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Home My WebLink About14730-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. ZI6113 Date September I, 1987 THIS CERTIFIES that the building install bow window Location of Property 57125 Main Rd South old hi &'o hid ....................... 's't/e i ....................... h ,;,iei County Tax Map No. 1000 Section ... 9.6) ...... Block 03 .Lot 19 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·.. gaF.cD..3.1.,..1.9.8.7 ..... pursuant to which Building Permit No. 14730Z dated.....Aprll ...... 3,. ........... 1987 ..... ~ 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 . .aa ..... install bow window in existing office building as applied for. The certificate is issued to Burr Lewis ..................... [o~n'o'r, '/~e'&'t;~a'n't) ...................... of the aforesaid building. Suffolk County Department of Health Approval N/A N/A UNDERWRITERS CERTIFICATE NO .................................................. PLUMBERS CERTIFICATION DATED: N/A Rev. 1/81 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) 1N? 1~1730 Z Permission is ....~....~. hereb/granted to: ..... ,o ....... ~, ~,~ ,~,,,a ~,....~..mi ....... .~ .......... ~.~....~ ........ ~.~..~ ..................... County Tax Map No. 1000 Section ...... .(~...~...:~ ..... Block ...... ..~...~ ...... Lot No ...... L.~. ............. pursuant '0 application dated ........ ....~.~.~......~..J ............. , 19..~.,~,'~and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall $outhold, N.Y. 11971 765- 1802 TOWN OF SOUTHOLD 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 similar buildings and installa- lions, 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- lion required to prepare a certificate. C. Fees: Additions $25.00 1. Certificate of occupancy New Dwelling. S25.0.0, Accessory ,.$10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancv $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date ...A.u.~.u.s.t.26:1987 . NewConstrucgion ...... Old or Pre-existing Building ............ Vacant Land ............ Location of Property 57125 Main Road Southold, New York House No. Street Hamlet Burt Lewis Owner or Owners of Property ............................................................ 63 3 County Tax Map No 1000 Section .............. Block ....... Lot ..... 19 Subdivision ................................. Filed Map No ........... Lot No .............. 4/3/86 Bur~ L~w~ Permit No...........]4730Z Date of Permit .., Applicant ..... Health Dept. Approval ........................ Labor Dept, Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $.. 25.00 Construction on above described building and permit meets all applicable codes and regulations. Applicant .................. Rev. 10-10-78 COMMENTS FOUNDATION (lst) FOUNDA~TION (2nd) ROUGH FRAME PLUMBING INSU'LATION PER N. Y. STATE ENERGY C,ODE ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN'OF SOUTHOLD BUILDING DEPARTMENT ?TOWN HALL · SOUTHOLD, N.Y. .... Disapproved a/c ..................................... ................................................ ...... (Building Inspector) APPEIC~TION FOB BUILDING ,~ ~ ~; ..... ~. ~: ~ ~ ~g~gNSTRUCTIONS ' a. T~s application m~? b~ :~qly~ill~&. J~ h~ f~e~er or in ink ~d submitted to the Building Inspector, with 3 , b. Plot pl~ showing' l~o~t~o¢ p~.~9~[ ~d'of~3ild~s on premises, relationship to adjoining premises or pubic streets or areas, and giv~g a det~l~d"d~sct~p~.~gf ~B~t of property must be drawn on the diagram which is pa~ of this appli- cation. ' '; -( 5 c. The work covered by t~s application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a BuJld~g Pemit to the applicant. Such pemit shall be kept on the premises available for inspection throughout the work. e. No bufld~g shall be occupied or 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 ~nspector. APPLICATION IS HEREBY MADE to the ~uilding Dep~tment for the issuance of a Bffilding PomJt pursuant to the B~JldJng Zone Ordinance of the Tow~ of Southo]d, Suffolk County, New York, and other applicable Laws, Ord~ces or Regulations, for the construction of build~gs, additions or altgrations, or for removal or demolition, as herein described. The app~cant agrees to comply with a~ app~cable laws, ordinances, building code, housing code, a~d regulations, a~d to admit authorized inspectors on premises ~d ~ build~g for necessa~ inspec~~ (Signature of ap~icant, or name, if a corporation) .... ....... (Mailing address of apricot) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner o f premises ...... zS~-.C~..h.