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Home My WebLink About20340-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Offlce of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20754 Date MAY 26~ 1992 THIS CERTIFIES that the buil6ing. REPAIRS Location of Property EAST END ROAD FISHERS IMLAND~ NY House No. Street Hamlet County Tax Map No. 1000 Section 5 Block 2 Lot 7.5 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 9, 1991 pursuant to which Building Permit No. 20340-Z dated DECEMBER 18, 1991 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 ADDITIONAL SUPPORTS FOR TIiE BEACH CLUB ASAPPLIED FOR The certificate is issued to F. I. DEVELOPMENT COP3 (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 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, H. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 20~40 N~ Z Permission is hereby granted to: ..z.....~..~.~.. ..~.:~....~.~.....~.~ .~.&~ ................ .................................. ~~......~..~:,..~-- -- .................................. County Tax Map No. 1000 Section ....~.~]~.]~ ......... Block .....~'~ .......... Lot No...~.~.t-~ pursuant to application dated ........ ~ ............. ..~.. ............. , Ig..~..L and approved by the Building Inspector. Building Inspector Rev. 6130/80 TOWN OF SOUTHOLD Building Department Town Clerks Office 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 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, Industrial 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: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 New Building ....................... Old or Pre-existing Building .':.:...,........ Vacant Land ......... ; .... Location Of Property ..... ~...~....~.......~ ........................................................................................... Owner Or Owners Of Property ....... ..~.',....~,..L ...... ...~.,~....~.....,~.~Pr...'.~...~.Y..~.. ....... ~.~.~...: ................ Subdivisior~.O,..,T',/,,P,.,~,,.,,,~,..... ,/,....~,,..4~.,,,c,./.,c...~ ......... Lot No. ,/'~.:....'~,.... Block No ............. House No ............. Permit No .q~..~'Y~,(-'? Date Of Permit ./.~/~./.~/....Applicant/ ~c~ ~/~' Health Dept. Approval ............................................ Labor Dept, Approval ...................... ~ ......................... Underwriters Approval .............................................. Planning Board Approval ........................... ,. ........... Request For Temporary Certificate ........ ~ ............. J ...... Final Certificate ......~ .......................... Fee Submitted $ ..... .~,.,o,/ ........................ Construction on above described building and permit me, ets all applicable codes and regulations. Sworn to before me this ................ day of ............................................ (stomp or,seal) Notary Public .................................... County FOUNDATION FOUUDATIO:~ ¢2nd) BOUGH FRAME & .PLUMBING I~;SULATIOM PER N. STATE ENERGY CODE FilIAL ADDITIOM~L COMMENTS: Consulting Engineer's', 21g Cencord Avenue CAMBRIDGE, MA~eSACHUSETTS 02138 (617) 864.0068 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y, 1!971,, TEL,: 765-1802 Exmnined ................. 19... Approved P,-~...//.~. .... 19~/Permit No.. o~..~. ~..0/~ .7_ Received ........... ,19... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS 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 Inspect~or 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'occup!e~ or used in whole or in part for any purpose whatever until g 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 ne'cessary inspections. - ..... . ............ :'7' ........ : ................ (S~gnature of apphcant, or name, ~f a corporation) .. ........ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........................................... (as on the tax roil or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name al~tl title of corporate et'ricer) Plumber's License No .... O~. t57..~.T .,~.?. .......... Other Trade's License No... cz). ~.o~/..-'. .~../~ ........ 1. Location of land on which proposed work will be done .................................................. House Number Street Hamlet Subdivision ..................................... Filed Map No. ~.. ............ Lot ............... (Nalne) , 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 ............................................................... 3. Nature of work (check which apphcable): New Building .......... Addition .......... Alteration .., ......... Repair ........ Removal .............. Demohtmn' ' ........ ,, .... Other Work ~" ..... ,2~'r~/b.~ ..... .~.~...~.,' ' .~"~'./9 ~.~,r~fi..f.. Descn on) 4. Estimated Cost ........ ~ ................... Fee . '. .... (to be paid on filing this application) 5. If dwelling, number of dwelling flnits ............. Number of dwelling units on each floor ................ number of card ' If garage ' · · · 6. If businesS, commercial or mixed occupancy, specify nature and.qxtent of each type of use ..................... .... ' if any: Front Rear Depth 7. Dzmenmons ofexmtmg structures ............... ....... : ..................... Height ............... Numlber of Stories ....... , ............................................... Dimensions'of same structure with alterations or additions: Front Rear Depth .................... i. · Height ...................... Number of Stories ..................... 8 Dimensions of entire new construction: Front ' Rear Depth Height ............... Numlber of Stories ........................................................ 9 Size of lot: Front i Rear ' Depth 10. Date of Purchase ........... l .................. Name of Former Owner ............................ 1 I. Zone or use district in which pr4mises are situated .................................................... ate any zoning law ordinance or regulation: 12. Does proposed construction viol , . ............................... 13. Will lot be regraded ......... [ ................... Will excess fill be removed from premises: Yes No ~ Addres~ Phone No 14. Name of Owner of premises ...! .................................................... Name of Architect .i . Address Phone No Nmne of Contractor ......... i ................. Address .... : .............. Phone No .............. 15. Is thio property located ~ithin 300 feet of a tidal wetland? *Yes ..... No~%... · If yes, Southold Town Tru!steeo Permit maybe required. I 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. ;'FATE OF NEW YORK, iS.S .~OUNTY OF .......... a .....' ............ ~r~,.~.. "~. ~../..f'..~ .................... being duly sworn, deposes and says that he is the applicant (Name of iz/dividual signing contract) tbove named. le is the ' (Contractor, agent, corporate officer, etc.) ~f said owuer or owners, and is dui authorized to perform or have performed the said work and to make and file this q~plication; that all statements cont~ ined in this application are true to the best of his knowledge and belief; and thaJc the ,york will be pct,,formed in the mannelr set f?rth in the application filed therewith. ~wom to be~{n~ ...... . ....... ~Iotary Publ' unty Notary Public ~um- o' ti¢~¥, ~c,. · .... /' ' '-"" · · · 27' .............................. No, 4s0~ ~,' (Signature of applicant) Ouatlfie(~ in Ter~ Ex,ires 12