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Home My WebLink About14317-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z13898 Date October 4 .8.5 .................................................. 19 . THIS CERTIFIES that the building ....dg. qk...&..w.a..J..k.. ............................... Location of Property .... 7. .5 9 ............ .L.J: 1..ag..b.a...n9 .............C.u.L..c.h.o.tj..u. ? ......... House No. Street Hamlet County Tax Map No. 1000 Section ..... 3:..0.4 .... Block .... 1 .Lot .. 25 Subdivision., .~As.s. ,a.~. .Z~. T.ra.s. .............. Filed Map No...1.1.7.9...Lot No ..... 125 conforms substantially to the Application for Building Permit heretofore fried in this office dated ..... .A.v, gk~g..6. ...... , 19..8.5pursuant to which Building Permit No... 14317Z dated ...... S.~9t;:~luh.~¥..3.0. ....... 19..8.5, was issued, and conforms to all of the requirements of the applicable provisions of the law, The occupancy for whiclt this certificate is issued is ......... .... De. ck. ar~d .xaaJ-J~ ............................................................ The certificate is issued to ............. PxQI~lgRT..&. tgS~r,.~lI2tg..t~]~1~t3~ ..................... (owner, of the aforesaid building. Suffolk County Department of Health Approval ............... 3I/A ....................... UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 I~OB, M NO. B TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO_ 14317 Z Permission is hereby granted to: ....... .Z~ ...... .~.~..~.~ ...... ~: ........................... ,o ......... ~..o..~.~..~..~.~ ......... ~.....~.....~..~ ...................................................................... at premises located at '~'0 ~ )Z/CC ~ ~ ~'~....~..e..~ .~..~. ............ County Tax Mop No. 1000 Section ...... ../..0....?. ........ Block .......... ~. .......... Lot No......~......-~.. ........... pursuant to application dated ................................................... , 19......~..~nd approved by the Building Inspector. Fee $ ........................ Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ~ 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, 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 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: I. Certificate of occupancv $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 $15.00 Date ......................... New Building ............. Old or Pre-existing Building ............ Vacant Land ..... '; ....... .......... .... Location of Property . ..-~.~. ...... ' ' ' House No, ~ Street , k~ Hamlet Owner or Owners of Property ....... ,~...~....~...~...~...~. J..~....~....C.[...~...~ .~ ......... County Tax Map ,o. 1000 Section .... ~.Q .~. ...... Block ..... ! ......... Lot ................ Subdivision...~.~.~...~..~C./~..~ ......... Filed Map No.././.-~. ~ .... Lot No. J..~..~..., ..... Permit No. ~ .~.[~...~'. Date of Permit .(~/~./.~..~.Applicant...~. jl~...~.?~....~.i~,~ .......... Health Dept. Approval ...... .~/.~. ............. Labor De~)t. Approval ...................... .. Underwriters Approval ..... ~V//~ .............. Planning Board Approval ...................... Request for Temporary ~ificate ..................... Final Certificate .... .Y~.'. ............... Fee Subm tte ........................ Construction on above described building a~d permit meets all applicable codes apcL, regula~ons. Rev, 10-10-78 "FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined Approved ....... .... 19 rpe mitNo. /7. .¢. Disapproved a/c ..................................... TOWN OF SOUTHOLD Received ........... ,19... .................................................. ........ ........ APPLICATION FOR BUILDINGPER~IT~ ~---//'/' -- ~ ~at~------- ...... ~.l .... (?-./(., 19 ~.,~.-' INSTRUCTIONS '~ · ; a. This application must be completely filled in by typewriter or in ink an~%s~mitted to the Building Inspector, with 3 se,~ 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 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, building code, housing code, and regulations, and to admit authorized inspectom on premises and in building for necessary inspections. ,,,,,,,~ /,; ("~ignature of applicant, ~a'tion) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. O.ca.z-). ~ .~.~ .......................................................................... Name of owner of premises ../'~.O..,~..I~'..~..T.....F~:.~'"~''' -- &-/-L~.~..~.,....~../.'.&.-..~..~b%.. ................. (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...~~q. .......... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location ofland on which proposed work will be done. .7. -%-O ~,//._/q ~ ..... .¢...q., .T:. ~/.Y. ?...5..u..~. ~..Z.: .................................. : ltouse Number Street Hamlet County 'Fax Map No. 1000 Section ...... [.Q, 4 ...... Block ....... ] .......... Lot ...... .~. ~ ........ Subdivision ].Y]/~ ./9....O. ~... ~J...~.~..~./~.(<)..../.-~.~..~.~.-~Filed Map No.../(//../7.?.... Lot../...'~..?. ..... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... .~./Ut L~'''~ .. 1~. fg..../~. Ji.~...~/..../~..O..~.' .~..L,~.-~. ........................ b. Intended use and occupancy ....... ~ ~ d~ ~ f~ ~ ~ ~.~.~../--. ~.' .:.'f '~ "~"~ 3. Natffre of work (check which applicable): New Building ..... ' ..... Addition .......... Alteration .......... .Repair ...a~,,~.,~ .~ .,~ ,, Rem,bvai ............ Demolition .............. Other Work ............... ~l O ~ [ ~ (Description) 4. Estimated Cost ......... .~..j. ..~......-.~. ............. Fee ........................ · .............. . ~' (to be paid on filing this application) 5. If dwelling, number of dwelilng units ............... Number of dwelling units on each floor ................ If garage, number of cars .... i .................................................................... 6. If business, commerciai or mixed occupancy, specify nature and extent of each type of use .................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth .............. Height ............... Number of Stories ....................................................... Dimensions of same strncture with alterations or additions: Front ................. Rear ................. Depth ................... ~... Height ...................... Number of Stories ..................... Dimensions of entire new construction: Front ............... Rear ............... Depth .............. Height ............... Number of Stories ........................................................ 9. Size of lot: Front .......... i ............ Rear ...................... Depth ...................... 10. Date of Purchase .......... i ................... Name of Former Owner ............................. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction viglate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises . .i .................. Address ................... Phone No ................ Name of Architect ......... i .................. Address ................... Phone No ............ ~ ... Name of Contractor ........ .................. Address ................... Phone No ............ ~.,., PLOT DIAGRAM l,ocate clearly and distinctly all buildings, whether existing or proposed, and. indicate ail set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. STA'rE OF NEW YORK, COUNTY OF ................ S.S ............................ I ..................... being duly sworn, deposes and says that he is the applicant (Name of individual si~ning contract) above named. He is the ........................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d~ly authorized to perform or have performed the said work and to make and fliP-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 mantlet set forth in the application filed therewith. . Sworn to before me this I ... Oount N1~4707~78, ~ultolk ~ Tern F.x~. M~h 30. I~x*,7-~