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Home My WebLink About14467-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.Z.gfi. ~..5.~ ........... Date .... d.a..n.u.a.v.y....1.5 .................,19 .~.6. THIS CERTIFIES that the building ...~. c. 9.e.s.s. 9.v~r. .................................. Location of Property ..... 1.6. 7 .5..4 o. c. .k .e . 7. . .C .v ?.e.k...bF... ............... .S.o..u .g.h.q 3:..d ........ House No. Street Hamlet County Tax Map No. 1000 Section .... .0.7.0. .... Block .... .0.2. ........Lot ....... 0..1 ~ ....... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·. ~.qv.:..8 ............. 19.8.5. pursuant to which Building Permit No... q 44 .6 ? g dated .. p.e.c.:..~ .1 .................. 198.5. ., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which tbis certificate is issued is ......... Ac ¢~.as ory..s ~o~.age..& .ga~.age. ~.u~ ~d~.ng..t.o..r. ~p~..s.t. q~..d.a..m.a~e, d...b.qi. $ .d.i.ng. The certificate is issued to Herbert S. & Geraldine Arm ..................... ...... , .............. of the aforesaid building. Suffolk County Department of Health Approval ........... .~/. ~. ........................... UNDERWRITERS CERTIFICATE NO ............ N/A Rev. 1/81 Building Inspector lgO~ NO. ~ TO~N O~ $OUT~OLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 14467 Z Permission is hereby granted to: .... ~ ~,~-~...~.....~.~....~.~..~...~(~. ..... j...~...V...~-.......J.~..g..~.~.......~.~...~. ...... .~c:t..u:.~.~.~. ........~ ~:...~ ........ . ~..~...9 ~ t ~ ~~ ,o ........ ~.~.~.~.~.~.~.....~.~.c~~,~.....~.~~.~. .t.~...~~.....~~..~ ~~ ...... ~.~,. .............................. at premises I~ated at .,..(.~.~..~ ......... ~~.~...~~..~L~ .............. County Tax Mop No. 1000 Section .~..7...(~.. ...... Block ~' ~-' Lot No....(~....J....~ pursuant ,o application dated .~..(:~....~.. ........ ...~.. ..................... , lg**~**.**,~--~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 765 - 1802 APPLICATION FOR CERTIFI'CATE 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 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 p:mperty 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. Fees: 1. 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 ~'~ ~ I ~({ I ~ New. Building .... r ~/~; ~ ~'- .... Old ~"~ C~,,~ or P, re-existing ~ Building ~ ............ ~¢~ ~¢/L'~Vacant .Land ............. Location of Prope ty [ .............. ._J .......... ' .................................... House No, Street I ,., .~ Ham/et Owner or Owners of Property,IL--/~¢'~'~'-'1'~ County Tax Map No. 1000 Section ...~.7.~.' . Block ...~..~ .......... Lot...(~J. ¢ ........ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. !~.~..~.~...~. Date of Permit .... / ..... Applicant .... ! .~..~..¢~,~, .e. ~.~.~.: ..~ ......... Health Dept. Approval ......... ~.~-~ .............. Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building ar~rr~,'t m~e~ts~at~plicable codes and regulations. Applicant ........................................ Rev. 10-10-70 FIELD INSt~ECT~ON FOUNDATION (1st) COMMENTS FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY FINAL ADDITIONAL COMMENTS: L 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined ·..-'~.."'~-.. ).~ ...... , 19 .~. ·~ Approved .~...~.~ ...... 1 .~.:me~itNo. l~.?~ TOWN OF ~OUTtClOLD Received ........... ,19... Disapproved a/c ..... -~ ......... ./ .......... ~ ./;~...~. ;~, ..~ c~ o~-Ao~r (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tkis 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 ~ Certificate of Occupancy shall have been granted by tlie 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 lierein described. The applicant agrees to comply with all applicable laws, ordinances, building code,,h'ous,[ng co,~l,~nd regulations, and to admit authorized inspectors on premises and in building for necessary inspections.~~l~~ (Sig_natu. u~re of,applicant, oLname, if a corporation) ,~ (Maiting address of applicant) State whether applicant ~s owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. Name of ow~e~ of p~em~ses .......................................................................... (~s o~ the tax mH o~ ]atest deed) I~ eppilcant is a corpomtin~, signature of duiy ~ut~o~i~ed officen (Name and title of corporate officer) Builder's License No. f_O. ~ ...(~ ...... ......... Plumber's LicenseNo ......................... Electrician's License No ....................... 1. Location of land on which proposed wqrk will be done .......... .~ ....................................... ~r' r~,~ c~,~ .~/..( ............ .... .~./-/., .............. .............. ~/ ........... Street Hamlet House Number County Tax Map No. 1000 Section ..... .O.~..~. ....... Block ...... .~..~ ....... Lot ..... .O. ! .~ ......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended us~an4 occupancy of proposed construction: 9, 10. I1. 12. 13. 14. Nature of work (check which applicable): New Building .......... 'A~tition 'i ......... Alteration .......... Repot ....... ., ...... Removal .............. Demolition .......... ! .... Otl~er Work ............... Estimated Cost ..... t.~..? tc,~ .......................... eec ...... s, .............................. (to b~ paid on ~ing this application) If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars .......................................... , ............................. If business, commercial or mixed occupancy, specffynalure~and extent of each tYpgxoLuse .......... x ./3.. t ..... Dimensions o£ existing structures, if any: Front .... ~.0....~..'.. Rear ... [~.~,~... Depth../.~:. ~ ..... Height . .'~ .~. ....... Number of Stories ....... J ............... .~ .............. .~.~.f~ ./1.... D ensions o 2, ruoture with alterations Front .. .... Reai .... ZrC azr- ........... Dimensions of e~ti]~e new construction: Front ..... ~...4-~/.. Rear .... ~. ~... Depth . .~[0..~ ..... Size of lot: Front ..... ~.' ~.'.t.~.. ~ .... Rear ..................... i Depth ...................... Date of Purchase ............................. Name of Former Owner ! ............. - ................ Zone or use district in which premises are situated ....................... ; ............................. Does proposed construction v~ate any zoning law, ordinance or regulation: .. ~O. ........................... Will lot be regraded .......... .~ .........~ ....... Will excess fill begem~ve01 ~rom premises: ' Yes No Name of Owner of premises .~('~'~..~.'..A~../1'.]... Address./.f.7.~..~>.-.~....~..~... Phone No...' ........ Name of Contractor (t~.~4d Address.1{4,~?. ..i ...... . .. Phone No. ~q~.~.. .. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and~iindicate all 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 corner lot. STATE OF NEWYORK,-- S.S ~/C6c.g-~6 .~. 6'/4 ~ ~ ;42 . being duly sworn, d~poses and says that he is the applicant (Name of individual signing contract) above named. He is the ........................................................... ~ .............................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed th 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 Notary Public, .c~.:. County