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Home My WebLink About8043-ZFORI~I NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector TownHall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building., ad~l.J,~,~r~ ................... ~ ................ Location of Property .. ~265 ................ k{lL~.l,. I~ ~tR~ ...............~P.~ q ~p,i,q ..... House No. ~reet Hamlet County Tax Map No. ] 000 Section . 0~.~. ....... Block . 0 7 ............ Lot.. D.0.5 ........... Subdivision.. ~l~.ncbe..T.. D. Lqk~o ..... Filed Map No. ~.0. .... Lot No...~ .......... conforms substantially to the Application for Building Permit heretofore f'ded in this office dated · .J.q~. %.5 ........... ,1975. pursuant to which Buildin8 Permit No...8.0.4. ~..Z. ............ dated ..... Ju,~. · ~ ................ 19. ? 5, was issued, and conforms to all of the requirements of the applicable provisions of the hw. The occupancy for which this certificate is issued is ......... ...~. ~c~c~ ~i.~. ~.o..ao..e.~ J,~.t~tng. ~.w.~ ~i;L~g, .................................. The certificate is issued to ....J.s, me~..J,. N.o.r. mar~..~, w~q ,. ~C.a~ t,~ry~, ....... of the aforesaid building. Suffolk County Department of Health Approval ...... n ~ a ................................. UNDERWRITERS CERTIFICATE NO .................................................. Buildin8 Inspector Rw. 1/81 FOBM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8043 Z Permission is hereby granted to: ~a.t ..~J~..Bem. L~.aL .&~......./.~,m~...~...o..~ at premises located at ...J~L~..,[~II~ .......................................................................................... ~:.;.J.. Peool~o ii.Y, pursuant to application dated .......................... ~IB~.....~ .........., 19..!~.~'., and czpproved by the Building Inspector. Fee $..,{.1 ~..-00.: ................ T_O~. N t~SOUTHOLD Bu;Idin~Department Town Hell Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY In~tructiom This application must be filled in typewriter OR ink, end submitted in duplicate 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 feature[ 2. Final approval of Health Dept. of water supply and sewerage disposel-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriter~ 4. Commemial buildings, Industrial buildings, Multiple Residences and similar buildings end installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the buildin~ 5. Submit Planning Board approval of completed site plan requirements where applicable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pra-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. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 New Building ............. Old or Pre-existing Building ............ Vacant Land ............. ! n of Poe a,,~,,'~ ~/.~ ~"'~/':"/" '~//']'?/~' ~.'" o ~ c.. '~ Locat'o r p rtyHou, ......................................................... No. __ Street __ Owner or Ownersof Property ....,.-~....~-~',.....'~.'....~.~..~..~..'~..'~...~..~..~.'.~'.'~. .... ./.~.~...~??..'~/ co..ty Tex Mep .o. OOO Section .7. S ock Lot . Health Dept Approval Labor Dept Approval ' Underwriters Approval ........................ Planning Board Approval .................... . Request for Temporary Certificate Final Certificate ..~.. ..... Fee Submitted $..~../~J~r_~..". ~2~. ~ ~-- Construction on above described buildi~lt ~lg~codes and regulation[ R~w. 10-10-78 ! j FORM NO. 6 t' TOWN OF SOUTHOLD Building Depa, b,,ent Town Hell Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions Ao This application must be filled in typewriter OR ink, and submitted in duplicate 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 na~ral or topographic features. 2. Fihal approval of Health Dept of water supply and sewerage disposel-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Unde~vritera. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings end installa- tions, a certificate of Code compliance from the Architect or Engineer resi~nsible for the buildin~ 5. Submit Planning Board approval of completed site plan requirements where applicable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings end "pm-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 building~ 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion reduirad to prepare a certificate. Fees' 1. Certificate of occupancy $5.00 2. Certificate of occupancy on preexisting dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 New Building Old or Pre-existing Building t~ . ........ ..... . ................ Vacant Land ........ Location of PropertyHou;e' '~"~" '~' "'~' ' 'No. '~' ' x' '~'e .... ~. . .,~. . .~.. . . . ~ .e. .~.. . ?,.. : . . . . .--'~. . . . . .~47 ~.l~.~;e.t · ................ ..... Owner or Owners of Property . · .~. · .~. · ~ ~'~ '~' '~ -~- J~ ~' ~/ B, k 7. County Tax Map No. 1000 Section ............ oc ............. Lot ............. Subdivision ........................ ~ ./..j...Filed Map No ........... Lot No .............. Permit No.~'~{~ of Permit ~.~Z.~. · 0,,cant...~.'..~..~'. (~?..