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Home My WebLink About14565-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N,Y, Certificate Of Occupancy No.Z.l. 4 8.4/~ ........... Date .... F· ? .b ?.u.a.p..7..2.5. ................19.8.6. THIS CERTIFIES that the building ...~9 p.d.. ~ .~ 9y.e. ................................. Location of Property .3.5.5. ~.u.m.m..~.~. Rd .................. .Sg.u.g.h. 9.1.d ..... l:l~se No. ' ' ' ' Street ' ' ' it~r~l'et County Tax Map No. 1000 Section . ...0.7.9. ..... Block .... .0.6. ........Lot ..... 1.8. .......... Subdivision.. ~ .e y.d.o. 9..H.e.J;5 .h.l,.s. ............ Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·. ,I).e.c....3.1 .......... ,198. 5.. pursuant to which Building Permit No .... 1.~. 5. .6.5.Z. ........... dated ... ? e..b.. ,2. 6. ............... 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 ......... ·..~Q~Cl..b.~o~.ng. ~.t. qv. ~. ~.n. iP ~.e.m .e ~-.q .......................................... The certificate is issued to ....... L o ~..S,. 3.~4~ ~,e..,v, ................................... (owner, ~e~ gO~q~,J{ × X of the aforesaid building. Suffolk County Department of Health Approval N//~ UNDERWRITERS CERTIFICATE NO... N//~ Building Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Yo BUILDING PEIU~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 14565 Z County Tox Mop No. 1000 Section ...... ...Q?...~..~ ..... Block ........ ..~....~ ..... Lot No ........ 1...~. ........... pursuont to application doted ~..%....e.~.~.....~.....~..~ ............ , ]9.~...~.., ond opproved by the Building ~nspector. Fee Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department 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 mllmmmmma to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of propertv with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supplV 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. C. Fees: 1. Certificate of occupancv $5.00 2. Certificate of occupancy on pre-existing dwelling $15.0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land CoO. $5.00 Date .......................... / New Building ............. Old or Pre-existing Building .... /. ....... Vacant Land Location of Property ... ~..~.'~.c~.-: ..... ~.~,~a,t~?/..~...~..~..~3 ............... :.~.~..Z,/..~./.¥~.~..~).... House No, Street Hem/et 0 0 S of Prop rty ~¢¢ ¢% /~2, ~../¢:/~.,¢~'..~../~. wneror wner e ............................................... County Tax Map No. 1000 Section .... ~.~. ....... Block ..... ~. ........ Lot .... /..~ ......... ,/ Subdivision..~..~'.~¢~.. ~'..-L~ !~.,~..7'~ .......... 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 $ ....... .~.~.O...O. ................ Construction on above described building and permit meets all applicable codes and regulations. Applicant .................................................... ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined 3~.~.~., 19~.~. '~' .a~3¢~.....o~.~ .~..~, 19~..~ Permit No~-~ ~ Approved ....... ~ .................. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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. 'i 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 ~sued a Building Permit to the applicant. Such permit .~hall be kept on the premises available for inspection throughout the work. ~ e. No building shall be occupied or used m whole or ~n 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 necessary inspectio~s./~ (Signature of applicant~'corporation) ?. ?1.. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. .... (~.. ~;..~.~..r~. .................................................................. ..... ] .. ,,, ~. ,,, ~;~/ ~r~P~.O¥~D ~S ~OTED Name of owner of premises ...~ O/~.. ~/~. ,.. ~ ~.~'~.. ~. ............ :: ' ' ~'~ ~l~[~ ..... i ;l'~' ~ .......... (asonth~:t ~ollor~~ ~ ~/ If applicant is a corporation, signature of duly authorized officer. , ~ ~. ~. L (Name and title of co,orate officer) ~65-1~O2 ~ Aha TO ~ ~ ~ Builder's ~icense No .......................... FOR PODH~D HumbeFs ~conse ~o ......................... 3. INSULABO~ EJect~JcJan's ~icense No ....................... ~ CO~PL~ ~O~ Othe~ T~ade's license No ......................THE REQLJi~MEN'fS OF THE STA'rE CONSTNUC~ON ~ ~ERGY ]. ~o~tio~ o~]ana on which ~oposed wo~ wil~ b~ done ........ CO~S..~m;~[~?~j~g~.~.~ ............ House Number Street Hamlet County Tax Map No. 1000 Section ...... 7.7 ......... ...... ........... ot. Subdivision ..... ~}?.¢p.~ . .~.~.L&~.T~. ......... Filed Map No ............... Lot ............... (Name) 2. State existing use and ~ccupancy ~f premises and intended use and ~ccupancy ~f pr~p~sed ~nstructi~n: a. Existing u~ and occupancy ...... ~ G. 4 ~...~. (G~ ................................... ................ , .......... b. Intended use and occupancy ~. · -~ .~. .~..~ 3. Nature of work (check which applicable): New Building ' Addition ......... Alteration .../ ..... ' ' ' . Qthp4' Work .... ~ ...... Repair .............. Removal .. i ........... Demoht~on ............ 4. Estimated Cost .... J~e. ~.. ~ ........ ;. ............................................... /O.a ~~ ~ (to b~ paid on filing this application) 5. Ifdwelling, number of dwelling units ............ '... Number of dwelling units bn ea~h floor ................ If garage, number of cars ............................................. k .......................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type~ of use ..................... 7. D~ensions of existing structures, if any: Front ............... R~ar ........ . ...... Depth ............... Height ............... Number of Stories ............................. ~ ........................... D~ensions of same structure with alterations or additions: Front ............. ~.... Rear .................. Depth ...................... Height ...................... Number of S~ofi~s ........... -, ........... 8. Dimensions ofentir~ new construction: Front ............... Rear .' ........ ' ......Depth ............... Height ............... Number of Stories ...... .................................................. 9. Size of lot: Front ...................... Rear ...................... ~epth ...................... 10. Date of Purchase ............................. Name of Foyer Owner .. ~ ........................... 1 1. Zone or use district In which premises are situated .......................... ............... .... , ........ 12. Does proposed construction violate any zoning law, ordinance or r~gulation: ..... . ........................... 13. Will lot be regraded ............................. Will excess fill be removed from premises: 'Yes No 14. N~e of Owner of premises .}a~3. & ,. ~.~ ~f... Address Y~3T,~m~ t F~.,i... Phone No. N~e of Architect ........................... Address ....... .~.~5~.. Phone No. Nme of Contractor .......................... Address .................. Phone No ................ PLOT DIAG~M Locate clearly ~d distinctly fll bufld~gs, whether existing or proposed, and, Ind~ cate fll set-back d~ensions from property Hnes. Give street ~d block number or description accord~g to deed, ~d show 'street names and indicate whether STATE OF NEW YORK, S.S COUNTY OF .................. ................................................. being duly sworn, deposes and says that (Name of individual signing contract) above namea. he is the applicant He is the ......................................................................................... (Contractor, agent, corporate officer, etc.) bf 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 ................ 4l ...... day of ..... .~,~. ............ 19... No,a.P blic,. .... County NOTARY PUBLIC. 8tal of Will Yedt