~/'. ~ ......................................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .... .~-~,~ .'W-:..: .~... ~./~...~'. ,?F'~,~--)~..~.~_ ...... .... .Q ................................. ................. House Number Street Hamlet County Tax Map No. 1000 Section ......... ~....~.... Block ....... ~. ......... Lot .... /. ~ ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............ .~. ~.---.~>. r .'.C'?.~('I.W~..~ .'Q-...2~. ................................ b. Intended use and occupancy .................................................................... 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... Alteration Repair .............. Removal .............. Demolition ......... ,.. Other Work ............... ~ : (Description) 4. Estimated Cost ...... ./.:~-,~.O ..................... Fee ..................................... '* (to be paid on filing this application) 5. If dwelling, number of dwelling units. / Number of dwelling units on each floor. If garage, number of cars ............................................ i ........................... 6. If business, commercial or mixed occupancy, specify nature and extent of each typ~ of use ..................... 7. Dimensions of existing structures, if any: Front ...... Z- .;~. .... Rear .... ~-~-:S*' ......Depth .... .~..D. ....... Height .... ~ .... Number of Stories ...... ~ .............................................. Dimensions of same structure with alterations or additions: Front .. ~'.' .~-?e.A..:.... Rear .................. Depth ...................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ........ ; ...... Depth ............... Height ............... Number of Stories ............................ , ........................... 9. Size of lot: Front ..... :~/.~:~......~_.:::::: .R~ :: ~a~f ~'o'r~ir'(~v~;;' ,Depth.../.~.~'.. ............. 10. Date of Purchase ...... 11 Zone or use district in which premises are situated . . 12. Does proposed construction violate any zoning law, ordinance or regulation: ../4 ,~ .......................... 13. Will lot be regraded ............. ~.. ............ Will excess fill be removed from premises: Yes No 14. Nmne of Owner of premises . .~.o.~Z-.'E. )~..Wrier... Address .0'~.~.~ .......¢.:.~'2 ~.1 .. Phone No.'7..:~.q~:~.~.~.. ... Name of Architect ........................... Address ............... ~... Phone No ................ Name of Contractor .... .~.'~ (g ~ .............. Address ............... i · · · Phone No ................ 15. Is this property located withint.00 feet of a tidal wetland? * yes ..... No ..... · If yes, Southold Town Trustees Permit may be required. 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 or description according to deed, and shov~ street names and indicate whether interior or corner lot. STATE NEW YOR , 0BCIIPANB¥ COUNTY OF .......... .. APPROVED AS PtOTED D~TE: i a_ B.P ,I' ~t) ~ NOTIF~ BUiLDInG DEPARTMENT A~ 765.1802 ~ ,A~ TO 4 PM ~R THE '1 ~OL~f~DA'vlfi)~q '~O ~QUIRED ................................................. being duly sworn s ~. r (Name of individual signing contract) ~ above named, i He is the ~ ... ': (Contractor, agent, corporate 6fficer, etc.) i of said owner or owners, and is duly authorized to perform or have performed the sald work and to make and file this application; that all statements contained in this application are true to the'l~est ~o~!s ~o,w, le~dge and belief; and that the work will be performed in the manner set forth in the application filed therewith. ~'~' ~ ' ' Sworn to before me this .............. 3 ] ....... day of ....... .~...O./~... ..... , 19 .~.~. ~Totary Public, . ..... ~....~., . .}0~............ J~2._ County .~ N£t£n & I~ ~ nature of applicant) NOTARY PUBLIC, State of New Ye~ '; No a707878 T~r~: "~ Match 30, 19,.~ "