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Home My WebLink About14144-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ..... z14836 Date ~qgust ~ 19 ~ THIS CERTIFIES that the building ga.b 1. e FP qr. · Location of Property 645 Sohthern Cross...............Road Cutcho~ue NtY..o..'' - - I21~)t~S~. HO] ................. Street ............ Hamle~ County Tax Map No. 1000 Section .. ~ .1.0 ....... Block . .~ ............ Lot ..... ~.7 .......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated July q6, 198.5. pursuant to which Building Permit No ~4~44Z dated . July 19, 19 85. , was issued, andconformstoalloftherequirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Gable roof on existing one family dwelling Ine.z Morrison The certificate is issued to .......................................................... (owner~le~r~ ~tca~,en~ x of the aforesaid building. Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO ................. N../.g .............................. Building Inspector Rev. 1181 ~vO~'~w NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~-_ Permission is hereby granted to._ ..... /~ /~/~ .._~ / 4~ .... ~~...Z..~..~..A~..~I~--~' '~ ~'.~,'~. ~~.~. .. ,' ~ ~. ~~..~.-.~.~ ....~ ~ ,~ ....... ~ ..... ~...~...~....~....~ ..... .... .~ ......... ~......~~., ............... ~ ........................... ~...~.....:: .... ot h,m~,~ i~,d ot.[~..~~ ....... ~.~ ....... ~..~ ...... . .... .................... d.~./.....~...~.zLe, z~ ............................ ~ ,~ ~,~ uo. ~ooo s~o~ ...l..l.~ ......... ~k ...... ~ ....... ~ ~o ...... ~...~. BuUdl~ Inspector. F~ S.~..,.~ ..... Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD 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 ~[all[~ 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 appl~icable. 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 occupancv $5.00 2. Certificate of occupancy on pre-existing dwelling $15.0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 Date. ?..~. ?...~./,~..;~2; .~;. ........ ...~/.. New Building ............. Old or Pre-existing Building ........... Vacant Land ............. Location of Property. (.*...~. ...... . .~¢?..~ .~.~...~&o~{. ~..~ ........... ~.~..~'.4.r..~___~.~ House No. Street Ham/et Owner or Owners of Property ........................................... County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. l/)/./, .~, ?..~. Date of Permit 7../. ?. ~ ,~.Appiicant .~¢,/.Z,~,~/~, p?~g~/f.~...~..~.., .'.2~, ,/~,: .... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and permit meets all applicable codes and regulations. .¢.,. ...................... Rev. 10-10-78 c o ~ ~ ~2~ FIELD INSPECTION DAT~_ ~ COMMENTS FOUNDATION (1st) FOUNDATION ( 2nd ) ROUGH FRAME & -- PLUMBING -- iNSULATION PER N. Y. sTATE ENERGY C,ODE ADDITIONAL COMMENTS: 765-1802 BUILDING DF. PT. INSPECTION [ ] FOUNDATION '"ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: TOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ,prav ,d ....... ....... , ..... ~isapproved a/c ............................................................................................ TO?~N_ OF ~OUTHOLO Application No ................................. {Building Inspector) APPLICATION FOR BUILDING P£RMIT Date ..... ~'..~...,~.. .......... ./...(. ............. , 19...~-~..~.,. INSTRUCTIONS a. This application must be completely titled in by typewriter o~ in ink and submitted in triplicate to the BuiJding 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 ofproperty must be drawn on the diagram which is part of this application. 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 issue 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 applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. .... ........ ...... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ome of owner premises ....................................................................... applicant is a corporate, signature of duly authorized officer. .................. iKi; ~;" ;;;Z '¢iT~';"~;F ~'~';p';;~'f;";;¥fi;:';';i ......... Builder's License No..~;./'.....'~.. ....................................... Plumber's License No. ~ . Electrician's License No ............................................. Other Zrade's License No ............................................... 1. Location of land on w~l~ch proposed work will be done. M~p.No.: ........................................ Lot No ......................... Street and Nu(J~q~r',/,~'- o ~..~/..~,,~__~.~ ........................ ~ ..... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ..~ ........................................................................................... b. intended use and occupancy .............. ~ ...................................................................................... 3. Nature of work (check whicb applicable): New Building.. ................. ,~ Reggj~ .~..~...~ ..... Removal ~ ................. Demolition .................... Oth 4. Est mQt d Cost ...... ................................ ..... '~,~, (to be 5. If dwelling, number of dwelligg units ............................ Number of d~ If garage, number of cars ...... ; ................................................................ 6. If business, commercial or mixed occupancy, specify nature and e: 7. Dimensions of existing structures, if any: Front ............................ Rear ddition ~ Alteration ~r Work .................................................... (Description) paid on filing this application) tiling units on each floor ............................ :tent of each type of use ............................ ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................ Dimensions of same structurejwith alterations or additions: Front ..... Depth ................................ H~ight ............................ Number of Stori, 8. Dimensions of entire new construction: Front ................... , ................ Height .................... Number jot Stories .............................................. 9. ,C~jze of lot: Front .................. i ..................................... Rear ................ 10. Date of Purchase ........................................................ Name of Forme~ 1 1. Zone or use district in which premises are situated ............................... 12. Does.proposed construction vi61ate any zoning law, ordinance or reg~ 13. Will lot be regraded . .............. i ............ Will excess fill be removed fro~ 14.Nameof Owner of premises ..~.... Address ./~/ Name of Architect ................ : .............................................. Address ... Name of Contractor ................................ Address ... PLOT DIAGRAM Locate clearly and distinctly al/. buildings, whether existing or proposed propelCy lines. Give street and blo~k number or description according to whether interior or corner lot. .............................. Rear ............................ ar ............................ Depth ........................ .......................... Depth ................................ Owner ........................................................ ffation: ........................................................ npremises: ( ) Yes ( ) No FZ~..~. 2(..( .,~.,,~ ...... Phone No ....................... ............................ Phone No ....................... ............................ Phone No. '1 ~..R..L~.~....~...... and indicate oil set-back dimensions from deed, and show street names and indicate STATE OF NEY~JYQRJ~, .. l ~ c (Name of in~vidf~l sig~ing contract) above named. He is the ~ ........................... ] (Contractor, agent, corporate officer, of said owner or owners, and is duiy authorized to perform or have perfo~ this application; that ali statements contained in this application are true thor the work will be performed in the manner set forth in the application fil Sworn to befor, e me this ,x~ deposes and says that he is the applicant etc.) med the said work and to make and file 'o the best of his knowledge and belief; and ~d therewith.