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Home My WebLink About14152-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.Z.q..4.~,8.8. .......... Date ..... .J.a.n.u..aF.y' .2..9 ................ 19 .8.6. THIS CERTIFIES that the building ... b.D.D. 5. .T .Z.O?. ................................... Location of Property . .q.0. Q0..g.~n..n.e.h.a.h..a..B.l.¥.d., ................... S.o..u.~.h,o.~ .d .......... House IVo. Street Hamlet County Tax Map No. 1000 Section 0~.7 ......... Block ..... 0.2. ........ Lot ...... .0.(3.7 ........ Subdivision....L.a.u.g.h.~.n.g..~.~.~.? .~ ........... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·..4u;Ly,. 1 5 .......... ,19 ~, pursuant to which Building Permit No. 1.4.1.5 ~2; ............... dated ..... .5.u.l.y...2.3 ............... 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 ......... g~ addition to an accessory garage. The certificate is issued to ...... ARTHUR RIOS ............... ...................... of the aforesaid building. Suffolk County Department of Health Approval ..... ~ {.A.. ' ................... UNDERWRITERS CERTIFICATE NO ............. ~/~ .................................. Rev. 1/81 Building Inspector FOB~ NO. ~ 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) NB 1415~ Z Permission is hereby granted .~.. ~.~-d~,~ ~, ~ ~, ~ .~ ~, .......................................................................................................... County Tax Map No. 1000 Section ..... ..(~.....~..?. ....... Block ..... ~ ............. Lot No......C~...?....'] .......... pursuant to application dated ....... ...~...:.~...L.~. ...................... 19~.%~ and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1.802 APPLICATION FOR CERTIFI'CATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted ,-~ 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. Su bm it P lann lng Boa rd approval of completed site p lan requirements where applicable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of pZ'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 $ :[5 o 0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 Date .... ~..~.,. ---.,.. ........ New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ./~.0. ¢ ........ ~.. :~..~..~n. ~J./~ .... .~..C~3.. ............ .~..o..~7~o.~. ~ ..... House No, Street Ham/et Owner or Owners of Property ............. I ....................................... County Tax Map No. 1000 Section ...Y~..,~. ........ Block ...O.~ ......... Lot...~..(?. ,~. ........ Subdivision ~,~C///~/~ /,4//)~. .Filed Map No ...... Lot No. ~ _ . .~ ............. ~,.~.o.~' ........... Permit No. I?./..§'~,. Date,q! Permit /~.~. ,/,~,..~¥.Apphcant 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 permi~t,me~ ts/all_.a, ppl,~ble codes and regulations. Applicant .....////'~/~ ~i~~. ~ ............................ Rev. 10-10-78 FIELD IN~PEO~ION i FOUNDATION .~ (1st) I,'O[JN DAT~ON ( 2nd ) 'ROUGH FRAME & FLUMBING INSULATION PER N. Y, STATE ENERGY C~ODE FINAL COMMENTS ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL , , SOUTHOLD, N.Y. 11971 ...... L~J.,~,,~ .&~*J~.. ~ .. 4).. (Bui~ing Inspector) APPLICAT[O~ FOB BUILDING PfiRMIT BLDG. DEPT TOWN (3F SOU"f I-{OLD Received ........... ,19... Date ................... 19... INSTRUCTIONS a. This application must be completely filled in by Wpewriter 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- dation. 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 ~t Certificate of Occupancy Shall have been granted by the Building Inspector. B APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the uilding 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, housin~_.qode, and regulations, and to admit authorized inspectors on premises and in building for necessary inspe~Z (Signature of applicant, or name, if a corporation) . ..,(.&). :-...J.~'.e~.~.~.. . .,,.. .. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~. ¥~ , , Name of owner of premises . ,/< ~¢J ........................... (as on the tax roll or latest deed) If applicant is a corporation, signature bf duly authorized officer. (Name and title of corporate officer) ~ilder's License No .........' ~.~.' .~'~ ..~. ......... Plumber s License No ......................... Elec.trician's Lice, nsc No .... .~ .................. y~.. ,. ,~ ., .. Othe~ Tf~dJe% Bicense So,.~.,.. ;"."~_~',~ .............. I. Location of land on which proposed work will be done .................................................. ... /7.4 ...................... ~, : ................ ti., c ............................ House Number Street Hamlet County Tax Map No. 1000 Section .. ~'~ ........... Block .... q~ ........... Lot...~ .......... Subdivision : .................... Filed Map No ............... Lot ............... (Name) 2. State existing use and ~ccupancy ~f premises and intended use and ~ccupancy ~f pr~p~sed c~nstructi~n: b. Intended use and occupancy .... "'" · ....................... .. t~.~ ~d< ........................ 9, 10. 11. 12. 13. 14. 0 Natur~ ofwork (check which applicable): New Building ..... ' .....'A~ldition . ..'(. .... Alteration ,. ......... Repair ...... R~m,oval .............. Demolition ............... Othe, r Work ..... ,, ........ Estimated Cost ...... .~'. ?..~f)..' ......................... Fee ................................. ; i n s a cation If dwelling, number of dwelling units. ............... Nu~l~ ~on~ floor ................ If garage, number of cars .... ! ........................ [ [~' [~' t[~[[ '~[[[~[ '~ ................. If bus,ness, commercial or mixed occupancy, specify nature a~t ~a~~ ................ Dimensions of existing stmctur?s, if any: Front ............... ~a~ ......... ~!plh ............... D~e~sions of same structure with alterations or additions: Fronl ... ~UZ .......... ~aF ...... ~ .......... D?th ................... ,... Hm~t ..................................... Dimensions ~f entire new consimction: Front ............ ~.~R~ ~. Depth ............... ~ei~ht .................. ~u~ber o~ SloPes ................................ . Size qf lot: Front .... ~.!...! ............ Rear .~/~ ............... Depth . .~ ~.~ ................ Date of Purchase ' Name of Fo~ Owner Z~ne or use district in which p~emises are situated ...................................................... Dbes proposed construction viqlate any zoning law, ordinance or regulal ion: ................................ W~119t be regraded ........ i ........... .~ ...... Will excess fill )e removed from premises: ~es No of of ...... No. .N~e of Architect ......... { .................. Address ................... Phone No ................ N~e of Contractor ...~f~ ............... Address .................... Phone No ................ PLOT DIAGRAM t,oeate clearly and distinctly all buildings, whether existing or propm property lines. Give street and block number or description according to dee~ interior or:corner lot. STATE OF NEW YORK, i ,, ~ (Name of individual signing contract) above named. ~ i, and, indicate all set-back dimensions from , and show street names and indicate whether APPROVED AS NOTED NOTI~ BUILDii~G DEPA[~TM~T AT 766-1802 9 AIl TO 4 PM ~R THE FOLLOWING INSPECZ 1 FOUNDA~ON 2. ROUGH ~RAMIi.I~3 a PLUMBING 4. FINAL C0aSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION ~ALL ME~ He is tile., ....................................................................................... ,. ; f (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 the work will be performed in the mantlet set forth in the application filed there' Sworn to before me this ............ / ..... day B~RNARD R. D~MPSk'~ Notary Public, State of~ New' No, 52-~982545 Qualified in Suf o k Coun Commiiiloll r~x~jr~. Mmch 80, County 'ficer, etc.) aned the said work and to make and file this best of his knowledge and belief; and that the vith. (Signature of applicant)