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Home My WebLink About11692-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector' Town Hall Southold, N.Y. Certificate Of 'Occupancy No...Zl136.8 ........ Date ... P.e. qg.rn.b.e.r...]..6 ................. 19.8.2. THIS CERTIFIES that the building ................................................ Location of Property ... 9.5 .Narr. ow. Pd.'cer. Rcl. ,..O.a ~.Ota.'c. ........................... House No. Street Ham/et County Tax Map :No. I000 Section .,. 02.7. ..... Block . .04 ........... Lot..q0.7 ............ Subdivision ............................... Flied Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ Nay. 6: ...... , 198.2.. pursuant to which Building Permit No...1-2.6.9.2. Z. ............. dated ....... ~Ia~z. 2 4 .............. 19.8.2., was issued, and conforms to all of the requirements of the applicable provisions of tt~e law. The occupancy for which this certificate is issued is ......... The certificate is issued to ... Bo-n3 ~mJ..n. Sok. c~bSn ..................................... (owner, lessee or tenantJ of the aforesaid building. : Suffolk County Department of Health Approval .... N/2k .................................. UNDERWRITERS CERTIFICATE NO ............ .i',1./. A. .................................. Building Inspector Rev. 1/81 FOEI~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP. EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 11692 Z Permission is hereby granted~_t~:) / ,~-- , / .... z'.~.~......./..~:~....~T ....................... ,o ...... .Cc~..~...~.~..cF......~_...~..e~..~..~..~.~......~zc/..r..~.z~.~.../.~. ........... at prem,ses ,~ated at ..X~....~m.m.../~m~.....~..:........................ ............ .~......~....~~.~...~e~......= ......... ~ze~..~...~ .... County Tax Map No. 1000 Sect,on ...... Block .......... ._Lot No. (.~..~./C ........... pursuant to application dated ............................... , 1 and approved by the Building Inspector. Fee $.,~,,.~,,,..--Y ........... Rev. 6/30/80 FORM NO. $ TOWN OF SOUTHOLD Building Department Town Hall Southold, N,Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with [he 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 tooogra~hic features. 2. Final approval of Heaitr~ Dept. of water supply and sewerage disoosa[--(S-9 form or equal). 3. Approval of e!ectrical 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. Submi: Planning Board approval of completed site plan requirements where applicable· For existing buildings {prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty 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. Data of any housing code or safety inspection of buildings or premises¢ or other pertinent informa- tion required to prepare a certificate. ,' C. Fees: 1. Certificate of occupancy $5.00 J ' ' 2. Certificate of occupancy on pre-existing dwelling land use ~/;) 5.00 7' 3. Copy of certificate of occupancy $1.00 Date ....... New Building .... '. · . Old or Pre-existing Building(X) ........ ¢/Vacant Land ·.. · O at'ono'*roperty .......... .... House, ~Vo. · . Srt.*er-- · Ham/et Owner or Owners of Property .......................... Count~ ra× Mao ~o..~O00 Section .... C?.~ ....e~oo.~ .... P..?. ..... 'or...¢?'9..'7. ....... Subc~ v s on .... X.. ................ Filed Map No. X .Lot No. Health Dept. Approval ......... ~. ' ,Labor Dept. Approval ~ Underwriters Approval ~ Planning Board Approval ~" . . Request for Temporary Certificate ..................... Final Certificate ................. Fee Submit[ed S ..... ~ Construction on above described building and permirmeets all appLtcable~codes and regulations. FIELD ~NS?~CTION DATE COMMENTS FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS: FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL ............................... PLEASE TAKE NOTICE that your application dated ...... ~ ................ 19 .~.~ for pe~it to const~ct... Co..~a~a.,o. ~000 S~¢~ion .... Q.~7... ~o~....~? ...... ~ot . ~.7 ..... Subdivi~on ..... '...z ........ Filed Map No. ~ Lot No .... ~ .......... is returned h=~with and disapproved on the following grounds.~.. ~ l//~ ~' ' ' ~a~d~'I~ect~ ........... RV 1/80 DETAIL B GABLE END FLASHING applicable only when gable end is attached to buikliflg DETAIL C SILL DETAIL A RIDGE insulated glass ~, DETAIL D WALL BAR sealant spacer (SIDE FILLER KIT) B %,, ~,,~-' (BASE WALL INRTALLATIONI NO DOOR OR WINDOW HERE FLAT SLAB or DECK INSTALLATION TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765.1803 Appilcatio. ........ Disapproved?c · . APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildin~ Inspector, with.3 sets o( plnns; accurate plot plan to w~le. Fe~a~ckn'd~ tO ~hedule. b. Plot plan showing location of lot and of Imildings on premiers, n~lation~'fip to adjo/ning premises or publ/c streets or areas, and g/vinE a detailed description of layout of property must be drawn on the dia~h'n wh/ch is part of this appli- cation· c. The work covered by ~ application may not be commenced before/seuance of Building Permit. d. Upon approval of this application, the ]htildin~ Xnspector will issue a Buildin&Permit to the applicant. Such penn// 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 a Certificate of Occupanc~ shail have been granted by the Building inspector. APPLICATION IS HEREBY MADE to the Building Depa~baent for the issuance of a Building Perm/t pursuant to the Buildin8 Zone Ordinance of the Town of SoUthold, Suffolk Couxtty, ~ York, and other a~plicabie Laws, Ordinances o~ Regulations, for the construction of buildings, add/t/oas or aitemtion~ or for removal or demolition, as herein described. The applicant ~rees to comply with ali applicable laws, ordinances, build/ag code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections, (Signature of al~l~licht, or n~me, if a corporation) ' (Mailing address ~f a -- State whether applicant is owner, lessee, agent, ~tect. en~eer, ~ae~ c~tmctor, ~ec~, plum~r or b~]der. ............. app~c~t co~tion, ~a~ of d~y a~ed ~fficar. a ....... ~ (N.e =d title of co~. officer)' I ~ r~;~'~, i ~ec~ci~'s License No ................... ~~[' '~ [ O~er Tree's ~cen~ No : ..... ................ ~caUon of~d on w~ch ~ ~~' ~ ~ ~ ~ ~0~ pwp~.w~k ~ ~ ~ne .................................................. ..... ..... House Num~ff~l~ ~ ~t~et I ........................... ~ T~ ~ ~o. ~ ~o~ ...~.~ ......... mock ...0.~ ........... ~t..~.q.7., .~ .... Subdiv~on ....... ~ ..................... ' ..... Filed Map No... ~ ........ Lot .. ~ ........... 2. State exis~g u~ ~d ~cup~ of p~s ~ ~ded u~ ~ ~ of pm~d comt~fion: a. ~ u~ and o~u;=~ ... ~ ib.~ .............................................. . 3. Nature of work (check which applicable): New Building .......... Addition..~. ....... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4. EstimateaCost ..~.tQf.~.t~..O. ........................ Fee~.../.~...~.. ........................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... ]. ........ Number of dwelling units on each floor ................ If garage, number of cars ........................................................................ 6. If business, commercial or mixed occupancy, specify nature ]nd extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ..... .~. ~' ...... Rear ...~/~ I~..t ...... Depth ...~.~..t ....... Height .... [~.~. ....... Number of Stories ....... ~ ................................................ Dimensions of same structure with alterations or additions: Front ..... ~.~ ........ Rear ..... ~ ......... Depth ...... ~'~. ........ Height ...~'-4.~ ........... Number of Stories .... /. ................ 8. Dunensxons of entire new constructmn: Front .... ~. ......... Rear .... ~. ......... I~pth ... ~.O./. . Height ....~..'-/.(. ..... Number of Stories ......... ~. ............................ : ~...~. ............. 9. Size oflot: Front .,.~.,/.O~.~..~. ........ Rear ..... ].OD.~. ...... Deoth ..~.~.,-.5.,.O. . 10. Date of Purchase . ~_)~'~,.. ~.~..?..~.. ........... N~rne of Former'6~vner .. ~r'" i .......... 11. Zone'br use district in which premises are situated ..... ~...~j. ~.~...t~'~./?/~. ............................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ....,~..d~. ........... 13. Will lot be regraded .... .~.,~ .................. Will excess fill be removed from premises: '" 14. Name of Owner of premises .~'M2r~ [6~. ~0J~),/~P,~ddress ................... Phone No ................ Name of Architect . .~ .......................... Address ................... Phone No ................ Name of Contractorff~lSO/$ ~l~. 't~.~.. ~ e~l/l~ ................... Phone PLOT DIAGRAM Locate clearly and distinctly all building, whether existing or proposed, and, indicate all set-back dimensions from properW lines. Give street and block number or description according to deed, and show street names and indicat~ whe~er interior or corner lot. STATE OF NEW 't~RI~/ /2 ~ ~ ........~~ ~ndivid~g ........ ~ contract) ............ berg duly sworn, deposes ~d ~ys t~e is ~e appli~t above named. of said owner or owne~, ~d ~ duly authored to perfom or have perfomed the ~id work and to m~e ~d ~e ~s application; that all statements cont~ed ~ this application are ~ue to the best of his ~owledge ~d ~f; and ~at ~e work will be perfomed in ~e m~ner set forth ~ the application filed the~with. Sworn to before me th~