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Home My WebLink About13824-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ..... .Z.l.q ~ .0.1 ...... Date ......... ~.u..Z y..3. ................. 19~..6. THIS CERTIFIES that the building ......... .f 9.u.r~d..a .~.~.qn. .......................... :. Location of Property ...4.3.5... i ........... .~.e. ~ .~.v.~.~,. ¥..D?., ............ ~l~.t;.t;.~..~ .u.c.!~ .... House No. Street Harnle~ County Tax Map No. 1000 Section ..... 1.3 ~ .... Block ........ .1 ......Lot .... ,2,3, ........ .. Subdivision ........... .~ .................. Filed Map No .... .X .... Lot No ...... .X ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ·..H~ r.cjn..~9 .......... 19 .~ ~pursuant to which Building Permit No ..... 1. 3. .8 .2 .4. Z. .......... dated ....... g~.~. ~. ~_..1 ............. 19 .~ 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 ......... The certificate is issued to ............. ~. ~I.~I~A...d....S..E ~,,L.~. ~ .S .......................... of the aforesaid building. Suffolk County Department of Health Approval ............... iq/,g, ....................... UNDERWRITERS CERTIFICATE NO ....................... ~1/~ ....................... Rev. 1/81 Building Inspector FOB~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT Q'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N_0 Date(~ :~; (~" J 13824 Z ...~.,~ ................................ Permission is hereby granted to: ................................................ ....... /) I , / __ Ut,/ ~ U \ .... ,, t .t premises located at ..,,~L,.~..~,. ...... ..,~....,~f~.4Z~!~......)..~.....~...; ....... ...~.. ~~ ........... County Tax Map No. 1000 Section ..... Z.~,~. .......Block ..... ..C~..../. ......... Lot No .....~.~ ........... to application dated ....... .....~..°.-~'l....~..~ ..........., 19,.~..~...~., and---- approved by the pursuant Building Inspector. Fee $.~,~. .................. Builcllng Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ,¢Jouthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions in duplicate , A. This application must be filled in typewriter OR ink, and submitted V 'Ko ~he Budding Inspec*- tot with the following; for new buildings or new use: 1, Final survey of property with accurate location of all buildings, property dnes, streets, and unusual natural or topographic features. 2.Final approval of Health Dept. of water supply and sewerage disposel-(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. Accurate survey of p~operW showing all propertv 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 preoare a certificate. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $I .00 4oVacant Land C.O. $5.00 $15.00 New Building Old or Pre-existing Building Vacant Land Location of Property . .~.~. · ........ ~<.) ~'~..T~¢.~;..~. '~', ~t ~- ~t 'r uL0._~_ House No. Street Hem/et Owner or Owners of Property .. -~--~-.~,~/"f] :~, S~L,~'~ County Tax Map No. 1000 Section z~/..~.. ?.,?.O. ..... Block .¢. (.'.O..? ...... Lot.. ~..~..~. ;..O. O Subdivision ................................. Filed Map No ........... 'Lot No .............. Permit No./.37.~. ~ Date of Permit ...Applicant ~ Z~ ,,~ .... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... RequeSt for Temporary Certificate:., .......... , ......... Final Certificate ....................... .....- t-ee ~uDmlttao ~ ...................· Construction on above described building and permit meets all applic_abl~codes and regulations. ~'O,:~[q ~/ Applicant ~.y~ ............. FIELD INSPECTION FOUNDATION (~st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY QODE FINAL 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL , r ~°0UTHOLD, N.Y. 11971 TEL.: 765-1802 Examined. ~..