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Home My WebLink About13815-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...,Z.1.4fi..2,7 ........ Date December 27 19 85 THIS CERTIFIES that the building ........ .D.e.c.k Location of Property 350 Mac Donald Rd (?vt. Rd 2) R.0.W. OFF Peconic Bay Blvd. House No. Street Hamlet L a u r e 1 County Tax Map No. 1000 Section . .1.4.5. ....... Block ..... z[ ......... Lot ..... 1 .4 .......... Subdivision.. ~D.~I~,~. ~Pg~,K ............. Filed Map No..~ .0.~.7... ,Lot No.1 ~. ~ .~ .~.-. ~. 7 .-,1.~.. 7/2/31 conforms substantially to the Application for Building Permit heretofore fired in this office dated ·..N..a,.c.h...2.8 ......... ,19 .~5. pursuant to wh/ch Building Permit No.. fi. 3..8 J.4. Z. ............ dated .... N..a?.c.h...2~ ............... 19g. ~., 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 ......... ·..Deck .add.J.~ J~ on..ko. ~s ~t.ng. pn.e. F~m~$¥..4~ l~-.J.r~g ....................... The certificate is issued to .... B.e.r.~r.a.m., e. rT..Wa. ........................ [owner, ~,~ l~r~af~ of the aforesaid building· Suffolk County Department of Health Approval ............ ~ ./.~ ........................... UNDERWRITERS CERTIFICATE NO. N ( A Rev. 1/81 Building Inspector I~OR~ NO. ~ TOWN OF SOUTHOLD BUILDING DEFAI~TM£HT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 13815 Z Permission is hereby granted to: __ . . ~ ~..~....~ ....... ~..~ ........... .~.~.....~.~.~.~,.~.,,.~d. ........... to..~~.........~....~ ....... ~...X..o.......~...~ at premi~es located at ............................................................................................................................ County Tax Mop No. 1000 Section ..... J .......... Block ..................Lot No .................... 10.~.;,..., ond the pursuant to application dated ..... .~.~.. ................ , ~' by Building Inspector. 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 A. 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- t/OhS, 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. 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- t/on required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $ ]. 5.0 0 3. Copy of certificate of occupancy $1.00 .v.o.nt .nd c.c. ..00Date,. New Building .... ~ .... .~. Old or Pre-existing Buildin/g/,~..../,~ ..... Vacant Land ............. Location of Property. ~ ~;'.~,. ..... ~.~.//~¢~ ~. ~'~.~..~ .'~. · ................... L · .~---~. · .~ · · House No. Street Ham/et Owner or Owners of Property ...... ~.~j~.'~..Q. [~..~.'.. [~..0.. ~'.(~..[~..~.. ~..~. ~t..~..C~'.. ............. County Ta× Map No. 1000Section../.Z~.Z~..',*~. ..... Block ...~.. ......... Lot..Z./~/... ......... Subdivision .......................... , ...... Filed Map No ........... Lot No .............. Perm it No. [..~.~.'1..~..~.. Date of Permit~.~. ·~?~.~,~./.App licant ~.~..~.~.~..~.. ~'~./~/..~. -~.~--~..'~.- · . Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Tempora~r~Certificate ..................... Final Certificate .... ~ ................ Fee Submitted $ .~.. ~-~.~. ..................... Construction on above described building and permit m, ee~ all ap~icable codes end reguJations. 7t Fi~LD;~NSPECTiON ~' ~ FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY %¸.. ~9DE FINAL COMMENTS ADDITIONAL COMMENTS: ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ., ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined.. ~/kt .O-A~ .~..~.., 19~..~. approved ....~0.A .c~...&..~., 19 .~.?Permit No..J..~.~. l.c}..'~- Disapproved 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 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- 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 a 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 Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, addifions 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 ,regulatigns, and to admit authorized inspectors on premises and in building for necessary insrp,.~ti~m. ~ -/, //5~ /.' ,,//~/~,,-f (Signature of applicant, or name, ifa corporation/ ~.~ .~.../z.. ~...~7,~../~X.'...~.:.~,×/.~... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises.../.~..~.~...~.'~..'~.-/~.. ~..,.~..~.~.~.~.~¢~o... ~/~.,/~.~.~'../~..~...~... ~ .~../~.51~ (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 ....................... Othe, Trad 's License No ...................... ( 1. Location oflan~o~ which proposed work will be done. .~ . . ~ .......... ~::~:~.~ ................... ~.~~.. ~..~ ....... , ..... ~~ . House Number Street Hamlet ooo e fion ........ ../ ............. .... .......... 2. Dmre existing use and occupancy ot premises and intenoea use and occupancy of proposed cmlstruction a. Existing use and occupancy ~/~//~ ~ .. ~/~:~, ~ . .~ ~ % ......... b. Intended use and occupancy .~..,~..,t;~~,}~f~. ~ ......... 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work.. ~.. ~,'~'. ~fi~. ..... ' ~.~ ripti ) I (Desc on 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. Danenslons of emst~ng structures, ~f any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions 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 Nu[nber of Stories 9. Size of lot: Front ....... .~.. ! ............ Rear ...................... De th , .................. 10. Date of eurchase ..~f.~...~¢. .................. Name of Former Owner 11. Zone or use district in which premises are situated 12. Does proposed construction viOlate any zoning law, ordinance or regulatinn: ..,//-,~. .......................... 13. Will lot be regraded . .~..,~..~. ........ Will excess fill be removed f_rom premises: Yes 14. Name of Owner of premises .f~. ' .~..~. ~'.' .~.' .2.,~'~ i. Address ~g'///,~;..~.,t0'~fr'~..~,lqC~one No. Name of Architect ......... , .................. Address ................... Phone No ................ Name of Contractor ....... ' ....... Address ............... Phone No . PLOT DIAGRAM Locate 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. STATE OF NEW YORK, ! ~ ,, COUNTY OF .~ ..... i a'a ... ~,-~..er.~. 7~...a-Z~ae..t/v..Ag.:. ~.~ ................ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ..................... ~ .................................................................... ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is ddly authohzed to perform or have perfomed the said work and to m~e and file ~is application;that all statements cont~ned ~ this application are true to the best of his ~owledge and belief; and that the work will be perfo~ed in the m~n}r set forth in the application filed therewith. Sworn to before me this Nota~bl~,.. ....................... County , ~ ~ ~V~k (Si~a~of applicant) Term E~ire~ M.roh ~, I~