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Home My WebLink About14105-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy September 10 85 Date ................................ ,19 ... THIS CERTIFIES that the building ...... s. atellite. ~i~h. ........................ Location of Property .......... Grand Ave. ~attituck h3~ .3.76o ................................................. se No. Street * Hamlet County Tax Map No. 1000 Section '107 . .Block 2 .Lot 7 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated Jul s..5 I Io5z ...................... 19 . pursuant to which Building Permit No ...................... dated ..... ~...u?_.~, .5. ................ 19 .~.?, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which ttfis certificate is issued is ......... .... .E?p.q~..ig.n' of t.v. receiver satellite dish. The certificate is issued to .... STEPTKEN M. SIMONS ................. ?oh;.'~; ~j ...................... of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE NO ......... Building Inspector Rev. 1/81 FO~e NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HAt. L SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NM 14105 Z Permission is hereby granted to: ...... ...... ..... ......... ~..O..........~.~.~ ...... z.~.~.3. .................. ........ ~.~..~. ~..~ .2...-...~..: ~.....z./. ,o ........ ~...~..~..~... ~......~. ~.... ,~Z,~./. ~..~.z:~ .......... ,.w. ~/,~/. ~.....~.. f...,7, fF.. ......... County Tax Map No. 1000 Section ..... /'-~'"'7 ...... Block .....~.....~... .......... Lot No .......... ~ .......... pursuant to application dated ........ .~.~.,~...~.. ......... ~. .................... , 19....~..,.Tond approved by the Building inspector. Fee *..~.~:,.C..~. ..... ~'. ~ Building Insl~ctor Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted ia ~ 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~t)perty 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- 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 $15.00 Date...~.~. ~......~.)... (?.o~...~. .... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ................. ........................ House No. Street Ham/et Owner or Owners of Property ............... ~ ,~/.~'/~ ..................................... County Tax Map No. 1000 Section /0 '/ Block ~ Lot Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ....... ................. Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ....... 7- t Construction on above described building and permit meets all applicable ~pdes and regulations. ~-__g~,~ ,~;L~J'~ Applicant ............... Rev. 10-10-78 COMMLN l o ~' ~ FOUNDATION FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY QODE FINAL ..P~ d' C ,o, ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 8OUTHOLD, N.Y, 11971 TEL.: 765-1803 ^p roved . . .:. .....¢: (Building Inspector) APPLICATION FOR BUiLDiNG PERMIT INSTRUCTIONS BLDI3. DEPT. TOWN OF SOUTHOLD Received ........... ,19.. · Date . . .~ . ., .......... 19... 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 HEREBY MADE to the Building Department for the issuance of a Building Perufit 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. (Signature of applicant, or name, if a corporation) ..... , . . . . /.o. .o. (Mailing address of applicant) ._/ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner o f premises . .~?.-~.~..~..~.~.'7.~....../~.'....~.?..P~. ?..ag'...~ ................................. (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 No. 1000 Section ..... /.'¢.7 ......... Block ...... ~ .......... Lot ..... .~. ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............ xg/v~- ................................. b. Intended use and occupancy ............ ~ ..... ].. ~...~,. / 10. ll. 12. 13. 14. Naturl~/l~viork 6alteck which ~' pplicable): New Building .......... ~ddition .......... Alteration,/ ........ R.~epaPtm~...~...~ ..... gO~v~ .... ~. · · ,.~... Demplition . .[.., ..... ,~,.. Other Work .............. Estimated Cosi ..... '~q~ ~. ...................... Fee ~ ~ ............................. : ~' (to be paid on filing this application) If dwelling number of dwellin~ units Number oF d ~lling units on each floor If garage, number of cars ... + .................................................................... If business, commercial or mix, ed occupancy, specify nature and extent of each type of use .................... D~ensions of ex~shng structures, ff any: Front ............... Rea .............. Depth ............... Height Nu'mber of Stories D~ensions of same structure ~ith alterations or additions: Front ................. Rear .................. Depth ' HeiSt umber of Stories Dimensions of entire new con~tmction: Front ............... Rea~ ............... Depth ............... N~mb ~,o-e ......................................................... Size of lot: Front ......... ~ ............ Rear ..................... Depth ...................... Date ~of Purchase ......... ~ ................... Name of Fome r Owner ............................ Zone or use dmtnct ~n which premises are situated ................. i ................................... Does proposed construction viblate any zoning law, ordinance or re,la :~on: ................... Will lot be regraded ............................ Will excess fie be removed from premises: Yes No Nam9 of Owner of premises . i .................. Address .................. Nares of Architect ........ ~ ................. Address ................. Name of Contractor ..... i ................. Address ................. ... I PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or propo., to dee property lines. Give street and block number or description .according interior or corner lot. . Phone No ................ · Phone No ................ · Phone No ................ ~d, and, indicate all set-back dimensions from 1, and show street names and indicate whether STATE OF NEW YORK, S.S I ,t COUNTY OF .................. ...~.~'..~ ~..~/~-A/. .~... ~.~..O~. ~. being duly s (Name of individual sighing contract) above named. .(< .~_ .O. O ~.) ,eisthe ..... .... (Contractor, agent, corporate o of said owner or owners, and is dgly authorized to perform or have perfo application; that all statements contained in this application are true to th~ ' work will be performed in the mannbr set forth in the application filed there' Sworn to before me this ............. /..~.. ........ day ;f... ~.~. HELEN K. DE ~Oi NOTARY PUBLIC, glare pi New r'Ofk No, 47111878, SuItoli Gount~_ Term Exp, res March 3Q, .... Count. y~ ,oses and says that he is the applicant 'ficer, etc.) ~ned the said work and to make and file this best of his knowledge and belief; and that the vith. (Signature of applicant)