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Home My WebLink About14407-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ........ ~. ~.4.Q~ 0... Date ..... P.e. cemb.a~. 5 ................ 19 S.5. THIS CERTIFIES that the buildhag ...... c~c.~..a,c]O~..L, iO~ ........................... Location of Property 13 7 0 Latham Lane Or legit House No. Street Hamlet County Tax Map No. 1000 Section .... ~5. ...... Block ...... 9. ........ Lot ...... 1. ~ .4 ........ Subdivision .............. .X ................ Filed Map No .... .X....Lot No ........ X. ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated · .O.q ~:Q~o.e.~. 2.4 ........ , 1985. pursuant to which Building Permit No ..... 14,4.0.7. Z. .......... dated ..... O. 9~p.b.e..~' .2.4. ........... 19.8..5, 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 ......... ·..D. eCk .~ddkt~o~..to. ~.x.is.t ~.g. 9~.e.~.~,%¥. d,~,e.~ .Z;[~g~ ...................... The certificate is issued to WILLJa~M J. & RUTH H. BOYLH~RT of the aforesaid building. Suffolk County Department of Health Approval .................. N../.~ ..................... UNDERWRITERS CERTIFICATE NO .......................... N../..¢ ..................... Building Inspector Rev. 1/81 ~)B3~ NO. ~ TOWN OF SOUTHOLD BUILDING DI:PARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDIHG PEIU~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 i4407'Z Permission is hereby granted to.~ ~,.~..~ ............................... .3.&...' ............ ~ .............. L~Z~....~.,~......~.~ .......... ..0...~..,....~....~., ....... : ...... ~..~ ............... tO .......................................... ~t premises Iocoted at ../...~.'Z~).......G~........~(-~.~...l::~.~ .......................................................... County Tax Mop No. 1000 Section ..... ..~../...~..'~.. ..... Block ..... ..~..~. ........ Lot No ...... /./..~. ........... pursuant to Gpplicotion doted ..... .(~...~.~...a..~. .............. , 19.~.~.Tand approved by the Building Inspector. Building Inspector Rev. 6/30/80 ~LDG, DEPT, ...... N OF_S,O UJH TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in Wpewriter 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 featu res, 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 pZ"operty showing alt 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- t/on 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.O. $5.00 $15.00 Date... ~/..~..'-; .~?.~. · :'.~. · .~. · .... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ................................................................... House No. Street Ham/et Owner or Owners of Property [..(v..L;,..[. ~ ~ ..... ~'.. .co. ................... / o- ? Lot ..... County Tax Map No. 1000 Section .......... ,¢ .... Blocl~ .................. Subdivision ................................. Filed Map No ........... Lot No .............. Perm it N o./.~..~ ,~.7..~ .'~, Date of Permit/.~)j~e~ .~ .~App l/cant . .~,, .'~",/ ....................... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ...................... Request for Temporary Certificate ............. Fee Submitted $ . .~'~,',~°~., . . ,X/. ,~. ! .~..~. ,% ..... .Planning Board Approval ...................... ...... Final Certificate ....................... ~onstruction on above described building and permit meets a),L~ppl~ble codes and regulations. Rev. 10-10-78 FIELD I~SFE~TION COMMENTS FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & ?LUMBING INSULATION ?ER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: Examined .O.~..~..O.,19~.h· ~* 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved .C} ~..~..O., 19 ~??. Permit No..I.q.q Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT BLDG, DEPT. TOWN OF SOUTHOLI) Received ........... ,19... Date ................... 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 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 [-IEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance o'f 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 admitauthorized inspectors on premises and in building for necessary jasl~erctions. ~., . ( 'g re~efj~pliffant, ~r name, ifa p ti ) (Mailinfaddress of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. Name of owner of premises .....