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Home My WebLink About16991-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. z-17050 Date July I, !988 THIS CERTIFIES that the building ADDITION TO ACCESSORY Location of Property .... 7..4,.5..G.r.o..t.o.n. Court Matt,ituck, N.Y. House No. ' ............. 'S't/e~i ...................... tJl~/el County Tax Map No. 1000 Section . . .1.0.7. ...... Block 2 ..... Lot 2.8 Subdivision ............................... Filed iX{ap No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated Hay 13, 1988 pursuant to which Building Permit No. 1699 1 Z dated .... M a.....y 13,' 19.......88 .... ... . 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 ......... DECKING AROUND ACCESSORY POOL AS APPLIED FOR The certificate is issued to LAWRENCE KELLY ..................... ?o¥.'e;, '/i~'a'~2tM~'~ 7.~ ................... of tbe aforesaid building. Suffolk County Department of Health Approval ...... ~./..~ .......................... UNDERWRITERS CERTIFICATE NO ................ ~./..3. ............................... PLUMBERS CERTIFICATION DATED: N/A ......... Building Inspector Rev. 1781 · o~J~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 167~t z ..... ~~'"'"" ........................ ~ .......... ,' ....... ;L ................. , .......... ; ............................... ~ D . ~'at premises located a~.~.........~..~....~ .......... ~~~ .............................. County Tox Map No. 1000 Section ...... )..,.O...~, ........ Block ....... .,~,,,~,, ...... Lot No...,,~,..~.,;,~,. ........ pursuont to application dated ......... ~.~.~...~ .................. , 19..~...~.., and opproved by the Building inspector. Fee $...~..~:....:~ Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall BLDG. DE~-'L TOWN OF SOUTHOLD Southold, N.Y. 11971 , ~ 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted I ~ 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 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 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-e~dsting" land uses: 1. Accurate survey of p~operty 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 inform+ tion required to prepare a certificate. Fees: Additions $25.00 POOLS $25.00 ALTERATION $25.00 1. Certifieateofoceupancy New Dwelling $25.00, Accessory,S10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 5 0.00 3. Copy of certificate of occupancy $ 5,00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 ~°. 1 ~ S]~-~'.I ! 5.Updated C.O. $ 50.00 Date ........................ New C OhS t r' uc t i on ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ..~. .... .~..~ , , .~.(~..k~.~ ............ .~..~..-~..~.~..X~..~..~. House No. Street Hamlet Owner or Owners of Property . .~, . ,(~. , L..~ .~...~.~..~ .~ .~%~ .] ....................... County Tax Map No. 1000 Section . .~ .~ .-'[ ....... Block ...~ . .r~ ....... Lot...~}~D..~ ...... Subdivision ................................. Filed Map No ........... Lot No .............. PermitNo. \(o~ I Date of Permit .~1 )'~'...Applicant ..~..~..~( .~.J..~. ~t~..~. 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 permit meets all applicable codes and regulations. Applicant ~ ~ Rev. 10-10-78 765-t802 BUILDING DEPT. INSPECTION, [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] I/NSULATION / FRAMING [//]~ FINAL REMARKS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING ~FINAL REMARKS -' ~ DATE 765-S802 BUILDING DEPT. INSPECTION [ ] FOUNDATION sST [ ] ROUGH PLBG. [ ] FOUNDATION ZND [ ~ INSULATION [ ] FRAMING ~ ]/~FINAL REMARKS: ~ ~,~ ~ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION IST [ ]ROUGH PLBG. FOUNDATION 2ND [ ]INSULATION FRAMING [ ]FINAL DATE ~//f~/~~'/ FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & .PLUMBING INSULATION PER N. STATE ENERGY CQDE FI'NA/ ADDITIONAL COMMENTS: ~ N.?~ .1_~t,:.,.)~}.?,(1~ .~i,{.L,/~' ~<:?~ ~/,I pARK # CERTIFIED TO: x~~ c.~c4~0 T~rLE INSURANCE COMPANY pLAY GRoUNU ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved....~.. ~. ~.~.., 19 ?.~. ee~it No. !.~. ?.~.~ ~. Disapproved a/c ..................................... ................................ ...... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... INSTRUCTIONS a. This application must be completely 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 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 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 ~ Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE t'o 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 inspections. .... '. .... .~..L.~$.T~..~...L.W..~. ......... (Signature of applicant, or name, if a corporation) ~.'4... ~ ~....~ .%.t., .k, ~.~.:..~.X.q..~. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... .~.,¢..~..U..O..~...¢... ............................................................ Name of owner of premises ...... ~.~.. , · .~. ....................................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title or corporate off' ) Builder's License No...% .~.. t..~..Q~...~..~ ....... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ......... ~.¢.~....¢..~.~-r...c~...c..~.~w ..... ..~. ~..w...~..~.~.~ ................. House Number Street Hamlet County Tax Map No. I000 Section .. I .~ .7. ......... Block . .~).~ ........... Lot...~. 3 .,.~ ........ Subdivision..~..~...~..~...~....~3... · .~.~.~.~'~ ~ Filed Map No..~o.L~.'..LI~. ·~. ..... Lot .... 9. ......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use a.nd occupancy .. ~) .~. E .~..L?..~..~....~..~..f~..~. [~,~.. ................................... b. Intended use and occupancy . .~.~,..C_~. ~....~..,~..~..~..~,~.~.......~...~..<~..~. ...................... 3. Nature of work (check which applicable): New Building ..... ' .....'Addition .......... Alteration .......... Repair .............. Removai .............. Demolition ............ -- Other Work..~.~-.~.]x/. .... ! (Description) 4. Estimated Cost ......... I. O1.~.~..~.~ .................. Fee ~' (to be paid on filing this application) 5. If dwelling, number of dwellini units .............. Number of dwelling units on each floor ................ If garage, number of cars ....................................................................... l~~qr ~ix6d occupancy, specify natu[e and extent of each type of use ..................... ~r/~[~/]~-~t~B~ubtuies if any: Front ............... Rear .............. Depth ............... Iii ~~. 1 J ;iNumber of Stories ...................................... ~ [~i,-°~s~re w~th alterations or additions: Front ................. Rear .................. iX~12),~Cd~.~re ~ Ions,ruction: Front....~3 ......... Rear .... ~ ........ Depth ...~J~ ......... 10. Date of Purchase . .~. · .q~..--i~.'...~.0:..q{$ ......... 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 ....... .~'P..~3. ....... ~ ......... Will excess fill be removed from premises: Yes ' ~ Name of Architect ......... ~ .................. Address ................... Phone No ................ 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 comer lot. STATE OF NEW YORK.... COUNty OF.. ... ~..__~ _~.-.-.......~:.--/being duly sworn, deposes and says that he is the applicant (Nam~t~ndividual s~gnlng con~act) above named. He is the ........... ~ ~3 ~%~.~ ~% ......................................................... (Contractor, agent, corporate officer, etc.) of said owner or owne~, ~d is d~ly authorized to perform or have perfo~ed the said work and to m~e and file this application; that all statements con~a~ed ~ this application are true to the best of his ~owledge and belief; and that the wor~ will be performed in the m~er set forth in the application filed therewith. Sworn to before me this ............... [.~ ...... day~f ........ . ............... l,""'"°'a"'~s""",~ ~~'~ [','~i,~ ~ ~30.'~ (S~ature of applie~t)