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Home My WebLink About13724-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No... Zfl.3~/-59 ........ Date ........ Ua.y..2.0. .................. 19 ~.5. THIS CERTIFIES that the building-~-v:~.c.c~nS~.~c$ ~.d..t~ O~.c~h ....................... Location of Property . ~5.Q2'1..~ ................. ?.~.q q~ .~.J..q .~.~Z .]31. y.cl...,. ........ .L.~.u..~.e.~.. House No. Street Hamlet County Tax Map No. 1000 Section ...~.~3 ...... Block ....0.~ ......... Lot ....Qq. ~ .......... Subdivision... X .......................... Filed Map No...X. ..... Lot No....X .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ·.. ~b..~.~.~.~..~. ~. ..... 19 .~35pursuant to which Building Permit No... fl.~.2~. 7, .......... dated .... .~.~..~.~.h..6. ............... 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 ......... .~.H..2~.L..Z.~..~.~..i~.O.Q .1~. ............................... (owner, of the aforesaid building. Suffolk County Department of Health Approval .... ZxO~..~?eCl~±~ect ........................ UNDERWRITERS CERTIFICATE NO ............ .n./?. .................................. Rev. 1/81 Building Inspector FO~]~ NO. ~11 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) 13724 Z County Tax Map No. 1000 Section ....................... Block ~' Lot No. ). ~ ............................................ pursuant 'o application dated ~.~-- ....... ..~...J ............. , 19.~.~., and approved by the Building Inspector. Building Inspectpr Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall ~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions ~n duplida~e A. This application must be filled in typewriter OR ink, and subm tted, ',V, :~dzhe 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: I. Accurate survey of pzoperty 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 )remises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certif{cate of occupancy 2. Certificate of occupancy on pre-existing dwelling $15.0 0 3. Copy of ce rtificate of occupancy $1.00 %~'/' '~ 4.Vacant Land C.O. $5.00 /Date New Building ...... ". ...... Old or Pre-existing Building ............ Vacant Land .... : ...... Loca[ion or Yroper[y ....................... / .................................... House No. . Street Ham/et Owner or Owners of Property .~.~?.~..//~i~ ~ County/ax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ......... ~ ~ ............... Filed Map' No ........... Lot No .............. ... 7.~, ....Applicant Permit No.. ~. ~, ...... Date of Permit .... ,~, .....t .................. 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 P~4 meets all appl~icable codes and regulations. Applicant ...... ~,,~ ..........Z4 ~-, ~,~.~,,. ............ FIELD INSFECTION FOUNDATION (1st,), FOUNDATION (2nd) FRAME & PLUMBING ROUGH INSULATION FERN. Y. STATE ENERGY ~ODE FINAL COMMENTS ADDITIONAL COMMENTS: 765-1802 9 AM TO 4 PM FOR THE FOLLOWJ?G [~S?ECTiONS: 1. FOUN%'~TION - TWO REQUIRED FOR P~'LJ2ED CONCRETE 2. ROUGN - FRAMING D PLUMS[NG 4. FIN~,,~: C.q)<STZUC'T~ON MUST ALL CqN?~'' ~CT~ON SHALL MEET THE REO~"~MENTS OF THE N.Y. STA~E CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. · -.. q /~iGNT OF WAYAS .~tOWN ON SU/~V£Y pf~EPARED FOF~ V~LMA c~ r~oW, PHYLLIS MOORE ~ D STANLEY t~AYNOR ON APf~ 2 1971 BY YOUNG ~ YOUNG tWGHT OF WAY50ESCR TO D STANLEY ,qAYNO~ NOTE' · = MONUI4ENT SURVEY FOR PHYLLIZ ~ MOOF~E AT LAUREL TOWN OF ¢OL/Ti,~/OLO SUFFOLK COUNTY, NEW YORK ~XLo 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined..~4~..& .~..., 19~.~. ...~.~..O,~ .~...~..., 19~..