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Home My WebLink About14194-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...Z.1.3.7.2. 7 ......... Date ...... .A.u.g.u..s.t..9. ................. 1985 THIS CERTIFIES that the building .... .A.c.c.e..s.s.o.r.y...d.e.c..k ........................... Location of Property ...4.2. 5...T.e.r.r. :F..L.a.n..e ................... .S.o.u..t.h.o. 1. d. ............... House No. Street Hamlet County Tax Map No. 1000 Section . .0.6.5, ....... Block ....... .0.1 ...... Lot ..... 2.1. .......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... J~.:Lg. 3 D ......... ,19 ~ 5. pursuant to which Building Permit No. 1 .4.q.9.4. .Z ............... dated ...fi ~ g.u.~. ~. ~ ................ 198. 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 ......... .... ~.c.q e. ~ .~.o.~.~..d.e.q k., .......... The certificate is issued to ... JOHN & JOAN S[~0RNBERGER of the aforesaid building. Suffolk County Department of Health Approval N / A UNDERWRITERS CERTIFICATE NO ................... N./..~ ............................ Building Inspector Rev. 1/81 FO~l~ NO. ~ TOWH 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) No_ 14194 Z Permission is hereby granted to: .. .~ . ..... ..q~.~~ ......... .~.:~.:.....].~..t.~..~~. ,o .~~........~ ...... ~.~~:~.,.....~....~ .......... :::::::::::::::::::::::::::::::::::::::::::::::::::::::: .... .......... ..................................................................................... County Tolx Map No. 1000 Sech' on ..... [...C~....~....~. ...... Block ..... .?..J ........... Lot No ....... .~.....l ........... pursuant to application dated ..... ...~.L~....~. ...................... , 19..~.~.'~, and approved by the Building Inspector. Fee $.~...~..: ............. Building Inspector Rev. 6/30/80 FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hail '~ ,~.~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions BLDG, DEPT, TOWN OF SOUTHOLD A. This application must be filled in typewriter OR ink, and submitted in duplicate 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. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accu, rate survey of peoperty 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 i,nforma- tion required to prepare a certificate. Fees: I. Certificate of occupancy $5.00 2, Certificate of occupancy on pre-existing dwe ng/ land 3, Copy of certificate of occupancy $1,00 use --Pre-Existing C.O. $15,00 Vacant land C.Of $ 5.00 ......... · ' g~"~.....~.. Older Pre-ex~sting Building ........ Vacant Land ............. ~,;J ~ ..... ~ .............. ~v~.~ .... ~. . , ~ .. . ~,. , ............ Owner or Ownersof Property ..~ ~ ~.~ ~& ' 3~ p~,~ ~ ,~ Coun / ~ "'~ .......... ~ ....... ~'~'~' =~ ........... ,, T,~ u~, ~o. ~000 s.~,io....~..~ ....... ~ook .... ~ .......... ,o,.. %.~ ......... Subdivision ................................. Filed Map'No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Ilealth Dept. Approval ........................ Labor Dept. Approval ........................ Unde~riters Approval ........................ Planning Board' Approval ...................... Fee Submitted $ .~ .... Construction on above described building and permit meets all applicable codes and regulations. ........................... f' IJ~,L D ~NSFECTION (1st) COMMENTS FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 \ TEL.: 765-1803 Examine~..~P.~ .~..., 19 .~.f Approve~~.~...~...., 19~...~". Permit No..).q} ?..%.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS JIt. 3 0f985 Received ........... ,19... a. This 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 ~r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :ation. 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 ~hall 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 ~hall 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 3uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ~egulations, for the construction of buildings, additions or alterations, or for removal or demoiltion, as herein described. ~he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to ~dmit authorized inspectors on premises and in building for necessary inspectiort~. __ ........ ..... (Signature of apl~licant, or nam~ il~ a corporation) (Mailing addre 3tare whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. q~:':: :~n~fiii' ' '~: .... ~i ~ii iltilt'iii~) ......................... f 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 ...................... Location of land on which proposed work will be done .................................................. .... .......... ............ ........................... House Number ct Street Hamlet County Tax Map No. 1000 Section ..... .~...~/ ........ 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 ....... ~'~-- N b. Intended use and occupancy ...... 3. Nature ofw0~k (check which applicable): New Building ..... ' ..... Rei~air .............. Remloval .............. Demolition ... 4.; Estimated C,ost .., ....;:~/.o..Q .o. ......................... Fee.. *. ,l~weln~qTumoer oi awelllng umts ............... Number of dg If garage, number of cars .... ~ ................................ 6. If business, commercial or mixed occupancy, specty nature and extent 7. D~efisionsofexistingstmctures, ifany: Front ............... Rear Height ............... Number of Stories .................... D~ensmns of same' structure with alterations or additions: Front .... '' Depth ' HeiSt ~ 8. D~ensions of entire new consgmction: Front ................ Rear H~,~ht ................. umber of Stone ...................... 9. Size of lot: Front ........ f.~ . ~ Rear 10. Date of Purchase .......... j ..... 11. Zon~ or use district in which pr~mis~s are situated . .... ~.. ~...~ ~.. tdmon .......... Alterat~on .......... ........... Other Work .... ~.. (Description) elling units on each floor ................ f each type of use ................ .............. Depth ............... ............. Rear .................. umber of Stories ...................... ............... Depth ............... .... Depth .... ,9~. ~'.~.~¢¢q~.. ~... 12. Does p~oposed construction violate any zoning law, ordinance or regulat on: .......................... 13, Will lot be regraded ........ ~ ................ Will excess rill 15 ~removed from premises: 14. Name of Owner of premises/~ev~ ,~f'/~t.~.. Address . .~.~5~....,>¢ef~.. ~. Phone No. Name of Architect ...... ~' .............. ./ .... Address .................. Phone No ................ Name of Contractor ........ J .................. Address .................. Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or propo: [, and~ indicate all set-back dimensions from property lines. Give street and bloc~ number or description according to dee, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ! S.S COUNTY OF ................. ............................ ~ ..................... being duly (Name of individual signing contract) above named. He is the (Contractor, agent, corporate of said owner or owners, and is duly authorized to perform or have perfo~ application; that all statements con,'tained in this application are true to th~ work will be performed in the manner set forth in the application filed there Sworn to before me this Notary Public ............. !... HELEN K.~VOE i NOTARY PUBLI~_, $l~te of New York . lerm Expires M~rch ~, yom, deposes and says that he is the applicant ricer, etc.) reed the said work and to make and rile this best of his knowledge and belief; and that the ~ith.