The URL can be used to link to this page

Home My WebLink About13656-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z13566 Date June 26 .................................................. 19.% THIS CERTIFIES that the building ....... D e c,k .................................... Location of Property .4.2.5. Q..~?.e.a..c..F.e.c. 9 P.~.q..B.a.y.. ~..1.v.d.: ............................. House No. Street Hamlet County Ta× Map No. 1000 Section 1.2.~. ......... Block .... .0 .4 .........Lot ........ 0. 2. .3 ...... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... ,D.~q ,..1.9 ........ ,19.8.4. pursuant to which Building Permit No, 1.3..6 ~.6.Z. .............. dated ........ J..a.n... $ ............. 19 .8.5., 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 ......... ..... D.~ S k..~cl ~l ;[.t.~ Qr;..t.q. ~p.e.. f. ~lu.i.3~ y..d.w.e. 1..1 .~.n.g .. ............................... The certificate is issued to .ROBE~.T ?OTDEVIN (owner, I~ ~rxt~q~j~ ~x of the aforesaid building. Suffolk County Department of Health Approval ............... N./..~ ........................ UNDERWRITERS CERTIFICATE NO ....................... N..././1. ....................... Rev. 1/81 Building Inspector FOB, M NO. ~' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CO~PL~ION OF THE WORK AUTHORIZED) N-° 13656 Z Dot~.~ ........... Permission is hereby granted~. . , ~ /, .~ .. ~' ~, ,~ ~ ~o. ,ooo ~,o~ .../~ ....... ~,~ ..~.~. ...... ~[o~ ~o. ~ ........ Building Inspector, ~v. 6~O~O FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ~[outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions in duplicate -; . A. This application must be filled in typewriter OR ink, and submitted< ,? ?o's. he Buddmg 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 featu res. 2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrica[ installation from Board of Fire Underwriters, 4. Commemial 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 pzcoperty 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 $15.0 0 3, Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 Date..,~,. ,~, .~', ,~TT. ,~,. ,~'. ........ New Buildin ...~[,~O... Old or Pre-existing Building ............ Vacant Land ............. Location of Property....~C~-~.-~..(~....~/z__.¢¢.~..~.....~..~..~...~.,'..~... ' '~" "~'t" 't~'~' 'fitS''' ''~'~ House No. Street Ham/et Owner or Owners of Property .... ~..~..f. ,.~...~1~<~... .............................. County Tax Map No. 1000 Section . ./~..~. ....... Block ..... .~. ....... Lot... Z.~. ........ Subdivision ................................. 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 $ Construction on above described building and ~1. ~7 codes and regulations. C.o. z /r FIELD INS~ECTI®N COMMENTS 'FOUNDATION (Ist) FOUNDATION (2nd) ROUGH FRAME & PLUMBING 3. INSULATION PER N. STATE ENERGY C~DE FINAL ADDITIONAL COMMENTS 'FORM NO. 1 ' · TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined ~ ff ., 19~ Approvead ~..5 ........ , l~.ff'.Permit No.[,.~.. ...... Disappro6~e t a/c ........... %......~ ...... '~-7 ......... APPLICATION FOR BUILDING PERMIT [EC t 9E 4 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 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, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building/96fie~ hou~ng code, and regulations, and to admit authorized inspectors on premises and in building for necessary ~)o~//~ _~5,~.'..~_7772.....__,~.. (Sig~/a~r'e of applicant, or name, if a corporation) ..6.+/ .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises.......°~'~' ..... :,. ...... .. t ..................................... (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 ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section ...I.~.. ·~. .......... Block ...... .~. .......... Lot...~...~. ........... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ~..~J.~. ¢,q t~/t ~ L~ . .[~.. yS]....~dv_..qt.,?..C~. .................. b. Intended use and occupancy ~-,~-t<, .,~.~2~.././..C~'.. 3. Nature of work (check which agp icable): New Bull Repair ............ Rem~vai ......... 4. Estimated Cost ............. ;~. ........... !ing ..... ' .....'Addition. ..... b/ .... Alt eration ..:.. ..... Demolition Other Work ~ ~ (Description) ......... Fee ~ (to be paid on filing this application) 5. If dwelling, number of dwelling pnits ............... Number of dwelling units on each floor ............. If garage, number of cars ..... . ................................................................ 6. If business, commercial or mixed occupancy, specil 7. Dimensions of existing strnctur{s, if any Front..' Height ............... Nun~ bet of Stories .... Dimensions of same structure with alterations or ar Depth ' ' .................... ,.. Height ....... '- 8. Dimensions of entire new construction: Front .... nature and extent of each type of use ............ ~..q-, ........ Rear ....~...~w. ....... Depth. ~.C~.. ~........ ........ litions: Front ............... Rear .................. .......... Number of Stories ..................... .~.~.';".. Rear ..... ~.... Depth ..) ~' 10. [)ate of Purchase ........... i ............... 11. Zone or use district in which pr~mises are situated. 12: Does proposed construction violate any zoning law, 13. Will lot be regraded ...... ~ Name of Architect ......... ! ............... Name of Contractor .V~...~... ~.' .~.'..~. ..... Locate clearly and distinctly all property lines. Give street and block interior or corner lot. Height ............... ~Nu~mber of Stories ........................................................ Size of lot: Front ....... '~.~ ............ Rea: ........ / ~.~ ....... Depth .. ·. Name of Former Owner ............................. ordinance or regulation: ............................ Will excess fill be removed from premises: Yes No ~ .'gAddress 1C~.a.~.~)q.~.~[~t~.~.~.... Phone No ................ · Address ................... Phone No ................ · Address . .~.e,~:..~.(...4b,t..n~0~one No..TZ.z..-.~q..7.q. PLO F DIAGRAM buildings, whether existing or proposed, and, indicate all set-back dimensions from lumbar or descripti. >n according to deed, and show street names and indicate whether ·.. being duly sworn, deposes and says that he is the applicant (Contractor tgent, corporate officer, etc.) authorized to per !orm or have performed the said work and to make and file this ined in this application are true to the best of his knowledge and belief; and that the ' set forth in the apl ,lication filed therewith. STATE OF NEW YORK, COUNTY OF S.S , (Name of individual signing contract) above named. He is the ...................... of said owner or owners, and is dull application;that all statements cont, work will be performed in the manne Sworn to before me this · /.~ · .--~.. .... dgy of[ 2.-e~. · ............ 19 ~.~ ..... ...... Notary Public, · ' HELEN K DE VOE ""- ................ NOTA[~Y PUBLIC. State of Ne~ York (Signature of applicant) ] Ne, 4707878, Suffolk Coun'tv :