~'. Permit No. ]..~.-/..~..q..:~'. ' Approved.. Disapproved a/c ..................................... (Buildlng Inspector) APPLICATION FOR BUILDING PERMIT TOWN OF SOUTI~{OLD 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 code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections7,ff . 7'~ ),, _ .......... · (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Nam e and title o f corporatefo, f.fiqer.~..)~.~.~ Builder's License No. ~.~.. ~.~.'. f. Plumber s License No ......................... Electrician's License No ....................... Other Trade's License No ...................... ~ & . .~...~..~ ~/,~,~, ~ 1. Location of land on which proposed work will be done. ~ 2// ~t' ~' ..... ..................................................................... House Number Street Hamlet County Tax Map No. 1000 Section / ~ ~ Block ~-- Lot / ~ Subdivision... /~2 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 . .".~..~.~ ...'~..{:....~' ....... .'. .... .~ ........ ;f' '.'' '~ .... ;7 ................ Intended use and occupancy . u- ' ~ ~ ' " ...... ' .... ;.,:',:'" · ......!7. '. ;~; . ·: ·. '. .......... b. ; 3. Nature of work (check Which applicable): New Building ..... R6m6val ~f~air q'e'~,,9.~' /,4 ~F~ ~ ~ ' , (Description) ~t~(~~ .............. e~(~'' ...... '/ .... ,Demolition ,.., ..... ~ .... Other Work ............... 4. Est~ate~ ~C'~st ...... ~ .~ ~ .................... Fee .................................... ,~ ~ '~ (to be paid on filing this ~applicati~ 5. If dwelling, number of dwelling ~nits .............. Number of dwelling units on each floor ..... (. ~ .... If garage number of cars ' 6. If business, commercial or mixe0 occupancy, specify nature and extent of each type of use .... ./ ....... 7. D~ensipns o[ existing structure's, if any: Front... ~¢ ( ........ Rear .... ~ ( ...... Depth.... ~ ........ Height~ tidbit../~ f .... Number o f Stories .. ~ .................................................... D~ension~,of s~st~cture w{th alterations, or additions: Front .. ~ ~ ........... Rear.. ~ ~ ............ Dep~...~. 8. Dimensions of estire new const~ction: Front ..... ~ ~ ...... Rear ...~.q ......... Depth .. ff.'. ~..~ff... Height ..... ~ ......... N~mbe[ of Stories .... ~ .... ' ...... ~ ....................... /,..~ .... ~ ......... 9. Sizeoflot Front .... , .................... "' 10. Date of Purchase~¢~¢~.~. 11. Zone or use d,stn~ ,n ~frrem,ses a;~tuated...Z K;~eC¢..4~~4. ....................... 12. Does proposed construction vig~ate any zoning law, ordinance or regulation: ...Sr/~ ....................... 13. Will lo~ be regraded ...... ~: '~" ' win ex,ss fil~ bel~mpv~d from premises: Yes ~$oY 14.NameofOwnerofpremises* 4 ,./frtg . Name of Architect .~ ...... ~ ..... ~ ........... Address Nme of Contractor, .~. ~,~IA~ r.~i.<.. Address ~J ~J~ 2252522' P~on~ No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block )umber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF...~'~ .E'~.~ .L-.I.~.. :S.S ......... ..... P~(. .~. ~ (..~. ..... )~.i .................... //~ O O/~ E being duly sworn, deposes and says thallhe is the applicant (Name of individual signing contract) above named. He is the ......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul authorized to perform or have performed the said work and to make and file this application;: that all statements cont~ ined in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this Notary Public, .. ~ ......... ~ IVOTARY PUBUC, STATE ~ ........ NO, §2-48814 28 OUAIIFIED IN SUFFOI K COUNTY COMMISSlOIV EXPIBE$ g~ARCH 30, ~9~0~' (Signature of applicant)