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Home My WebLink About17424-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-17677 Date JANUARY 12, 1989 THIS CERTIFIES that the building. Location of Property 80 OLE JULE LJ~NE House No. County Tax Map No. 1000 Section 114 Subdivision ACCESSORY Street Block 12 Filed Map No. MATTITUCK~ N.Y. Hamlet Lot 18 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 8~ 1988 pursuant to which Building Permit No. 17424-Z dated SEPTEMBER 15, 1988 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 ACCESSORY SHED The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF H~ALTHAPPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED WILLIAM ~ MARIAN BRANT N/A Rev. 1/81 TOWH OF $OUTHOI.D BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST IBE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 017424 Permission is hereby granted to: ...... ................ ......~...~....~..:¥..:../..~.~.~...~ ....... Caunb/ Tax Map No. 1000 Section ....... I.I..~. ......... Block ........ ./..b ....... Lot No...~/...~. ................. pursuant to application dated .......................... ~~.~-~- .~. .............. , 19.?...~..., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 TOWN OF SOUTHOLD BUILDING DEPARTHENT TOWN HALL SOUTHOLD, NEW YORK 765 - 1802 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY NEW CONSTRUCTION ....... OLD OR PRE-EXISTINC EUILDINC ...... VACANT LAND ........ Location of Property ............................ . .... HOUSE NO. STREET HAMLET Owner or Owners of Propertyi.~.~k~-.k~q~..~..~.~N.~..k~.~ ................. County Tax .ap No. lO00 Section 5~.. Block .o~. Lot Subdiv£sion ....................... F£1ed Map ........ Lot .......... Health Dept. Approval .................. Underwriters Approval .............. Planning Board Approval ................ Request for Temporary Certif£cate ....... Final Certificate ................ Fee Submitted: $ .\ ~. '.(~ 9 .............. rev. 10/14/8~ FOUNDA'TION (1st) FOUNDATION (2nd) ROUGH FRAME & .PLUMBING INSULATION FERN. STATE ENERGY CODE FINAL ADDITIONA~L COMMENTS: ~m~ Z ~ ~ 0 n~' ~ ~ ~ (5~6) 727,4455 ~,,. ,- 'i. ' '~ ':' ,' r ,.'.~: ' ":~;' ~.~" .,,. ,,. ,,.=~ ..... ~, ,.: . '.' ~ .: ~,' ' AVENUE :~, ~ . ,. , ,~. _ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF HEALTH ............ 3 SETS OF PLANS .... SURVEY CHECK ..... SEPTIC FORM ................ CALL . . . ~ ..... MAIL TO: Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by Wpewriter 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 liyout of property must be drawn on the diagram which is part of this appli- cation. ¢. 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 s~all 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 La~vs, Ordinances or Regulations, for the construction of buildings, a,d, ditions 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 inspections. ............ .~ .~x ~.~...~ ~,~;: ....... (Signature of applicant, or name, if a corporanon) - , (Mailin,, address of app-licant)¥, '"~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...~..',~ .~..~ R-. .................................................................................. Name of owner of premises . .'~..x,.'NX:. ~,.'~,~."t',.. -.~. ~.'5'h%.xs,'.~.~.~.. :~.x~. X'c~ .~-'X.~] ................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corpo/'ate officer) Builder's License No .... .q~.~..t.~ .~..~...~. ........... Plumber s L~cense No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ..... .~.~..~..~..~x.~..e,~..?x~. ,'~..,..~ ~.~.~.. ......... ...% ~ .................. ~.',:,¢....T.x~L~.. 5.,~..x-¢...~,. ........... .X .~ .~¥.x~. ,~ ~. ~ ~...X .\.~ X =% House Number Street Hamlet ~ County Tax Map No. I000 Section ....~.\..~. .......... Block ...~. ~ ........... Lot ..... ~.~ ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed constrnction: a. Existing use and occupancy ..... .~ cp.~.~%. ......................................................... b. Intended use and occupancy .... .~..,~.qX,~..~.~, ................................................. 3. Nature of work (check which applicable): New Building .... .J' .....Addition .......... Alteration ..... . .... Repair .............. Removal .............. Demolition ........ i ...... Other Work .............. · ~ ~ .~: ~) .~1 : (Description) 4. Estimate'd Cost i ............................ Fee ....... I .............................. ttq be paid on filing this application) 5. If dwelling, number of dweiling units N · · ' ' ' ............... umber of dwelimgiun~ts on each floor If garage, number of cars . ................ 6. If business, commercial or mixed occupancy specify nature and extent of each type of use ............... 7. Dm~ensonsofexmt,ngstnctures,,fany: Front ............... Rear .... i .......... Depth ........... igl f St ' He it ............... Number o cries ......... dditi ' ' ....... Dimensions of same structure xvith alterations or a ons: Front ......... , ....... Rear ...... pth igl , ' ........ De ...................... tie it ............... Numbs[of Stories ................... Dimensions of entire new construction: Front ............... Rear ............... De ........... ~H.e~ght ............... Number of Stories ...... i pth Size o ct: Front ...................... Rear ................. ... Depth .................... Date of Purchase ............. · · .............. Name of Former Owner ............... Zone or use district in which premises are situated ............... ~ ............ gl I i ..... Does proposed construction violate any zonin aw, ordinance or regu ation: Will lot be regraded ............. ' ............................. · Will fill b ' ' ' f O f P .............. excess e removed from premises: Yes No Add i PI N ' Name o wner o remises .................... ress .. · lone o.. . Name of Architect ............. ' ........................... f C .............. Address ................... Phone No ............ Name o ontractor .......................... Address ............ ~ ...... Phone No ................ 15.Is this property located within 300 feet of a tidal iwetland? *YES .... NO .... mil yes, Southold Town Trustees Permit may be required. ... 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 s low street names and indicate whether interior or corner lot. 9. 10. I1. '12. 13. 14. STATE OF NEW YORK, COUNTY OF ............ S.S .......... ('~ ..................................... being duly sworn, deposes and says that amc of individual signing contract) above named. ~ he is the applicant Itc is tile , (Contractor,,agent, corporate officer, etcO of said owner or owners, and is duly authorized to perform or have performed the !said work and to make and file this application, that all statements contained m tin ..... s ap'gflcation are true to the best of his knowledge and belief; and that the work will be perfomed in the m~ner set forth in the application filed therewith. Sworn to before me this ' . ~l~ ~ ....' ....... ;,'~7~f~L~ (Signature of applic~t) Term E~plr~ ~h'~, 1~