ant L~n:TM . Location of Property .. 2.E)..(,).. ~..C:~7~-....' ................ ~c'7~: ~ ~_ House No. Street Ham/et Owner or Owners of Property ........................................................... County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ........................... i..,..Filed Map No ........... Lot No .............. Permit No. ate of Permit .. . cant .................................. Health Dept. Approval ...................... Labor Dept. Approval ........................ Underwriters Approval ...................... Planning Board Approval ........ Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ................... ~ ...... Construction on above described bull m e codes and regulations. co:) F~E L~iNS~ECT~ON COMMENTS FOUNDATION {1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: TOWN OF SOUTItOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765q 802 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(~57/not on file.)- /5/ No Health Dept. Approval on file. /Z/ No final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. Building Permit ~ ~_ ~ ~_ ~/_ ~__ Z Building Dept. **~/~/ No Plumber Solder Certificate on file. { all permits involving plumbing being issued after April 1,1984 ) TOWN OF $OUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL $OUTHOLD, N.Y. 11971 TEL. 765-1802 To Whom This May Concern, Please complete the enclosed application for Certificate of Occupancy and enclose a check for $5.00 (the f~e for the C.O.)' and I will be able to 'complete the Certificate of Occupancy. Thank you so much for your cooperation in this matter. 765-1802 BUILDING DEPT.' INSPECTION FOUNDATION IST [ ] ROUGH PLBG, [ ] FOUNDATION 2ND [ ] INSULATION DATE Examined., ' .% .... 19 g.~. Approved ~...~' ..... 19~.Lq· 'FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL °.,OUTHOLD, N.Y. 11971 TEL.: ,765-1803~_~ Permit No ............ Disapproved a/c ..................................... ................................ (BmTding Inspector) " APPLICATION FOR BUILDING PERMIT BLDG. DEPT. TOWN OF SOUTHOLD Received ........... ,19... 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 tiffs application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector wiil 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 necessaw~,nsp~ections.tx; ~ureo f~~if a c orp oration) ?. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, on,neet, general contractor, electrician, plumber or builder. .... ......................................................... Name of owner of premises...J~..~. ~. · Ffl~ .~. · .0.iQ.. · .~A. ........................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized of ricoh (Name and tit!.,etof,corporate officer) . Builder's License N ................. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... I. Lojaationoflandonwhichproposedworkwillbedone..t~..O..O.....~..~...~..~.'.....~* ....................... t~;a~e' ~u;~r' ' ~ ..................... ~ir;;i ....................... t);~n',;; ........ ; ~ .... ~ ........ County Tax Map No. 1000 Section ....... ]..~..~. ...... Block ....... ~ ........ Lot ~ Subdivision ..................................... Filed Map No ............... Lot ././.:/7. ~- (Name) 2. State existing nsc and occupancy of premises and intended use and occupancy of proposed construction: · . m a. Emsnng use and occupancy ...... ' .............. J. i". ............................................ b. Intended use and occupancy ................................................ 3. Nature of work (check which applicable): New Building ..... ' ..... Addi'ti9n ........... Altoration ...... i... Repair ............ Removal .............. Demolition ...: ..... '... Other Work ~[~(~.K... (Description) 4. Estimated Cost... 0~. j j~/.6'f..4~. ......................... Fee .... : ..... i ............................ ' (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling uniis on each floor ................ If garage, number of cars ............................................ i ............................ 6. If bus ness, commercial or mixed occupancy, spec.fly nature and extent of each type of use ..... ' ........... 7. Dnuenslons ofemstlng structures, if any Front .~.~..I :~g~ ...... Rear ~..'.d.~,~ ........ Depth f~.-9- t .~. Height .. Number of Stories ..... [. ~..~. ................ - '. ..... i. Dimensions'of same structure with alterations or additions: Front ............ i ..... Rear .................. Depth ...................... Height ...................... Number of Stories ...................... Dimensions of entire new construction: Front .......... ..... Rear ........ i ....... Depth ............... Height ............... Number of Stories · ' ' ......... Size of lot: Front . ].~.~e.3.Q. .......... Rear.../.~,i~..,.<~.4'7 ......... pepth ............. Date of Purchase ............................. Name of Former Owner . ! ............................ 11. Zone or use district in which premises are situated .................... ..... 12. Does proposed construction violate any zoning law, ordinance or regulation.' . .' .~.' ~.l ......................... .......................... 13. Will lot be regraded ....... d~.~ ................ Will excess fill be rem(~ve,d from premises. Yes 14. Nmne of Owner of premises . .~..'~'./.~D.~¥ ......... Address~..? .14/~./7~a~o. ~..~ .... Phone ~7o..). ~. ~ ~../.o/.-7~..' Name of Architect ............... Address ............... , .... Phone No ........ Name of Contractor ~. il~f.'/'[~:/~ i i~i; i i i i i i ~'~ 1~o ~ ........ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number 0r description according to deed, and shin street names and indicate whether interior or corner lot. 9. 10. STATE OF NEW YORK, S.S 6 i e~ X'~¢:)O0 ' ~ · . ~f~J~.. ~..~.~ [ ~ ~ ............... being duly sworu, deposes and says that he is the applicant (Name of individual signing contract) above named, l He is the ......................................... [ ........................... (Contractor, agent, corporate officer, etc.)~ of said owner or owners, ~d is duly authorized to perfom or have perfomed the s~id work and to m~e and file this. application; that all statements contained ~ this application are true to the best of his~owledge and belief; and that: the work will be perfomed in the m~ner set forth in the application filed therewith. ~ Sworn to before me this ~ ............ 4K of .... ........ 0 26.7' _j ~L~ONSTRUCT~O~ SHALL THE REQUIEEME~TS OF ~'HE N.Y STATE CONSTRUCTION ~ ENERGY CODES NOT RESPONSIBLE ~R