The URL can be used to link to this page

Home My WebLink About13917-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ..... .Z3.4 -PS. ..... Date ........ P.e. 9.e.m.b.e..r' .1.9. ........... ,19 .8.5. THIS CERTIFIES that the building ....... U .n.h.oAt..e.d' .a~ .d.d.J..t;.~o..n.. .................... Location of Property ...2.~ 0 .............. ?.e..n.d~..D. ~... Laurel House No. St~e~ i ....................... County Tax Map No. 1000 Section 128 . .Block 5 .Lot 2 Subdivision .......... X ................... Filed Map No. X .Lot No. X conforms substantially to the Application for Building Permit heretofore Filed in this office dated .... ~. p;c.:i,],..29. ....... , 198..5. pursuant to which Building Permit No ..... .13917z dated ..... .M~y..7 ................. 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 ......... ..... LVnhea~:~d. a~lditipx~. ~:Q..~r~..e.x.~.s..~.~.n.q..dy.e.l.Z. Sp.g... ........................ The certificate is issued to KAREN & PJ[Y WILLEAMS ..................... i ...................... of the aforesaid building. Suffolk County Department of Health Approval .................. .N.~.. .................... UNDERWRITERS CERTIFICATE NO ......................... N..~. ...................... Rev. 1/81 Building Inspector i~0mw NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PEP. MIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK ^UTHORIZED) N~ 13917 Z County Tax Map No. 1000 5ection .../..~.,.~.,. ........ Block ,..~...~...'~.. ....... Lot No. ,~...,.~,. ......... pursuont to application dated .......... (..~. ................ , 1 d approved by the Building Inspector. Fee 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 Wpewriter OR ink, and submitted ~ I~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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Lanc~ C.O. $5.00 $15.00 Date .~. ~C.~-.~.., .~3t~.,, ?.~, ./?.y.~. New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ...~...~...O.....~. ~..~Td~...~..~,,'.o..~. ' . .. ~ ,r..~_.. .............. House No. Street Hamlet Owner or Owners of Property .~..~...~.. ~ ..~...~ ~..~.~aJ~..~. County Tax Map No. 1000 Section . ./..~,~. ........ Block . ,C)..~. ......... Lot .(~), .~. ........ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./.~.(:/LT...~... Date of Permit ,°~/7/'?.'$/...Applicant ~).O.O..F~, .q,~,~'.~,~9....~.'..~..d~..,.../-~,..C,.... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate .. ~' ................... Fee Submitted $ ........................... nstru,ction on above described building an~l,~it meets al~,applicable codes a~d regul;tions. FIELD INS~ECTi~ON COMMENTS FOUNDATION 2. ( 2nd ) ROUGH FRAME & PLUMBING INSULATION FER STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: BUILDING DEPT. INSPECTION FOUNDATION IST [ ] ROUGH PLBG. FOUNDATION 2~[] INSULATION FRAMING~ FINAL ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined ..... ,19.2.?- Approve ' ...7, ....... 19 ' ermit 7'.. Disapproved a/c ....... Z~.... 7. .... ,- .................. (Building Inspector) APPLICATION FOR BUILDING PERMIT Rece±ved ........... ,19... INSTRUCTIONS 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 )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 tins application may not be commenced before issuance of Building Permit. d. Upon approval of ttlls 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 a 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 Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or gegulations, 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 regulafions, and to ~dmit authorized inspectors on premises and in building for necessary~nspections. ~ . · .~.3. ~...;~..v.(.~ .<~ ./.~ ( ~ :~ .-c... ..... (Signature of applicant, or name, if a corporation) (Mailing address of applicant) gtate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· · .............................................................................. Iame of owner ofpremises . .,~..(~..~.f~. ~,);~ ((~/Y)~' ..~.~ ~'~(~f((f~O~)~ ................ applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No...~..~. ? .................. Plmnber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on winch proposed work will be done.. ~; ............................................ .. &..5o .................. House Number Street Hamlet County Tax Map No. 100OSection ..lgO? ........... Block ..~ .......... Lot.~ ............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of pr~misesi~d !ntended use and o~upancy?~proposed construction: a. Existing use and occupancy ..................... ~. ....................... b. Intended use and occupancy ..... .~r. :~z.'~....~-~,~m--~-r ...... ~ ............... 3. Nat~r0, fwork(checkwhlchapphcable):NewBuilding .......... Addition .......... Alteration .......... Repmr ~ . . .alllemoval ......... Demohtlon .... Other Work .......... .~,1 ~ '. g~ '~i _/ ~ (Description) 4. Est~ t4~.Cost .. .Q~..~:~ .' :} ......................... Fee. . ............................ t ....... t. ~T ' ~' (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 ..... i ................................................................... 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 ............... Number of Stories ........................................................ 'I)imensions of same structure with alterations or additions: Front ................. Rear .................. Depth ................... i · · Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories .......................................... ~ ............. 9. Size of lot: Front .......... ~ ........... Rear ...................... Depth ...................... 10. Date of Purchase .......... i .................. Name of Former Owner ............................. 11. Zone or use district in which pr~mises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................. :.. 13. Will lot be regraded ...... .'-~ i ................... Will excess fill be-removed from premises: Yes No 14. Name of Owner of premises/~F~/O~f6~ ./~./~/~OJS~dress/~.~..O..~. f?,~:~.. Phone No ...... Name of Architect . ...~ ..... i ....... .~ ......... Address ........ ~ .'~.~.c7.. Phone No ................ Name of Contractor f~f~ .. ,/~..QrT/. g .~O ........ Address f~.~.~...~..~.~.~./..C~.....irfiALghone No. 7~.~'5~.. 27.&.. PLOT DIAGRAM Locate .clearly and distinctly al1 buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and blockinumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF ................. . ............................, .'.................... being duly sworn, deposes and says that he is the applicant (Name of individual sig¢ing contract) above named. He is the ..................... i .................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is ddly authorized to perform or have performed the said work and to make and file this apphcatxon; that all statements contained m th~s application are true to the best of his knowledge and belief; and that the work will be performed in the mann'er set forth in the application filed therewith. Sworn to before me this ...c~., ....... day gf ...... ~... Notary Public, . ..... NOTARY PUBLIC, State o[ New Vortt ................................. No. 4707878, St,'*~!~ Counl~ Signature of applicant) · -' MON~iMKNT REVISIONS F~. M,/9;'5 ~D/OB FBON DATA OBT~ED FROM YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERH[AD, NEW~ ALDEN W. YOUNG ~ ~ TOWN O~ SOUTHOLD SUFFOLK CO., N.Y. ' -t OF4~W YOR~. OF OCC ) · [AP?RDVED AS NOTED ~OTI~ BUILDING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR ~H~ FOLLOWING INSPECTIONS' 1. FOUNDATION - ~O REQUIRED THE REQUIREMENTS OF THE N.Y. STATE GONSTRUCTION ~ ENERGY CODES· NOT RESPONSIBLE FOR DESIGN OR CON,RUCTION ERRORS.