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Home My WebLink About14285-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ..... z 1 fi 6.6.1~ ...... Date ........ ~[ul~r. .18, ................ 19 8.6. THIS CERTIFIES that the building...a.c.c.~.s..sp.rX . .b.u.J..i.d..i.n.g ......................... Location of Property . .2.4. 4 O. .H..a.r. b. 9.r. .L. .a.n.e. ,....C.u.~qh. 9.cj. qe' t . .Iq.o.w. . y.o.r..k. ................ House No. Street Hamlet County Tax Map No. I000 Section .~.0.3. ........ Block ...0.~ .......... Lot ...2,9. ............ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... .S.~.p. ~..e.m~..e..r..1.6. ~., 19..8.6pursuant to which Building Permit No...1.4. 2. .8.5.g. ............ dated .S.e.p .t.o.r~..e..r..1.6. ~. ............19..8.6, 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 ......... .......... .a.n..a..c.c.e.s.s. 9.ry..b..u.~3.d.i..n~ ............................................. The certificate is issued to Herbert Bell & Ruth T. Bell ..................... ?o¥,,'d-, ~g4~ ...................... of the aforesaid building. Suffolk County Department of Health Approval .............. .Iq/.~. ........................ UNDERWRITERS CERTIFICATE NO ...................... .Iq./.~. ........................ Building Inspector Rev. 1/81 FO~ NO. 0 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) N~ 14285~Z Permission is hereby granted to: u.~..~.~.~~, ............... ......... .'/.. ........ ~~....z~....~ .......... .~~.~....~....V.:....L?..~..~_ _ ....... ~ ~ at premises located at ............................................................................................................................ County Tax Map No. 1000 Section ...~...O....~.. .......... Block ...... ..~....J ......... Lot No ....... ...~.....~ ......... ...... ~ ...................... 19.~..~.., and approved by pursuont to application dated ,~ r the Building Inspector. Fee $..~.....: ............. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted m~ 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. 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 5. Updated C.O. $15.00 $15.00 Date .......................... NewConstruction ...... Old or Pre-existing Building ............ Vacant Land ........ _~... Location of Property..~,..Z/~.~. ~. ...... Z~:',~.f..~3.J,~....L./,4,., ,~..~.-~. :. C(A~.~. ~. o.~. ,b. ,~,. ..... House No. -- ~ ~,_ Street ~ ~ Ham/et Owner or Owners of Property./7~--~, ,l~? '~/~ ~C2 ~/~L ~ ~., ~--L_~__ County Tax Map No. 1000 Section ..... /~).~ .... Block.. 2.~..l ......... Lot .... L.~ ....... Subdivision ........................... I · ·.]..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 $... ~.~. ~ . .~.~... ~. ~..~.. ~.~. .... Applicant -.../¢~LA~/. ~/~ ......................... TO FN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 To Whom This May Concern, Please complete the enclosed application for Certificate of Occupancy and enclose a check for $5.00 (the fee for the C.O.) and I will be able to 'complete the Certificate of Occupancy. Thank you so much for your cooperation in this matter. 7GS.'1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. FOUNDATION 2ND ~ ] INSULATION [ ] FRAMING REMARKS: ~FINAL DATE INSPEG~I'OR ,'OUNDATION (1st) COMMENTS ~UNDATION (2nd) OUGH FRAME & PLUMBING iNSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: ' 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1~02, ;.xamined ..........~.~. · .~-'~ ) ~. ...., 19~'' kp proved~O~.~-~....~..., Permit No. )isapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... Date ................... 19... INSTRUCTIONS 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 Buildh~g 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 g 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 tuilding 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 demolition, as herein described. the applicant agrees to comply with all applicable laws, ordinances, building code, housing c/9~e, and~ions, and to ldmit authorized inspectors on premises and in building for necessary inspections. (Signature of aplffffcanf, or name, if a corpora ' ) % x..3z .....C. (Mailing address of applicant) ;tare whethex applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. fame of owner ofpremises ...~l ..... e - : .... '~¢...S.~*..~r~ .[:..~¢.~ .............. (as on the tax roll or latest deed) [f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's LicenseNo .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done. ....... (.u. ...... House Number Street Hamlet County Tax Map No. 1000 Section ..... /1~). 3e ~... Block .. ~).. t/:. ~.. ~ ..... Lot.. (~)..~.?:..t~..~). .... .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 ...... ~.~-. X./.'i~....~-'-'-~. t/.~. ~ .c.~.'- ............. i .......................... b. intended use and occupancy .................... ~..:. ' · · · ~ .' :..: ............ N~v?8'ofwork (chec, l~.,~hich applicable): New Building ..... ./-~.... 'Addition .......... Alteration .......... Repaar ..... ~ .............. Other Work .............. · Removal .............. Demoht~on . .~..OO: OC> (Description) 4. Estimated Cost ......... ~ ........................ Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units .............. Number of dwelling units on each floor ................ | If garage, number of cars ' 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ................ Height ............... Nurpber of Stones ........................................................... Dimensions of same structure With alterations or additions: Front ................. Rear .................. Depth ' Height Number of Stories new construction: Front ' Rear Depth Dimensions of entire ....................................... H~ioh* Nt mb°,r nY Stc~r~oq . . . S~ze of lot: Front ....... [.O:O.. 0.. ....... Rear .... ].O.C~..,. C~ ........ Depth .../.~ .O ............. Date Of Purchase ... ,~,~./(2. ,g.. [.~. ........... Name of Former Owner . .~.F~.~N ff....~./~.~.& ~ T. .... 11. Zone or use district in which premises are si.tuated....~t~-~, t'¢.~T.t'./3/-~ .................................. 12. Does proposed construction ¥i6late any zoning law, ordinance or regulation: ..~..o ........................... 13. Will lot be regraded ..... fi~.'.i ....... ~. ............ Will excess fill be removed from premises: fi/o Yes No 14. Name of Owner of premises PJeT~.~.~]' .~.~..or.a. T-./~.~t-. AddressA~/..~qg/sPt/e I-~L .~9.~. Phone No/O./(~. 7;5.¢.: .7.~ ~../.. Name of Architect ' Address Phone No Name of Contractor ' Address Phone No i PLOT DIAGRAM ' l,ocate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and bloc]: number or description according to deed, and show street names and indicate whether interior or corner lot. 9. 10. STATE OF NEW YORK, S.S COUNTY OF ................ ........ : .................... i ..................... being duly sworn, deposes and says that he is the applicant (Name of individual si~'ning contract) above named. He is the ' (Contractor, agent, corporate officer, etc.) of said owner or .owners, and is dhly authorized to perform or have performed the said work and to make and file this application; that till statements cofitalned in this application are true to the best of his knowledge and belief; and that the work will be performed in the manfier set forth in the application filed therewith. Sworn to before me this ................. ~ ...... day of ................ 19... No ta,~ Public, .. ~..~ ~)~'~?...~,.. County N0l~,e~,~k~' s~s~,~/ (Signature of applicant) APPROVED AS NOTED ' NOTI~ ,BUlLI~t~ DEPAHTMENT AT 765~1802,9 A~ TO ~ P~ ~R .TH~ FOLLOWING i FOUNDATION TWO REQUIRED . FOR POURED CON~ETE 2 ROUGH FRAMI~PLUMBING 3. INSULATION 4, RNAL CONSTRUC~N MUST BE COMPLETE E~R C~. ALL CONSTRUCTION SHALL MEET THE REQ~IP~MENTS OF THE N.Y STATE CONSTRUCtiON ~ ~ERGY CODES. NQT RESPOnSIBlE ~0~