~.-./.'.~-.~../~-,~.. '.'.~.'..,4~.~..Z~9~....~...~.:..~. · .~.~..~. · · · -~- · ....... (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 ...................... 1. Location of land on which proposed work will be done .................................................. ...................... . ........ House Number Street Hamlet County Tax Map I~9. 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 ...................................... b. Intended use and occupancy ~ ! ~..~.~ .~. ~ 3. Nature ~fwork (check which applicable): New Building ..... ' ..... Addition · Repair Removal Demolition 4. Estimated Cost ............................... Fee ......... ......... Alteration ..i....... Other Work ' (Description') ~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............. Number of d~velling unit~ on each floor ................ If garage, number of cars .... ... ....................................... ~. .......................... 6. If business, commercial or mixed occupancy, specify nature and extent of each typ~ of use ...'.' ............... 7. Dimensions of existing structures, if any: Front ....... g:~ .... Rear . .~ ......... Depth .~.~:~ .t. Height ~ ~-,/. Number of Stories . .~-~.. ' Dimensions of same structure with alterations or additions: Front '" Depth ...................... Height ...................... Number of Stories ....... ' ............... 8. Dimensions of entire new construction: Front ... f..C~..~ ...... Rear ......... ' ...... Depth ...'~ .......... Height ..... ./.~)..." ..... Number of Stories ..... ~ ' . Rear 9. Size of lot Front ./.~'{> .............................. pepth . ~2~.. ....... 10. Date of Purchase .. ,~ .'; ./.o..'7.~J'/. .............. Name of Former Owner . .. ........................... 11. Zone or use district in which premises are situated /~ ~ o . , 12. Does proposed construction violate any zoning law, ordinance or regulation: . ,,gl'. ~..' ......................... 13. Will lot be regraded ........... d..P~.~O. ........... Will ex,.ess fJll be removed from premises:... 14. Nam e of Owner o f premises ~J4(..'.~..,/-~-~.P, PT~-d7'. Ad dress ./.~J.~., ~.o. ~: .~ .,~..8~,. ? .~.(~r..Ar.,r~pl~one No(,.~/..~..~..~ :~..~.~ Name of Architect ........................... Address ................ i... Phone No ................ Name of Contractor .......................... Address ................ i' ' ' Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex/sting or proposed, and. indicate all set-back dimensmns from t names and indicate whether property lines. Give street and block number or description according to deed, and show interior or comer lot. STATE OF NEW YORK, COUNTY OF .~.ct. ?..~.~.4.~. .... ~.fl[]a,*t ~.l'T.l~oT/~ ar, 7t'~ ~. being duly sworn, deposes ~d says that he is the applicmt above namea. ~e is the ~ ~.~ ~.C ' (Contractor, agent, co.orate officer, etc.) 1 >f said owner or owne~, md is duly auto. ed to perform or have perfomed the said work and to m~e ~d file tpplication; that all statements cont~ned ~ this application are true to the best of his ~owledge and belief; and that the ~ork w~l be perfo~ed in the m~ner set forth ~ the app~cation filed therewith, ]worn to before me this · .. ~'. ............ day of...~.~.~.Q..e<.~.. ....... , 19. ff.~' qotary Public, 2d..~..,~. UNDA ~. gOWAk~l NOTARY PUBLI0, State of New Yor~ .......... NO~ 5g~45~4771 ~ . , QUalified ia Suffolk County / CommisSion Expires Mar=~ 30~ ~f/~- i~;g~ature of applicant) - 1~*~,. "x%"', ~ , , . / ', ~ ,. ' 'h. ~ M~", '-.~'. ~., /~ ~ .-. ',~/ ~,~-, ~-,. . , / ~~ '~:~'~',. . ,' -~ / -' :~?~: ::~: / ':~ ......... . ,' . , ~~ ~~~ ~:-~. ,/.~' , . ,. .~~~____~~"'~ -~.~_ w . . .~.. . ~ - .. .: /~~Z"~:A~ ~%- ,- ~ .. . , . ,~~ ~" : ~.a, /~ ~ .- . '~~~.~''~. . . ~ '~.], . , , ., : .- ., ~:,~' ' . ' ' ' ' ' " ' ' ' ' ' ,~" .' : ''C ' ' : '.' . SUF~LK COUNTY, NEW ~ ,~o. , ,I,I ' I :1~. .l~l~ , ~D~,~[-'> .' '""- ,., - "' ' '""' " ..... ' .... '"" ..... ' ' '~' '~1 *ND~NOSURV[YOR~.Y. SUC[~S[NO. ' " , ' ' -'".' ,,' .'~:11 .o-,,0..,o.,~ , . . . , ,,' ,, . , o