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Home My WebLink About20217-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildinq Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20871 Date JULY 21, 1992 THIS CERTIFIES that the building Location of Property HEDGE STREET House No. County Tax Map No. 1000 Section 10 Subdivision ADDITION FISHERS ISIk~ND, N.Y. Street Block 7 Lot 17 Filed Map No. Lot No. Hamlet conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER ,17~ 1991 pursuant to which Building Permit No. 20217-Z dated OCTOBER 21, 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 DORMER ADDITION TO EXISTING COTTAGE AS APPLIEU FOR. The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED FRANCES T. DOYEN N/A PENDING - JULY 14~ 1992 N/A Building Inspector Rev. 1/81 lro~M NO. ~ 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) NO 2 0 21 7 Z Dote .....~....~ ...... ,~./. .................. , ,~..~../ Permission is hereby granted to:. , ........... .................................. " ?'i ...... ' ................. ~":~'~':': ............. ~ ...... :~ ...................... ~""':~ ....... i at premises located at ........~~...~,,~,~, ............. ,~,~,~~....~ County Tox Mop No. 1000 Section ...... ./..~.. .......... Block ..... ...~... ......... Lot No, ...~....~.... ........ p PP ..,.~,..~.-~.v ...................... /. ......... , ly.x.../., ono opproved by the Building Inspector. Fee $ ..~, ,.,.~,/.. ,,~,,. ~,,, Rev. 6/30/80 TOWN OF SOUTHOLD BUILDINC DEPARTHENT TOWN HALL SOUTHOLD, NEW YORK 765 - 1802 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY HEW CONSTRUCTION ..X....OLD OR PRE-EXISTING HUILDING ...... VACANT LAND ........ HOUSE NO. STREET HAMLET County Tax Hap No. 1000 Section /O Block .7. Lot Subdivision ....................... Filed Map ........ Lot .......... Permit mo ............ Health Planning Board Approval ................ Request for Temporary Certificate ....... Final Certificate ...~. ............ Fee Submitted: FOU~DAT~ON ( 1 s t ) FOU~';DATIO:; (2nd) 2. EOUGH FRAME & .FLUMBtNG II;SULATION FERN. STATE ENERGY CODE Fi;;AL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTNOLD, N,Y. 11971 TEL.: 765-1802 ~sapproved a/c ..................................... '7 BOAKD OF HEALTII ......... 3 SETS OF PLAN'S .......... SURV£Y ................... CIIECK .................... SEPTIC POR:I .............. CALL HAIL TO: (Buildirlg Ins.~ct6r) ~ APPLICATION FOR BUILDING PERMIT Date .... INSTRUCTIONS --[ This application must be comp etely filled in by typewriter orin iuk and submitted to tLie Building Inspector, with 3 ; o1~' plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buihlings on premises, relationship to adjoining premises or public streets ar~s, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appI/- c~ The work covered by this application may not be c})mmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to tLie applicant. Such permit il be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in wLiole or in part for any purpose whatever until a Certificate of Occupancy :1 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 !ding Zone Ordinance of the Town of SoutLiold, Suffolk County, New York, and other applicable Laws, Ordinances or alations, for the construction of bu;idings, additions or alterations, or for removal or demolition, as herein described. applicant agrees, to comply with al/ applicable laws, ordinances, building code, housing code, and regulations, and to :it autLiorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corvoraaon) (Mailing address of applicant) e whether applicant is oxvner, lessee, agent, arcLiitect, engineer, general contractor, electrician, plnmber or builder. - .... .... ..... : .......................... 'plicant is a corporation, signature of duly authorized officer. ' (Name and t t e of corporate officer) Buildcr's ,License No .......................... Plumber's License No ........... : ............. Electrician's License No ............. ; ......... OtLier Trade's License No ...................... 9cation of land on whicLi proposed work will be doue ............... ........................... . oca ............................... : ....... ~use Number Street ' ' · .... Hamlet .... .7.. .... bdivision Filed Map No. (Name) .............. Lot ............... .~¢ existing use and occupancy of premises and intended use and occupancy of proposed construction: ~xisting use and occupancy ~..~ 12)~.. NC-.~ ' intended use and occupancy .................. ~-r ............. Nature et work (check which aPPlicable): New Building Repair v .......... Addition ...... ,\iteration .............. Remo al .............. Demolition ......... i .............. Other Work ............... (to be paid on filinl; this application) 5. If dwelling, number of dwelling units ......... Number ofdwclling units on each floor If garage, number of cars , ' ..... 6. ir business, corn nercial or m - ................................. ,.. . . ~' ~:~e(l pccl pancy, specify nature and extent of each type of use ' · · ~ · ' '. i ' 7. Umlcnsrons o! ex:s mg structures l if al y, Fro ~t / ! ' .................... Dunensrons of same st "~vtta alteranons or additions: Front Depth ............. , ................. Rear ............ ........ ~ Height ...................... Number of Stet/cs ........ ' .... 8. Dimensions of entire new constmdtion: Front .,. 0. DateofPurchase ! ~' .......... Dept~ //~ / .......................... Address ................... Phone No. -- ..... Name of Contractor ........ ,.. ............... Is this property within '~' =' ..... ~ ....... Address ..., ................ Phone No... ouu ~eet or a tidal wetland. *Yes ........ ' ......... · If yes, Southold To~n Trustees Permit may be required. No ......... ' '' "" I PLOT DIAGRAM Locate clearly and distinctly all bulldings, whether existing or proposed, and, indicate all set-back dimensions from operty lines. Give street and block number or descriptioh according to ter/or or comer tot. I an~,.s~h.~ street names and indicate whether FE OF N 'YORK,!' OF , lk ....... s,s ' ....... · ..... , (Name of individual signing corriract) named. tile ........................... I ....................... '(Contractor agent corporate ....................... officer etc) ............... d OWner or owners, and is duly authorized to perform or have perfor/ned the saki work and to make and file this alien; that all statcmeuts contained in ithis applicatiou are true to the best ofhjs~knowlcdge aid belief- .viii be performed in tile manner set forih in tire application filed therewitlE ' , --~ that tire to before me this ......... day of 19~( ' Public .......... cou. ' MARY B. PANKIEWtCZ ~ 0 IIOI'ARY PUBUO, ~A~ ~ N~ ~ ~ - . ..... County