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Home My WebLink About14517-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Bui!ding Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. g. ! ).q. 8. 6. .......... Date . .. g.a.n.u.a, r F..2.9. .................. 19.8.6. THIS CERTIFIES that the building C..h.~.m.n,e. y..&., c. 9.a.~' .&...~.qqd...b.u.~..n .J_.n.g ..s .g.o.v.e. ...... Location of Property ..... .~.5.. ~Hp3. b.~ 99.k' .L..a.n.e. ~...~g.c.k.s. 9.n.'.s...L.a.qd..~.ng...~.a.~,.~ ~..~.u.c.k.. House No. Street Hamlet County Tax Map No. 1000 Section .... 1. .0.6 ..... Block .... 0..9 ......... Lot . . .1.8. ............ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .4a..n....2. Q ............. 19 .8.6. pursuant to which Building Permit No, 1fi. 5. 1. y.Z. .............. dated ...d..a.n.., .2..8 ................. 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 ......... C.Q~ ~.~,.P. cl C ~..~..q b~-~q~ Y..a.qql. j.n.s..t,g.~.% .~..c.qa. %..&..wgp.d..b..ur.n.~.n. g' .s.~ 9y.e.. ......... The certificate is issued to .... M .5 .c b.a. e. ~_. ~.... $ g.a,n,. ,&, ~q,u, s. ,a .n..E.:..E ~a. n. .................. (owner, ~ ~ax~X X of the aforesaid building. Suffolk County Department of Health Approval .......... ~/..g ............................. UNDERWRITERS CERTIFICATE NO .................. N../..A ............................. Rev. 1/81 Building Inspector FOEM NO. ~ TOWN OF $OUTHOLD BUILDING DEPART,~ENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERJ~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLIZ'rlON OF THE WORK AUTHORIZED) 14517 Z Permission is hereb/granted to: ...~..~..,..5'~......~..~ ................... .~ ..... ...... ............................................ County Tax Map No. 1000 Sec' tion ........ ~.~,..~..~--, , x ..... Block ...~.......~.. ...... Lot Na ......... ~/....~.. ..... pursuant to application dated .~ .......... .~....~... ........... , 19~..~', and approved by the 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 A. 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~operty 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 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 New Building ............. Old or Pre-existing Building $15.00 b/ Vacant Land Location of Property .... ,~? ~ ' /-/Z)/z~/~04).~.. /<~'/~ /~f~/7~/7/'C~//- /~3'/' House No. Street Hamlet Owner or Ownersof Property ,.. / ~ ~ ~ ~ ~ D~ County Tax Map No. 1000 Section . (~.~..-.~.~ ~, Block .... ~ ....... Lot ....... ~ ..... 5. ....... ............. ~ermit ~o...~ ...... Date ....... Health Deot. A~proval ........................ kabor De~t. Approval ........................ Unde~r[ters A~proval ~ .~lannin~ 8oard Approval ...................... ~equest for Tem~orarg Certificate ..... :~ .............. Final Certificate .... ~.~ Fee Submittod $ ~ ~pphcant .................................... 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 8OUTHOLD, N.Y. 11971 ', TEL.: 765-1803 E×amined /./.. 3. .¢. ..... ,19 Approved ././~.~. .... ,19~Permit No..l.q..~../.7~--~ Disapproved a/c ..................................... ':OW~' OF SOUTHOLD Received ........... ,19... 5' ~.0, (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .... ../..~..~.O. ........ 19o~ INSTRUCTIONS a. Tiffs 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 schedhle. 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 app!icant agrees to comply with all applicable laws, ordinances, bu~,~ing code, housing code, and regulations,aand to admit authorized inspectors on premises and in building for necessary inspections. ///~,~ ~ ,d~' (Signature of alSplicant, or name, ks4 corp( t'o ) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .~'~-:~/F/:¢.~ ~...~..~.../~..r,~./)..,~..Ofi,~T.tJ..~.'.t..~...~.... ........................... (as on the tax roi1 or latest deed) If applicant is a corporation, signature of duly authorized officer. Builder's License No ......... ..~...~..~..C. ;. Plumber's Licensb No .......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ............ ~ ................. ~ .5' ......... House Number Hamlet County Tax Map No. 1000 Section ./.d.~..7 .~..~ [..~.... Block....(Q.. ~ ........... Lot .... /.~.. ........... Snbdivision...~/..~..~./.~ J.~..~.5.'. d~ .,~.t.O. t).~.(Q..~.~ .... Filed Map No..~-./>2~.O. ..... Lot..././ .......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .............. ~..~.~....~/-ff... ~~ ............................ b Intended use and occu ancy ............... .&Y.,.. q- ~ /x~ ' [ 3. Nature of work (check which applicable): New Building ..... ' ..... Addition.. ,I ....... Alterat!o~ ......... ' Repair .............. Removal .............. Demolition ..... = ...... '.. Other Work ~ ./~ ,~ . i _ (Description) (to be paid on filing this application) ' 5.If dwelling, number of dwelling units ............... Number of dwelling unit~ on each floor ................ If garage number of cars ' 6. If business, commercial 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 structure with alterations or additions: Front ............ : ... Rear .................. Depth ...................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ......... . ...... Depth ............... Height Number of Stories 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner 1 1. Zone or use district in which premises are situated ........................... i ' · 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 ' . Phone No ................ Name of Architect ........................... Address ................ i... Phone No ................ Name of Contractor .......................... Address ................ :... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, an& indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and,~howl street names and indicate whether interior or corner lot. sTATE OF NEW YORK, COUNTY OF ................. S.S ................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. ~e 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 ~pphcation; that all statements contained in this application are true to the best of his knowledge and belief; and that the ~vork will be performed in the manner set forth in the al~plication filed therewith. ~worn to before me this '7, ::' i~,2~c~'~[?~?icant)