~ .......... Date .Apl ~ ............. Approval Labor Dept Approval ' Health Dept .................................................. Underwriters Approval Planning Board Approval ................. Request for Temporary Certificate ..................... Final Certificate... ~ ................ Fee Submitted $. · .~./~ .................... Construction on above described buildi~ codes and regulations. Rw, 10-10-78 ~ .................. ........... ' a. This a~lication must ~ complexly fill~ in by ~ewriter aC.in ink and s~mi~ in tripli~te ~ ~ Bui~ In~, With 3 ~ of Pl~s, aocumte pl~ plan ~ ~le. F~ acco~mg to sch~ule. b. Plot plan shying I~ation of lot and of buildings on premises, relationship to ~joining premiss or p~lic stme~ o~ ar~s, and givi~ a detail~ d,cription of I~ ofpr~e~ must ~ drown ~ the diagram which is ~ of ~ls a~licati~. c. ~e wo~ c~er~ by this a~li=ation may n~ be c~menced before issuance of Building Permit. d. U~ appeal of ~is applicati~, ~e BuildJ~ Ins~tor will issue a Building Permit to the ~licant. S~h permit shall be ~t ~ the promises ~ailable for in~ti~ th~h~t the work. e. No ~ldi~ ~all be ~cupi~ or u~d in whole or in ~ for any pu~ose whoever until a Ce~ificate of ~cu~y shall h~e ~en gmnt~ ~ ~e Buildi~ Insp~or. APPLI~TION IS HEREBY ~DE to the Building Department for the i~uance of a Bui~i~ Pe~it.pu~t ~ the Buildi~ Z~e O~inance of the T~n of ~hold, Suffolk County, New York, and ~er applicable ~, O~i~ or Regulations, for the constm~ion of buildi~s, additi~s Or alter~i~s, or for mm~al' or demolition, as homin d~ri~d. ~e applicant agr~s to comply with all applicable I~, ordinances, building c~, h~i~ c~e, a~ ~ul~t~, a~ ~ admit authoriz~ insp~to~ on promises ~d in buildln~ ~r n~e,a~ i~tions. 'n / ............................................. ....................... //~-r/~: (Signature of applicant, or name, if a corporation) -7~'~ ~/~. //'O~ (^ddress of applicant, State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...~,,/"~.~.~..'~4~'~'/.~...~...~// ........................................................................................... If applicant is a corporate, signo/t(Jre o~/duly authorized officer. ' ~ (Name and title/of corpc)16te officer.) Builder's License ~o~ ..~....z~......~ .................... ' Plumber's License No ................................................. Electrician's License No ............................................. / Other Trade's License No ............................................... ,~// ../~//~ ~v~e6,.. -- 1. Location of land on which proposed work ?ill be done. Map ~ .~...~.~ ................. v ........... Lot No ......................... Street and Number .................. /.~. ~.../..4.../-.....,L.~(..4/...~.~....,~.~.~.°4~'~./..~..:~......~.., ..~.'.. ........................................ i ......... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ..... ./.....~..~. ~.~......~.'~../../..~..'...~....~:?.~......#...~.....'...j .................... b. Intended use and occupancy ..../...~ ........... 3. Nature of work (check which applicable): New' Building.. ................. Addition .................. Alteration ...../......, .... Repair .................. Removal .................. Demolition .................... Other Work .................................................... (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 bus!ness, commercial or mixed occupancy, specify nature and extent of each type of use ' Height ........ /.~. ........ Number of Stories ................................................................................................................. D mens °ns of tame ~trusture w th a terat ons or add tons' Front ~ ~ R~n, *~' ,~ ' 8. Dimens ons of ent re new construct on' Front ~_ ~ .... ~, ~ ~,~ .... ,, _, Z-~- 10. Date of Purchase ................................. ; ...................... Name of Former Owner ................... --~. ........ ~ ........................... 11. Zone or use district in which premises are situated ........... ~_...~....o...~.../...~.. ..................................................... 12. Does proposed construction v o ate anv zonina aw ordnance or r~nu ation' ,dJO. 13. Will lot be regraded ..........~....'~. ............. Will excess fill be removed from premises: ( ) yes (l.~ No Name of Architect - Address ................................ 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 corner lot. STATE OF NEW YORK, C O U I',,~Z~ OF ................................ ~/'~' ...... · .~,~-~'I......~ .//.././.2: .-~/~...... ...................... being duly sworn, deposes and says that he s the applican, ~ (Name of individuo~'signing/ontrect~ ~ ,,,,,abgve name. ~ / ' He is' the .......... ~...;.....~.~~.~ .......................................................... (Contractor, agent, corporate officer, etc.) '~'~ .............................. of said ~ner or o~Ders, a~ is duly aut~rized to perform or have performed the ~id~ork an~ to ~ke ~nd fife this a~lication; t~t all statements contain~ Jn th s app cat on are tree to the best o~hJs know~dge and belief; and that th~ w0rk will ~ performed in the manner ~t fo~h in the application filed ther~it~ / Sw~ to ~fore me this ,~ / / PU~IC,