The URL can be used to link to this page

Home My WebLink About13826-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. z~ 3633 Oate ........ Jul ., 19 ?. THIS CERTIFIES that the building ..... D~9~..~. ~.e~C~, ............................ Location of Property . .5?5 ............... G~;L.~.~q~'.~..~.e ............. ~.o..u.~.~.o.~.~. ..... House No. Street Hamlet County Tax Map No. 1000 Section ..... 7.0. ....Block .......... q '1....Lot ..... 5 ........... Subdivision ................ X .............. Filed Map No .... ~7 ....Lot No ....... ~. ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated April ~ 19 85 ~3826Z ..................... , . . . pursuant to which Building Permit No ...................... dated April 2 19 ~?., 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 ......... Ingroumd pool and fence. GEORGE S. & BEATRICE W. SMALL The certificate is issued to ..................... ?o~n'o),~~ ..................... of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE NO ...... Building Inspector Rev. 1/81 FO~M NO. 2 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) 13826 Z Permission is hereby grant~Lte~ , ...................... ..~..~.:...~.....~ ..................... .~.~.....~..:.~.....u..~..~...~ ...... .............................................................. : ............ ; .......... 7P ............. ~ .............................................. at premises located at ...~...~...~ ............. County Tax Map No. 1000 Sectio~.....~)..~...°.. ....... Block ........ LI ........... Lot No ...... ~;;;~.~.. ............. pursuant to oppllcofion doted ..... ~. ............................ , 19~....~., ~nd opprovod by th~ Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD 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 ia ~ 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. Accurate survey of p~toperty 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. C, Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $15.00 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 Date .........~'~/J.~. ./.~} ............. ~,~..~. New Building ............. Old or Pre-existing Building ............ Vacant Land . ..l~. ......... Location of Property 57J' C/~,I~FTE.~.$ / A~VE SOu~'HOLF9 House No. Street Hamlet Owner or Owners of Property G .~..0.~..~..~...~.: $.PO..~.L..t~ ...... .~..~.~."~..~. ! .C~I~......'~..-..~...~..~..L..~.. County Tax Map No. 1000 Section 070 Block !~ Lot. ' Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. /..3..~..~.~... Date of Permit,~/.~./ .....~.~..Applicant., ~.~. ,O.~. ,J, ,/~,, ~.:..,~,, .~.~.~ ......... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Subm,tted ......... Construction on above described bu ilding and permit meets all applicable codes and regu lations. Rev. 10-10-78 FIELD INSPECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION FERN. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS: lo~ui~l THE NEW YORK BOARD OF FIRE UNDERWRITERS ..,e ~.-ii io, l~ ~,.,..,,ca,io. No.o./i,,~ ~'r~/~ N 688920 ~r~e ~ll, Critten~ ~e, ~t[~l~, ~ Y i~ the following Iocatto,~; ~ Basement ~ ~,t m~. ~ s,,d F~. ~tside Section Block Lot was examined oa ~r~ ~ ~D~ and found to be in compliance with the requirements of this Board. FIXTURE OUTLETS i DRYERS 1 1 FIXTURES RANGES OVENS DISH WASHERS EXHAUST ,FANS NCANDESCEN¥ FLUORESCENT OTHER APPARATUS: E R V I C NOr OFECCCOND,pR~, r A w a. A W. G, A W a / P~ul Durns 'lbwn ~,Oor Laae $outhola, N Y liST1 Lic Z~2 E This certificate must not be altered in any manner; return to the office of the Board if Inspectm il may be identified credentials. 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ' · ~ .... ,19~-~.~'' Approved ~'~..'~..-. i, 19~..~fPermit No. J.~.~..~5.~. ·~ Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,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 Cextificate of Occupancy shall have been granted by tl~e 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, 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 regulations, and to admit authorized inspectors on premises and in building for necessary inspectio/~.7~/~ "~,t;" ~? ............. : ' Yd.7; v ........... : ......... : ...... (Signature of applicant, m na~ ,r~ ]fa corporatmn) (Mailing address of applicant) ]/c~O j State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............ ...................................... -: ........ Name of owner of premises ,~. ~E7. ~?,,~6~,.~(~,~.: .~i,.. t...~'.~.~ .~.T-. ~..'.Q~...~..~.*..Tf?. ~ ........................ (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 .... q~ t~) '- ,'T' './. [ .... ~/.,. .......... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... i. Location of land on which proposed work will be done .................................................. House Number Street Hamlet : . County Tax Map No. 1000 Section .. 0 jT.C.~ , . 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 ~ ~ ' / cc .0t7 - ; ...... b. Intended use ~d occupancy ~. 3. Nature of work (check which applicable):.lqew Building ..... ' ..... Addition.. ........ Alteration ., . .~ .... Repair ........ ' ...... Removal; ..... :..' ..... Demolition .............. i Other Work~/I. Vl I. 4 Estimated Cost ~ ......... '7.~. OC), @_CQ. Fee i (Description) '" (to belpaid 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 ............... Number of Stories ........ ................... i .......................... It ti ddition ' Dimensions of same structure with a era OhS or a s: Front .......... ' Rear ............... Depth ...................... Height ...................... Number of Stories .................... 8. Dimensions of entire new construction: Front ............... Rear ....... ~ ....... Depth ............. Height ............... Number of Stories ........................... i ......................... 9. Size oflot: Front ~.=..L,,~.~.,.'~/~_. ........ Rear..j.~'~'~¢~)O ............ iDepth 10. Date of Purchase .-,)-.id(,.~ I.~.., /.~.7. cj ........ Name of Former Owner ... ' i ....... 11. Zone or use district in which premises are situated 7: ./:~lS;b.I/.dt.c, .d~. Z~.~.c-. .....i .......... '"... 12. Does proposed construction v. iolate any zoning law, ordinance or regulation: .d~.O ................. ~ ...... 13. Will lot be regraded .... AJ.O ...... .,~.~ ........... Will excess fill be removed from premises: ~ No I4. Name of Owner of premises~-.~.~.S.,''~-' .J~7'¢t(-~.[~*~l.~ddress ~,~O..cT. Tbl'F4c~. ....... Phone No. 7~.-. ~/~..~// .... Name of Architect . rh ........................ Address .... Phone No ....... _.., ........ Name of Contractor .I(-olgt .~.. ~. ~d'/~. ...... ... Address iJ~i~tlt~/~ .... Phone No..'~7..2,-7.-..?'~.~0 .... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property fines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF NEW YORK, S.S COUNTY OF ................. NOTIFV'~;.jj L.blNG 7~B-180¢ 9iAM TO 4 PM ~OR THE 1. FOUNmA~'ION - TWo REOuIRE~ FOR Pf)t~RED CONCRETE 2. ROUGH -[ I:RAMIHG 2. INSLILA'T,ION 4. FINAl ..: CON'S'FR~C:~ !ON MUST BE (7"~4~ FTF FOR ALL CONSTRUCTION SHALl., MEET THE REOUIREMENTS OF TH~.N.Y. STATE CONSTRUCTION & ENFvGy CODES. N;OT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERqmRS' ................................................. being duly sworn, dep6ses and says that he is the applicant (Name of individual signing contract) ' - above named. ~ tlc is the ' (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the iaid work and to make and file this application; that all statements contained in this application are true to the best ofhi~s knowledge and belief; and t. hat the work will be performed in the manner set forth in the application filed therewith. : Sworn to before me this i day of 19 ' Notary Public, . ................................ County .... (Signature of applicant)