} ..... , 19 Approved... ...I .....,19 $ (. Permit No. L Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... Date .................. , 19... INSTRUCTIONS e. No building shall be oc shaJ1 have been APPLICATION Building Regulations, for The a. This application must be completely filled in by Wpewriter 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, or used in whole or in part for any purpose whatever until a Certificate of Occupancy Department for the issuance of a Building Permit pursuant to the Suffolk County, N~,' York, and other applicable Laws, Ordinances or or for removal or demolition, as herein described. thie laws, ordinances, building code, housing code, and regulations, and to /A~ignature of/Kpplicant, or name, if a corporation) a ........ //4,~tT'/'/TtF~[~iling ad~¥e~ss~o'f applicant) State whether appll$~4$~s owner, lessee, agent, architect, engineer, general contractor, electrician, plu bur or b fide. Name of owner of prelmses ·~ '~" ~ ~'"' ~ ...................... '~ ~x~"C w 'id' ~[~¢ba~ ........ (as on the tax roll or latest~[~}~ ' ~ ~ If applicant is a corporation, signature of duly authorized officer. DATE: ~/'l~r ~.P. .............................................. NOTIFv BUILDING (Name and title of co~orate officer) 765 18~2 9 AM TO 4 PM FOR FOU a'VING MSPECTIONS: Builder s License No .......................... l. FOHW~AT~ON - TWO ReD ,IRED Plumber's License No ......................... 2, [""~ '~H - FRAMING~ ~ P~ .... IJM31NG Electrician's License No ....................... 4. r ' ('n~, ql':,~ ~ '. 73N MUfT fi!IF pr'hLj~pziM~N'TS OF THF N.Y, .............. ~TA., r...COMSTROGTION · .& - ENER6~ .... 1. Location of land on which proposed work will be done. ~ CO~c E FOR House Number Street Hamlet County Tax Map No. 1000 Section ... ff~¢.¢ ...... Block ...'~/~ 97 ...... Lot..~ ~ .~.~ ..... ..................................... Filed Map No ............... Lot ............... Subdivision (Name) "- 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .. . ~ ................................ b. Intended use and occupancy a~/dAo~'z~./~. ~ .~..~'..d/e~.../~.~.~..~ .~..~.4.ffff.. s.~c.~. ~--g$7. ~..a(. ~. ....... 3. Nature o work (check whmh applicable): New Budding .......... Ad&t]on .......... Alteratwn .......... Repair ...'.~ 5[ ....... Removal .............. Demolition .~ .......... Other ~'~/~/(/'Y~ ~>/~ ~"~7 (Description) 4. Estimated Cost.,~.~..~.dtU/7/~/~- ~'°~O0'a~ M~ogt.~ , · ........................ 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. ................ 7. D~rnens~ons of ex~st~ng structures, if any: Front ............... Rear .............. Depth ............... Height Nfimb r of Stori / Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................. ~... Height ...................... Number of Stories ...................... 8.. Dimdnsions of entire new construction: Front Rear Depth Height ............... Number of Stories ......................................................... 9. Size of lot: Front ...(ot~.t./v. 5'. ............ Rear .~"~.,/.0 ................ Depth~/i'.q...~'..~ .c/.(.,. .......... 10. Date of purchase '~.~0~¢,~I5~¢~,... t fi.r). [.g ......... Name of Former Owner ~.~.:'.J'.o~.~./~y~/~..,,q,.~.~,~,~... 1 1. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction vilolate any zoning law, ordinance or regulation: ~). ............................. 13. Will lot be regraded ....... [ ......:,. iq..~ ......... Will excess fill be removed from premises: ~ No 14. Name of Owner of premises ~./~U/~/t. 4,..~,Ak~.. Address/0 K-~71/I.~..~ .T2~¢/l{//.T(./~0,~hone No. ~{~.cf,fF.-~.~. 5.- ?.... Name of Arclutect ........ ~ .................. Address ................... Phone No .......... ~..~... Name of Contractor . ~ D.. [5f4 ¢$.~,~ Address ..... Phone No. ff.~..~..-- ..... ~' PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. t 0/ STATE OF NEW YORIG ,, S ~. COUNTY OF... J:..q.~. :~.'.[..~:... ............... ~.?..f'?fi. !~.. ,~.,,. ?f. ?(..r'? .......... being duly sworn, deposes and says that he is the applicant (Name of individual sig~ing contract) above named. He is the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dt~ly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........................ day 6f .................... , 19,. $otaryPublic, .~ ............................. County ~OTlS~RY P-,,l~12~C,/Itttt~ ot INew Yorl~ f//// (Signature.o~ appJicant) Suffolk l~ount¥ ~No, ~2-0(~76~50 C~ammisa/on'~x~lre~ ~larch $0, ~9~ (,> q