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Home My WebLink About14831-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No .... ~ .1 .4.5.1. l ....... Date ........... 4u..rig..1.3. .............. 198.6.. THIS CERTIFIES that the building ..... gl>.qv.q, g?.o..u .n.d..i~o. 9.~ ....................... Location of Property ... 2.6.5 ............. g.u~nle..1..~.v.e., ............ .S.qu. ~..h.o.l.d. ........ House No. Street Hamlet County Tax Map No. 1000 Section .... .6.3. ..... Block ......... 2. .....Lot .... .q ,5 ........... Subdivision ............ X ................. Filed Map No .... .X .... Lot No ........ .X ..... conforms substantially to the Application for Building Permit heretofore filed in tiffs office dated .... fi, l~ C ~- )~..2 ~3 ........ ,19.8. ~ pursuant to which Building Permit No.. q 4 ~3 3 q z dated ........ ki~.y.. 3 .............. 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 ......... ·. A.hov~..g~ o~,n.d., p 9.o.], ......................................................... The certificate is issued to ................ ~]~A~..&..~ .I~,.L.I.A .H.Z. UKA.S .................... of the aforesaid building. Suffolk County Department of Health Approval ................ ~l/.A ...................... UNDERWRITERS CERTIFICATE NO ...................... ~ ? 5 ~.9. l ~ .................... Building Inspector Rev, 1/~1 ~0~w NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERNilT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 14831 Z Permission is hereby granted to: ...... ~ ...... ~ ...... .~....._~..~ ............ ...~X...~....~.:~.:...~..4.t~./. ....... n ,o...~...~.......~ ...... ~.....~,,~...~..~.~.~ ......... .......'*'~'r- ......... , ............ _'*_' ........................... . ':'"*~ ............. ~ ................................................. at premises located at .....~....~.....~....../~.~...~.:.....~,~'~~.4~_ ......................... pursuant to c~ppiicotion doted ......................................... I '/'~ --~ ''~) , 19 ..... ~...~.., and approved by the Building inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - !802 APPLiCATiON FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted m I~mm~ma 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 sifnilar 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 property 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. 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.O. $5.00 5. Updated C.O. $15.00 $15.00 Date ...................... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ~ ~ ~'- ~ .~ .~.. ,~2 ~ //q L~ ~ /~ ~" .................. ......... ................. House No. Street Ham/et County Tax Map No. 1000 Section ..~.~ .~ ...... Block .... ~. ~ ...... Lot../.~ ....... '... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. [ :~.~. 9.~,Z. Date of Permit ~.~/~..~.~..Applicant..~..,~. r~. ,C,~. ~, .=. ~..c~. (,<~. ,~, ..... Health Dept. Approval ........................ Labor Dept. Approval ....................... Underwriters Approval. ~..?.~.~ ~.?./.L~. ........ Planning Board Approval .... ._/~ ............. Request for Temporary Certificate ..................... Final Certificate ...................... Fee Submitted $. ~.; .O.Q ................... Construction on above described building and permit meets all applicable codes and regulations. O'r~:~'~ ' L'~/( Applicant . .e.~'~..~...(2~... ~ ............... Rev. 10-10-7a FIELD INSFECTION --~-~--~ 1. FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME & FLUMBING (2nd) INSULATION PER N. Y. STATE ENERGY CODE FINAL~/ COMMENTS ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION []FRAMING []FINAL REMARKS: DATE ~./~/~///~ INSPECTOR 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 8OUTHOLD, N.Y. 11971 TEL.; 765-1802 xam ned.. .... .... o~ 19~.(q. Permit No ) q ~ -'~'! ~: Approved Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT APR 2 8 1986 BLDG, DEPT. TOWN OF SOUTHOLD Recelved ........... ,19... Date ................... 19 INSTRUCTIONS a. This application must be completely filled in by,typewriter Orin tin~affd~ubmitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according ~g s~¢~ed~le..~` 2~[1 ~ b. Plot plan showing locatiorPof lot and of build~hk~ b~ ~i~fiil~es~ relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property~l~ust be drawn on the diagram which is part of this appli- cation. ~n~~ c. The work covered by this application { ed before issuance of Building Permit. d. Upon approval of this application,~ l]~il~In.