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Home My WebLink About13741-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.Z.'I.3.3..8.3 ........... Date ..... ~..p.v.5.1.. ] .9 ................... 19.8.5. THIS CERTIFIES that the building ........ S.h..o .d .................................... Location of Property ..... 1.~75..~a. ¢grn.~.s...~.o.a.d. .................. .S 9.u.~.h. 9.1.d. .......... House No. Street Hamlet County Tax Map No. 1000 Section .. 0..7.8 ....... Block .... .3 .......... Lot ....3.(3... 1. ......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·. M.~v. ¢g..6. .......... ,198.5.. pursuant to which Building Permit No ..... 1.3 7.4.1.~ .......... dated ...... ~.a .v.c.h...8 .............. 198. .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 ......... ·..A. ¢c.~a s 9~-y..~ h~.d, .~-o..r.~V..y.~ .r.d.. ............................................ The certificate is issued to .... D.o.n...L.q b. 9.v ............................................. (owner, le~C~X ~O~)X X X X of the aforesaid building. Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO ................ .N./.~. .............................. Rev. 1/81 Building Inspector FOEM NO. J 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) NB 13741 Z Permission is hereby gront,~.~: ~" ....... i1.~..~ ....... v,~.....~....~). ........................ ............... at prem,ses located at .../. ........ .-~ ...... ~..~ .................... ~.~~... ........................ Counly Tax Map No. 1000 Section .....~.?....~ ........ 8lock ........ 2. ......... Lot No..~.Z..! ......... pursuant to application dated ................................................. , 19.~.~., and Building Inspector, Fee ~ ................ approved by the ~l'~l~ng InsDector ~ 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 in duplicate 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 featu res. 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~Coperty showing all property lines, streets, buildings and unusual natural or topographic featu res, 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.../y,/..O~. ·d. ,~. ......... New Building .[~...... .... Old or Pre-existi~g Building ............ Vacant------Land ............. Location of Property ~o.~?~..~.. ..... · · .~. · · .~. · · .~. i~. .... ~o ~'~"/'' ~"~' ' ' '~' ' ¥/~/'o~ Owner or Owners of Property'...'~. ~. ~1. ..... . . .~...(~.~...~. ............................. County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. [.~.'~..~.[..~. Date of Permit ~.~/.~'~.'~..Applicant....-~-~(~?~,'~ .... .c~.. ~ ........... 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~,meets all/pplicable/~d, es and regulations. Applicant .... · ,~L__~_~. ~-~- · · ~ ,~L .-~.~ .................... F1EL~ INSPECTION FOUNDATION COMMENTS FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: Approved . . .~IIA,~.~..~.... 'FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N,Y, 11971 TEL,: 765-1802 ., 19..~ ., 19 .~.~. Permit No..] ~.~.Y.~..' .~ Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS -- BLDG. DEPT, TOWN OF ,SQU, THOLED Received ........... ,19... a. This application must be coznpl6tely 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 skowing 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 inspecfions. ' .~ ~ ~..c~.. (Signature of applicant, or name, if a corporation) .. >..:.,.;... ! .... (Mailing address of ap!51icant) State whether applicant is owner, lessee, agent, architect, engineer, general cpntra~ctor, electrician, plumber or builder. · ~~ ~- ; AS NOTED ........................................ . ................. D^;TE, ~ ~.- B'P '4~' '/' ~ ¢t')' ~ ......... N~e of owner of ~remises D ~ ~ ~ ~ ~ FEE: ~S . ~2: .~Y ;....~ .~ ~, v .................. (~ ;~'~e'i~x'~T~l~&Bl¢ D'EPX~ENT AT 165 lpg9 9 AM TO 4 PM FOR THE If applicant is a corporation, signature of duly authorized officer. FOE ~ ~'*/IF,'G INSPECTIONS. 1. FOt/N~-ATtON _ TWO REQUIRED Frh') D'~{J~D CONCRETE (Name and title of c 2. Rflll¢' ~ FRAMIN~ o Pl UMBING Builder's License No 4. F~ ..... ~"c .... :3N MUST Plumber's ~ ........ Al I C ...... '-" 'Crh?N S' *ALL MEET m~'Y r,~-, '':"~:NtTS OF THE N.Y. Electrician' ~T~"~ c"~m':'Rt~CTON & ENERGY c~-'c b~'h'r REqPQNSIBLE FOR 1. will be done.. [~¢.7~ ....... ~ ~.(~ ...................... House Number Street Hamlet co~.~v ~a~ Ua~ ~ .... ~ .:. ~ ....... mo~. ....... ~ ......... 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 ..................................................................... b. Intended use and occupancy ...~. J.~..~.~ . . .~...¢'.... · .~. · .Q .~..~. [..~.~...Q~..c 3. Nature of work (check which ~pplicable): New Building .......... Addition .......... Alteration Repair .. '~l~[['- · '. ~4,'~ Ren~oval .............. Demolition ............ Other Work ............. -2~' ~'~ (Description) 4. Estimated Cost . . .~..0 .~. t ..... , · .: ...................... Fee .................................... '!~ ~4, .i ~' (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 mixled occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing strnctu~'es, if any: Front ............... Rear ............. ~ Depth ............... Height Number of Stories Dimensions of same structure with alterahons or additions: Front ................. Rear .................. Depth .................. i. · · Height ...................... Number of Stories ...................... 8. Dimensions orr entire/thew cons~ruction'~ ....... Front ! ........ Rear .............. [~/ Depth ... ~) .......... Height .............. Number of Stones ....................................................... 9. Size of lot: Front ......... ; ............ Rear ...................... Depth ...................... 10. Date of Purchase ......... ~ ................... Name of Former Owner ............................. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded . ................... Will excess fill be removed from premises: Yes No fp 14. Name of Owner o remises . ~ .................. Address ................... Phone No ................ Name of Architect ........ 2 .................. 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 block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, I S.S COUNTY OF ................. : ~ .......................... . ..................... being duly sworn, deposes and says that he is the applicant (Name of individual sig~ing contract) above named. . He is the ' i (Contractor, agent, corporate officer, etc.) of said owner or owners, and is ddly 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 . .. ............... Coun N0~RY ?UB[IC. Sta~ 0[~N~v Y0r~ (Signature of applicant) Term fixp~res h?arch 30, 1~ ; i ~"~-~'~,' ~/ ~ ' .~ ~ ~ ..~--~,~ ~.% "'. ................ ,. .~.~ W~ ~u~v ~ ~W~