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Home My WebLink About14483-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No .... g J 5.~.7.9 ....... Date ...... 4 .u.n.e..5. .................... 198.6.. THIS CERTIFIES that the building .... ~. 9 p.d.-. 1~ .u r.n.~, r~ g..s.~, o. ¥.e ....................... Location of Property ... 5.7.7.5 ............... ~,~..u..?¢ Rd, ........ C.u..g.c.h.o.g.up ..... House No. Street .... Hamlet County Tax Map No. 1000 Section .... .1.1.1. .... Block ....... 1.2. ......Lot... ~ ............. Subdivision .......... X .................... Filed Map No...X. ..... Lot No ..... X. ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated November 8 ...................... 19~.5. pursuant to which Building Permit No ..... 1.44..8.3.g. .......... dated ..... Be c ¢ ~he r. 2.6. .......... 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 ......... ·..W.o o d =.b. up. u ;J-Jn.g. ~ ;i;.o.~.~ ........................................................ The certificate is issued to ............. F~,~.q~ ,5.Gt~[I~.T.Z. .......... [owner,j~,~( ~txt~r~t) .............. of the aforesaid building. Suffolk County Department of Health Approval N/P~ UNDERWRITERS CERTIFICATE NO N/A Rev. 1/81 Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 14483 Z Permission is hereby granted to: ..... ~...o..~ g~.L~.~.........~....~.~....~.~.o.~ k% .... C~.~..~....~.~....~.~ ....... .... .~.c~.c~..~.~.~.~.,...~.:..~ ...... u~3.1 ro ..... ,~..~...~L~,L,..,.~.~..~........~..~..~.~.~...~ ,.,,,~.,-E~...~...~ ....................................... ......... . .~..~,..::.~ ......... .~...t~. ~ .~...~.-~... ........... .~...~L~..~..~.~... ~ ................................ o, ~r,,~iso, Ioca,~ o,....~....-I..7.....~. ...... ~-.~.~.~-~~..~'/~' ................ C--¢ = ~, ....................................................................................................... .~.~..../:d...<;;~..~.~.. r..h4.. ....... Cou,w Tax Map No. ~ooo s,:,~o. ..... I.L.l ............. ~,o~ ...... 1..~. ......... ~ot No..~..~-C.... pursuant to oppJication dated .... ~.C~..~..,.....~. ...................... , 19..(~... ,~--and approved by the Building Inspector. Fee .... .~ ........... Building Inspector Rev. 6/30/80 ~ORM NO. 6 OF SOUT.OLD L~~o ~g Department ~ 'own Hall ut ~Id, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 'l'his application must be filled in typewriter OR ink, and submitted ma ammmmm~m 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 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-confo, rming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~Coperty 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. C. Fees: 1. Certificate of occupancy $§.00 2. Certificate of occupancy on pre-existing dwelling $15.00 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 D ate ......... New Building ............. Old or Pre-existing Building ~ t LanU . Location of Property ,, c~ c O House No. ~ Street Hamlet Owner or Owners of Property .................................. County Tax Map No, 10'00 Section ..... [ Block Lot Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. ~, ,~, ~, ,~,. Date of Permit/,~,?~,~/~pp licant Health Dept, Approval .................... ~,, ,Labor Dept, Approval ........................ Unde~riters Approval ........ ~ ~ ........... Planning Board Approval ,. ..................... Request for Temporary Certificate Final Certificate Fee Submitted $ .... ~(' ~l~'~i Construction on above described building and perm~ts all applicable co~s and regula~ons, ....... ............ 765-1~02 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. Memorandum from .... BUILDINO INSPECTOR'S OFFICE TOWN OF SOUTh. OLD TOWN HALL, SOUT~tOLD, N. Y. 11971 765~1802 Jan. 14, 1986 Dear Ms. Schultz: I am enclosing your Building Permit for your wood burning stove. Please call our office to arrange for an inspection. This is needed before we can issue your C.O. We have an applLcation for the C.O. but we need a check for $5.00. Thank you. Yours truly, BuildLng Dept. Sec. FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL ~o .o,-r~./o~ .7~ .~. ,~.. ~/' ....... PLEASE TAKE NOTICE that your application dated · .~.~..x~. ~-'~t~.I~.(-~ .~. · .<~.., 19 ~ for pe~it to ' t{~ ~~..N~O~..'~.~ g~ · .~ ........... at Hou~ No, ' Steer ...... ~;ml~;' County Tax Map No. 1000 Section .... L t J ....... Block .... I. ~ ....... Lot . ~0. ~ .... Subdiv~Mon ................. Filed Map No ................. Lot N~ .................. is returned herewith and disapproved on the follow~g pounds ............ , ................... . .~&~.~...~ ~...'~.~. t ~...~.~ .c~. ~ ~. o .~ ...... '] , :'. , ~uilding Inspector nv 1/80 , TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL,: 765-1803 Approved~-~...Z.~'. ...... 19 .~..Sermit No ............ Disapproved a/c ....... /7 ................ L. .....:~ ' ' ''/ · ........ (Building Inspector) TOW~ o~ ~ou~om_, j Eeceived ........... ,19... INSTRUCTIONS a. This applicafic~n must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans~.ac'curate plot p an to scale. Fee according to schedule. b. Plot plan showingqocation of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving h 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 ayaflable for inspection throughout the work. e. No building shall be<occupied or used in whole or in part for any purpose whatever until ~t 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 Btfilding 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, bulldirj~oc~e, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspe~i9~ , , . / ~ , ........ (Signature of, applicant, or n e, ' p ' . r!. ........... ~ , ,, (.Mailing)~dress o[ a~.plican~) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, eleclrician, pmmoer or ouilder. Name of owner of premises ..................... ~- ~tr~t~ ~ ~ · (as on the tax roll or latest deed) If applicant is a corporation, signature of duly author/zed officer. / (Name and title of corporate officer) Builder's License No ...... .¢ .~..~ ............ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... I'. Location of land on which proposed work will be done .................................................. .....' . ................... ....................... House Number ...... Street 'H~mlet County Tax Map No. 1000 Section .... /]../ ........... Block ..... /3 Lot. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ,. Existing use and occupancy ......... .~ ................. V.. h..h/...~-. ..... / ..... ? ....~. ...... tO~/ w~' c~5 v~ er- ~ b. Intended use and occupancy S ~/~ff ....... ... ~..l~t).~.{~ ..... I....~ .....~.~ ...... 3. Nature (~f work (check which apphc~ble) .......... Alte : New Building .......... Addltmn ..... Repair .............. Removal. ............. Demqlitinn ............ i.. Other Work~.e0w~-~ 4. Estimated Cost ........... Fee ....... .n (to be plaid on filing this application) 5. If dwelling, number of dwelling units ...... umber of dwelling unit~ on each floor ................ If garage number of cars ' 6. If business, commercial or mixed occupancy, spec 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 structure with alterations or additions: Front ....... : ........................... ......... Rear .................. Depth ...................... Height ...................... Number of ~ .tories ...................... 8, Dimensions of entire new construction: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ............................ .................... 9, Size of lot: Front ...................... Rear ......................................... 10. Date of Purehase ............................. Name of Former Owner ............................. 1 l, Zone or use district in which premises are situated ......................... 12. Does proposed construction violate 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 ................ Address .............. ;~ Ph N · ' ' ' · . . . . one o ................ Name of Architect Address ~hone No Name of Contractor Address Phone No PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate 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 comer lot. STATE OF NEW YORK, COUNTY OF S.S being duly depqses and says that he is the applicant ' ............ ; .................................... sworn, (Name of individual signing contract) above namea. "· He is the ......................................................................................... (Contractor, agent, corporate officer, etc.} of said owner or owners, and is duly authorized to perform or have performed the s dd work and to make and file this ~pplication; that all statements contained in this application are true to the best of hi~, knowledge and belief; and that the ~*ork will be performed in the manner set forth in the application filed therewith. Sworn to before me this (Signature of applicant)