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Home My WebLink About14518-zFORM NO. 4. TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate O[ Occupancy No. ,~..1.4.1.9.2. ......... Date ......... J..a.n.u.a.~.¥...3.0. ........... 19 .8.6. THIS CERTIFIES that the building ..... .A.d.d..i.t.i. qn. ................................. Location of Property . .3.8.5. ................. G..r.i.s.s.o..m..L.a.n. ? ....... Southold Hot~se No. Street ............... I~l$/n/o~ County Tax Map No. 1000 Section .... 0. 7..8 ..... Block ..... q 1. ........ Lot ..... 0..2 .9 ......... Subdivision...S.l.e.e. py..H.q .1.19.w' ............. Filed Map No..6.3.5.1....Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated · .g..a..n.u.a.r.y....3.0. ...... ,19..8.6pursuant to which Building Permit No...1.4..5.1.8.Z. ............ dated ..... q.a.n.u.a..ry... 3. 9 .......... 19..8.6, was issued, and conforms to all o f the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... .... 7.-:-.-:r .-. p.e.c..k..hd.d..~.~.%qn...~.o...E.x.~.~.~..~.n.~..9.n.e. ?.a..m.~.l.7' p.w.e.~. 1..~.n.9..777.-.-.7 ..... The certificate is issued to ................. G..E.R?.G..H?.Y.,..J..Az~I~,.E.S...&..D.O..N.N.A. .............. (ownor, t~trx~ of the aforesaid building. Suffolk County Department of Health Approval ........... N../.R. ........................... UNDERWRITERS CERTIFICATE NO ................... N../.R. ........................... Building Inspector Rev. 1/81 ~'o~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERt~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is herebt granted to: ........................................ ............................................ County Tax Map No, 1000 Section ..~..~...~.. .......... Block ~..../ ............. Lot No...~.....~:~'........~/.... pursuont to application dated .~ ...... ~ ................ , 1~., and approv~ by the Buildl~ Inspector. ~/~ ~ ~ ~.~/~..~. ....... ~uilding inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE 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 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. 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. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $15. O 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.C. $5.00 Date ......................../7. --OL~ ..~.W New Building .'..~. ......... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ~-., .~ .......... .,..~.~..~.~.O..~ ......... ............. .................. House No. Street Hamlet Owner or Ownersof Property ..... ................. County Tax Map No. 1000 Section O.?.~ .......... Block J~.l ............ Lot .~. ~)-..~. ........ Subdivision ~(~l O-~O .~ 1 .~' .O.[! .0 u.~)' .Filed Map No ........... Lot No. Permit No ........... Date of Permit .......... Applicant .~..~. ~. :~.. %~-/~6 t~ .~.x~.. Heelth Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $...~.: ..~. ~__._~onstructi~on on above descr bed building and perm t..meets all,gpplicable code.~and regulations Approved~'~ .5~... 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 ., 19 ..~. ~ ., 19~. Permit No. ]..~. ~,~.~ Disapproved a/c ..................................... Received ........... ,19~.. (Building p - ~ , , _ APPLICATION FOR BUILDING PERMIT~/ Date .}..~.'.~.O. .......... , 19.~. INSTRUCTIONS a. Tkis application must be completely filled in by typewriter or in ink hfid ~ubmitted 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~td~a'~0ifii~g premises or public streets or areas, and giving a detailed description of layout of property mus~t~ 13~dt~w;n ori[.il~e~diagram which is part of this appli- cation. c. The work covered by this application may not be commence4 b6f~)~e'i~s~.~?.~c~Building Permit. d. Upon approval of this application, the Building Inspeptor. will is~u~t a'Bm~dit/g P'ermit 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 who!e or in part for onY p, urpbse-whatever until a Certificate °f 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 inspectors on premises and in building for necessary inspections. ! .~' ~~~ if a corporation) ......... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....~.-.~.a'.m..-~..~.. :~...~..O..K)..~3....~. .... ~..C?..~.~..6. ~..~..'7~. ....................... (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 ...................... I. Location of land on which proposed work will be done. . ( ~ ~O}'~ . .............................. .................................... House Number Street Hamlet County Tax Map No. 1000 Section ...~.-~ .cz~ ........... Block ..O..I .............. Lot .~..q). ~. ............ .~ 6> ~lO/(0~O ............................... Lot Subdivision . ~"[~'..~' '~l ..... Filed Map No ................ (Name) 2. State existing use and occupancy of premises and intended use and occupancy ofpro?osed construction: a. Existing use and occupancy ......... ~. · ./~. · · · .~ - · · ~ .......................... b. Intended use and occupancy ....... /~....~. i{.~../.~_~...........,e , ................ ?, .......... 10· 11. 12. ,13. 14. Nature of work (check which applicable): New Building ..... ' ..... Addition . .i ........ Alteration ........ Repair ............... Removal .............. Demolition ........... i. · · Other Work. ~"~.~ .~. lC ..... ' (Desc on Estimated Cos ............................. Fee.. t' '"~ · · ', ............................. " (to be paid on filing this application) If d elli m ber f d elling nits Number f dwellinguni~s each floor W rig, rill o W u ............... o on ................ If garage number of cars .' If business, commercial or mixed occupancy, specif:~ ~nature and extent of each type of use ..................... Dimensio,ns, o[texisting structures if any: Front .q. ~.. .... Rear .-'~.. L2 I Depth ~ ..~. ' ~ ~ ' fSt ' '" ....... ' ........~ .... Height ............ Number o eries ... Dimensions of same structure with alterations or additions: Front ............ : ..... Rear .................. Depth ...................... Height ...................... Number of!Stories ...................... Dimensions of entire new construction: Front ............. Rear . . i Depth Height .............. '. N~lmber of Stories ........................... Date of Purchase . .C~ q~. ....................... Name of Former Owner /~[. Zone or use district in which premises are situated... }'~'~ .~ ~ ............... i ............................ Does proposed construction violate any zoning law, ordinance or regulation: . ~A,).D. .......................... Will lot be regraded ...M.Tt.% .................... Will excess fill be removed from premises: Yes ~ No Name of Architect ........................... Addres~ ............... ~ Phone No ................ Name of Contractor .~f~ .19~ .~· Address : ....................................... Phone No ................ PLOT DIAGRAM Locate 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 corner lot. ~ OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF- OCCUPANCY STATE OF NEW YORK, COUNTY OF... S.S .-sa · .E?'~ I¢fll'6.4l'~.x/ ......... ............. being duly sworn, deposes and says that he is t~e~applicant (Name of individual ~igning contract) : above named. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that ail statements contained in this applicati0n are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the abplication filed therewith. Sworn to before me this (Signature of applicant)