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Home My WebLink About20458-zFORM NO. 4 TOWN OF SOHTHOLD BUILDING DEPARTMEW£ Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20812 Date JUNE 19, 1992 THIS CERTIFIES that the building Location of Property BELL HILL AVE. House No. County Tax Map No. 1000 Section 9 Subdivision ADDITION FISHER ISLAND, N.Y. Street Hamlet Block 3 Lot 15 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 24, 1992 pursuant to which Building Permit No. 20458-Z dated MARC~ 2¢ 1992 was issued, and conforms to all of the requirements of the applicable previsions of the law. The occupancy for which this certificate is issued is ATTACHED STORAGE BUILDING AS APPLIE~ FOR. The certificate is issued to MARIE L. GAILLARD (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Building Inspector Rev. 1/81 lrOlUl NO. ~ TO~VN 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) N~- 20458 Z D,~e ..... .'~...~ ......... .~ .......... , ,,..~.9-. Permission is hereby granted to: ~..~.,...~,.~ ......................... ..~...~~.~,...~.~ ~ ~.~~_.-- . ~ ,,~ ,o ...... ~.~~~~~__ ..... ~...~ ............ ........ : .......................................................... ................................................ ~.~ ................................................................................................ co..~ ~ ~ .~. ~0oo ~.o~ ...... .C.~. ...... ~ ...... ~...~ ..... ~o~ ~ ......... L.~:~. Building Inspector. Rev. 6/30/80 8LOG. OEI~. ~ FOEM NO. S TOWN OF SOUTHOLD Building Deportment Town Clerks Office Southold, N. Y. 11971 ~PPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted- in DUPLICATE to the Building Inspector 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, I~dustrial buildings, Multiple Residences and similar buildings and installations, 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 property 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 in- formation required to prepare a certificate. C. Fees: l. Certificate of occuponcy~ 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date ...~-..c~nJ/[ cji ....................... J °t~..~. New Building ......~. ......... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..~.. ................ .~..: .......... .~. .................... }?....~ ...................................... · .................... Owner Or Owners Of Property ..................................................... ~ ....................................... Subdivision ................................................................ Lot No...(..~... ..... Block No..o....~. ..... House No ............. PermitNo,~..°M~ DateOfPermit'~/,"~/c~..~...Applicant ~ C~rO'T-P, fJc~'~'lr~J' ~'~J¢, Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fina~ Certificate .......................................... Fee Submitted $ ..~....~'......%o. ...................... Construction on above described building and perr~dt meet,~ all al~l~licable codes and regulations. A~hcant-~ .......................................... , ............... Sworn to before me this ~- " / N trY PU ~"**~" "*~*'~'~ ~...o_a ..,__bli . . ,.........:.--.............~,,.. ,.: , , (stomp or seal) Public, Stale of .o. qumlified in Suffolk Co~ FOUNDATION FOUND~TIOU (lst) (2nd) ROUGH FRAME & -PLUMBING INSULATION PER N. STATE ENERGY CODE FI~;AL ADDITIONA'L COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTH~LD~ ~L¥. ~t~t TEL.: 765-180;t BOARD OF HEALTH 3 SETS OF PLANS SURVEY CHECK .... SEPTIC ........ · CALL APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tlfis pphcatzon must be completely fiIled in by typewriter or in ink and submitted to the Building I~apector, ~t~th sets a£ plans, a~urate plot p~an to sc~ie. Fe~ ~ording to schedule. b. Plot pl~ showing location of lot and of bulldogs on premises, relationship to adjoining premises or pub5c streets ~ or areas, and giv~g a det~led description of layout of property must be drawn on the diagram which is pa~ of t~s apph- cation· c. The work covered by tMs application may not be commenced before issuance of Bufld~g Permit. d. Upon approval of this application, the Building Inspector will issued a Building Pe~it to the appEc~t. Such pe~it shall be kept on the premises ava~able for Espection throu~out the work. e. No bulldog shall be occupied or used in whole or in part for any purpose whatever until a Ce~ificate