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Home My WebLink About14164-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y, Certificate Of Occupancy No. Z13676 Date July 29 .................................................. 19 85 THIS CERTIFIES that the building Addition Location of Property . .2.9. .6 .5 ................ M..ip.n.e.h..a.h.a..B..ty.d.: ...........S.c..u.t.h.q 1..d... House No. Street Hamlet County Tax Map No. 1000 Section .... 0. 8. 7 ..... Block ....0.3. ......... Lot .... 0.3. ~. .......... Subdivision... ,L,a..ug.h.i.n.g. ,W.a,t.e. ,r,s .......... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated July 24 , 19.8.5. pursuant towhich BuilflingPerrnit No. 14164Z dated ........ J.u..ly..2.9. ............ 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 ......... .... p.e. qk. ~.~4i~i.o.~ ~Q ~w~.l.l&~g .-~r.- The certificate is issued to ILSE SCHEIBLE (owner, &=~==-u,- of the aforesaid building. Suffolk County Department of Health Approval ........... N./..A ............................ UNDERWRITERS CERTIFICATE NO .................. .N./..A ............................ Building Inspector Rev. 1/81 lvOB~ NO. B TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CrHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO Permission is hereby granted to: .......... ~-Z. ~ ......... ~...c~.~.~.~'~......?. ........... ........ .~.?~.~.~..~/~./.~.....~.~.~.,... .......... ~~.~..~.:.~......~/.~ .... ........ ~~ ...... ~....~.~.~.~......~...~.~-- ................... to ....... ~~.~ ......................................................................................................................... / ot premises ,,ated at ....... ~Z.~.....~.~.~......~.~, ............................... ................................................................................................................... :~Z~.~...~..~. County Tox Mop No. 1000 Section ...... ,~..~...~.. ...... Block ..~...'~.. ........... Lot No..~.~..~... .......... pursuant to application doted ...... .~..G<.~..~........~...~... .................... , '{9 ..... and approved by the Building Inspector. Fee $....'~.. ............. Building Inspector 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 ~ 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 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. C. Fees: 1. Certificate of occupancy $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 ........ ........ New Building .... )~ ........ Old or Pre-existing Building ............ Vacant Land ............. Location of Property ~. ~'~.../2~. x/]¢/]~..~. //'0 . .-~..o.~..7~.o.~. ~..~?~/ 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 ........... Date of Permit .......... Applicant .................................. Health Dept. Approval . ,~).~ .................. Labor Dept. Approval ........................ Underwriters Approval..~.! .~ ................... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ .......... ~..O ............. Construction on above described building and perj~it meets ail apg~able codes and regulations. C'~Z, ~ ,.~u,"% ~ Applicant ...... Rev. 10-10-78 ~ '~ORM~O. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c ........ ~ .~.~.._. ...........//~)~ ........... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BLDG. DEPT. TOWN OF $OUTHOLD Received ........... ,19... ~ a. Tins application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ~ets 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 !~ 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 ~uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or egulatinns 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 insl~ctions. ~ ~ -~(Signature of applicant, or name, if a corporation) .... hq. .... I .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ff~...~.~...,f~-~.. ~r/~.~. ~_~ ................................................... ; (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. f--' Other Trade's License No. ~ t. Location of land on which proposed work will be done. ~..~...~..~. ~.4///~f/~'//eZ,~./~/A~.(. ~..~./././~. ........... House Number Street Hamlet County Tax Map No. I000 Section .... '~. ~. .......... Block .... ~ ............ Lot .... ~ .~. ........... Subdivision.__ __ ~.~./,q/~...~..,~. ~L~. ............ 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 ..... : .~.~..~..q :.. · .(~-'L~. · ~¥..t~-~ ......... e~::v~iaw. ,.s.~r~l~ .............. b. Intended use and occupancy '~a'x~'~r'-~-~ ~'3l ' ~ ' ~ -- ~\ ~'"~ ~'~fi 1~ ~ ,,~ ~ .............................. ;~*i iii '4~i ~ ~ ...... 3. Nature of work (check which~ 4.. EstimateO~ost .. ? ~ pplicable): New Building .. ~ '~' reval .............. Demolition . ~.. ...................... Fee 5. 'If dwelhng, number of dwelhn~ units .............. Number of dx If garage, number of cars .... . ............................... 6. If business, commercial or mix '~d occupancy, specify nature and extent 7. D~menslons of existing structu 'es, if any: Front ............... Rea: Height ............... Number of Stories ................... Dimensions of same structure With alterations or additions: Front ... Depth .................. !... Height ...................... - 8. Dimdnsions of entire new construction: Front ...4.~..~. . .(o.'l. .... Rem . ~ t ............... Numbe, ,,fS,one~.. ~ ................ ddition..~'. ~. ~..~--Alteration .......... .~ ........... Other Work ............... ! (Description) (to be paid on filing this application) ,elling units on each floor ................ >f each type of use ..................... .............. Depth ............... ............. Rear .................. lumber of Stories ...................... · .~.~.. ~ ..... Depth .~q..~ .......... 9, Sizeoflot: Front ......... ~ ............ Rear ....................... Depth ...................... 10. Date of Purchase ......... ~ ................... Name of Forme Owner ............................. 1 1. Zone or use district in which premises are situated ...................................................... 12. Does proposed construction vi61ate any zoning law, ordinance or regula ion: ........................ 13. 'Will lot be regraded ....... ; .................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ~[ .ee~...~...e~ .k~..~ ....... Address Phone No Nme of Architect ........ --~ .................. Address ...... Nme of Contractor .~ ................. Address ...... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or propo property lines. Give street and block number or description according to dee interior or corner lot. STA'rE OF NEW (Name of individual sig~ing contract) above named· He is the. .............. ~ ........................ of said owner or owners, and is duly authorized to perform or have perfm application; that all statements contained in this appIication are true to the work will be performed in the man,er set forth in the application filed there~ Sworn to before me this Notary Public ..... ~~.~ ......... County ........... Phone No ................ .......... Phone No ................ ~d, and. indicate all set-back dimensions from and show street names and indicate whether ~orn, deposes and says that he is the applicant ricer, etc.) rned the said work and to make and file this best of his knowledge and belief; and that the 'ith. (Signature of applicant)