~ will issued a Building Permit to the applicant. Such permit shall be kept on the premises available f~!2~ lect~thli~l~o'ut the work. e. No building shall be occupied~ ~7~ [~~n 12art~''~ 'for any purpose whatever until a Certificate of Occupancy shall have been granted by the Bu~ ~/~st~'~lIk~* ~$~ ~ .'~ APPLICATION. . IS HEREB¥[~ ~(~ }~1~1~ tment for the issuance of a Building Permit pursuant to the Building Zone Ordinance of Jl~J~w~ o~,~.~.~.., County, New York, and other applicable Laws, Ordinances or Regulations, for tlie constm~.~ ~ldi~ ~,~' or alterations, or for removal or demolition, as herein described. The applicant agrees to comply ~. tl~I~.al:~ s, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on pre'l~ts~ ~ for necessary insoections. ~ .~...~..~. ~ ~ (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owne.~r, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. -Nam;of owner ofpr~mis-es .~.. If applicant is a corporation, signature of duly authorized officer. .............................................. NOT~Y ~tflLDING DEPARTM~T AT (Name and title of co,orate officer) ?6,5 '~2 9 AM TO 4 PM ~R THE Builder's License ~o .......................... Plumber's License No ......................... Electrician's License No. 4 - -' ..... r, t.~, t,N MUraT Other Trade s License No ................... 1. Location of land on which proposed work will be done. ~zr~z~U~,~;a~,v~M. ~. 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 nsc and occupancy of proposed construction: a. Existing use and occupancy.. ~.../2~.. _~_~, ~ ,~ / .... b. Intended use and occupancy ............................................. 3. Nature of work (check which applicable): New Building ' Addition ...i ....... Alteration .......... Removal .............. Demolition ............ '.. Other Work....~...¢-P~...... Repair ~ ~ --(Description) 4. Estimated Cost .......... ~...' ..................... Fee . .. ' ............................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling uniti on each floor ................ If garage number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear ........ i ...... Depth ............... Height Number of Stories . Dimensions of same structure with alterations or additions: Front ............. : .... Rear .................. Depth ...................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ......... ...... Depth ............... Hight Nu bet of St ries e ............... m o ........................... ; ............................ 9. Size oflot: Front ...................... Rear .................... .. Depth .................. .. .. 10. Date of Purchase ............................. Name of Former Owner .. ........................... 1 1. Zone or use district in which premises are situated .......................... : ........................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... i ........................... 13. Will lot be regraded ............................ Will excess fill be removed, from premises: Yes No 14. Name of Owner of premises .................... Address .................. Phone No ................ Name of Architect ........................... Address .................. Phone No ................ Name of Contractor .......................... Address .................. Phone No ................ 15. Is this property located within 1100 feet of a tidal wetland? * yes ..... No . * If yes, Southoid Town Trustees Permit may be required. PLOT DIAGRAM ' Locate clearly and distinctly all buildings, whether existing or proposed, and~ ind;icate all set-back dimensions from property lines. Give street and block number or d6scription according to deed, and showi street names and indicate whether interior or corner lot. ' ~'" '~ ' ENCLOSE POOL ?0 CODE STATE OF NEW YORK, S.S COUNTY OF ................. ................................................. being duly sworn, deposes and (Name of individual signing contract) above named. says tha~he is the applicant He is the .............................................................. : ........................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performe~l 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 ........ ' .... a~.~. ........ day of ..... ~ ....... , 19 ~.. /~). ~..ftC/..t~.... County J2~ Notary Public, ~lk'~ _~_~'/~_~~,/ ' ] - , ]~Si~t'ature of appJi;e~t)