of Occup~cy shall have been granted by the Build~g Inspector. ' APPLICATION IS HEREBY MADE to the Bulldog Dep~ment for the issu~ce of a B~lding Pe~it ~uant to the Building Zone Ordinance of the To~ of Southold, Suffolk CounW, New York, ~d other applicable Laws, Ord~ces or Regulations, for the construction of bufld~gs, additions or alterations, or for ~emoval or demolition, as here~ described. The applicant agrees to comply with all applicabqe laws, ordinances, bufld~g code, housing code, and regulations, and to admit authorized ~specto~ on premises and ~ bulldog for necessa~ inspections. ( '~ pplicant,~r ~fme, ](fcor~dration) ' ' (Mailing address of applic~t) State whether applicant is owner, lessee, agent, ~chitect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...... ~ . ~ ................................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly,authorized officer. ...... .. (Nam~and title of co~ora~e officer) .... ' ' ..Z4. oZ4. / B rider s Lme~e No ................... Electrician's License No... ~.5 ~ ........... Other Trade~ License No. . ~: .... Location of land on which proposed work will be done; ti N b St ............................... ouse um er feet, Hamlet County Tax Map No 1000 Section ' Black Lol Subdivision ' --: Eiled Map No (Name) Stzte existing use and occupancy of premises and intended use and occupancy of proposed construction: A. Existing use and occupancy ...... ' ........ .... . ........ [ ......... ...... B. Intended use and occupancy ..... '~ .... ~ .................... ''. ......... 3. Nature of work (check which applicable): New Building .......... Addition ....... .... Alterat,,oa; ~(.~ ~ ..... '. · ~ · . n-'__z_1 ~.~^,.,;~. . ....... So~mraing pool ....... , . . · mepn,r ............... ~x~muya ..... 0 ........ ~e.,v,lja~. ....... ' Tennis Court .......... ~ccessory Buzldxng...h~. ..... Fence ....... Other Work; ........... 4, Estimated Cost .......... ~,.F~r.q>.. ................. Fee ....~.,~:~?~ ..... 3~w'.'.~,....... . ....,' '· i Ca ha paid on filing this al~lelicationl 5. If dwelling, number of dwelling qnits ............... Number of dwelling units on each floor ................ If garage number of cars i ............. 6. If business, commercial or mixed[ occupancy, specify nature and extent of each type of use .................... · ' ' if any: Front Rear Depth ? Dm~enmons of existing stmcture:~ · .............. Height Number of Stories. ... ................... Dimensions of same structure with alterations or additions: Front................. Rear ................ Depth ! lleight Number of Stories 8 Dimensions of entire new constrnction: Front . Rear Depth Height Number of Stories ' 9 Size of lot: Front ~ ' Rear Depth 10 Date of Purchase ~ .. . ........NameofFormerOwner · ......... - 11. Zone or use district in which pre[roses are situated ............................ ~i .............. ~ ' 12. Does proposed construction violcte any zoning law, ordinance or regulation: ..................... 13. Wilt lot be regraded.........,..; ............. . . . Will excess fill be removed from premises:, . Yea .... Nara~ of Owner of prcmi~ea ' ," Addre~ Pltone No Name of Architect . ' Address Phone No ................. Name of Contractor ......... ! ...... : .......... Address ................... Phone No .......... .. -~ .. 1~.~.~ this property located wzthin t00 feet of a tidal wetland? *YES .... NO.~.. ~If yes, $outhold Town Trustees Permit may be required. ' PLOT DIAGRAM buildings, whether existing or proposed, and. indicate all set-back dimensions from dumber or description according to deed, and show stree~ names and indicate whether~ Locate clearly and distinctly all property Hnes. Give street and block interior or corner lot. STATE OF NEW YORK, COUNTY OF ................. .......... ..... . (Name ofindividualsig~mg above named. S.S contract} being duly s~vorn, deposes and says that he is the applicant I-~ is the : ' ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to pe,rform or have performed the said work and to make and file this application; that all statements con!dined in this application are true to the best of his knowledge and belief; and that the Work will be perfommd in the m~ner set forth in the application filed therewith. - ...... ..... ~ ~ ~ub ~c gt~te ~t New ~e~ .... · ........... ~, aeoasse ~ (Signature of applic~t',