HomeMy WebLinkAbout9464-zFORM NO, 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No..g113.7.6 ......... Date .. ~.ecelm, b.~r.. ,]..6. ................ ,198..2.
THIS CERTIFIES that the building . .0.ne...f.a.m. Jr..17..d/..e :~.l.J:.n..g ........................
Location of Property .. g/.est:.
Sou~ No. ' ............. 'S'de~i .......................
County Tax Map No. I000 Section .. 7.8. ....... Block ...1 ............ Lot ...... 2.7. .........
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
· .Septe~lber..22 ..... , 19.77pursuant to whi'ch Building Permit No, .9.4.6.4. g. ...............
dated . S.epteraber. 2.2 ............ 19.77, 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 .........
.... bu.ild, one. family, d. we ll.ing ..............................................
The certificate is issued to .. l~.ichard .and..Sus~-n.
(owner,/essee or't~t~a'n't) ......................
of the aforesaid building.
/
Suffolk County Department of Health Approval ... ~?..~.$0.-3.7. ..............................
UNDERWRITERS CERTIFICATE NO... 37.7.378 ........................................
Rev. 1/81
Building Inspector
FO~ NO. ~
TOWN OF SOUTHOLD
~UILDIN~ DEFAItl'MENT
TOY~4 ~JARK'$
SOUTHOLD, N~ Y.
BUILDING FEI, MIT
CFI'tIS PERMIT MUST BE KEPT ON TH£ PI~EMISE$ UNTIL FULl
COMPLETION OF THE WORK AUTHORIZED)
N? 9464 Z
Permission is hereby granted to:
· .~.~.u...~..~.~.~ .............. : ..........................................
to ..b.u.~d..~.~..~n~..~",,u~l~'..,d~e~Ll~n& ....................................................................................
at premises located at ...~,a~t...,~;[ ....... ~-,~e.s:t...(~z'.eek..E,~:t, .................................................................
Glenn & Grissom Southo.~.d.. .................................
pursuant to application dated ......................... ;~e.~t.....22 ........... , 1~.~....., and approved by the
Building Inspector.
F.. $..~.~. ..........
Building Inspector
FOKM NO, ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
TEMPORARY
Certificate Occupancy
No. Z89.%0 ...... Date .. March .2 ................. , 19..7.8
THIS CERTIFIES that the building located at . .1.9~+.~, Glenn .Road. ........ Street
Map No... 381,.8 ..... Block No ........... Lot No ..... ~.2 ...........................
conforms substantially to the Application for Building Permit heretofore filed in this office
dated .September. 22 ....... , 19.??. pursuant to which Building Permit No...9.~6.b~Z
dated .September. 22. ....... , 19.77., was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is ...... PRIYA~E. ONE. ,FA}ilL¥ .DWELL~.NG .... ,~3e~..NOT~ ...................
The certificate is issued to ... H.iol~ard..&. ,%usan..Greena ...........................
(owner, ~
of the aforesaid building.
Suffolk County Department of Health Approval ...... r/.-.~.0.-.~? ......................
UNDERWRITERS CERTIFICATE No ............... .P.e.n.d..S~g. .....................
HOUSE NUMBER ., · 19~,~ ...... Street ....... .G. le~m .Hoa~ ......................
............................................. . .out ho. ....................
NOTE Building Inspector.
1. Chimney is not approved f,'or use
2. Insulation on the inside of the foundation not protected per code.
3. Garage is not to be ocaupied
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Clerks Office
Southold, N. Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building
Inspector with the following; for new buildings or new use:
l. 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--IS-9 form or equal).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, /v~ultiple Residences and similar buildings and
installations, 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 19,57), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of property 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 in-
formation required to prepare a certificate.
C. 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 ...... ..~..,.......~OId or Pre-existing Building/m ........................ Vacant Land ............................
Location Of Property .~~ j>'6'r ~J ~ ~~ .
n ............................. ................................................................
Owner Or ~ ers O~ 'ap ~y ..... ~ .....................................................................................................
~.~,v,.,o. ........ ~.~..E~.~..~ ........... ~o,.o ............. ,,oc~.o ............. .o.,..o .............
o, ...............................
Health Dept. Approval ................ ;~ ....................... Labor Dept. Approval ................................................
U.d.rwr~.e.. *,,rov~ ............... ~....:~.~ ......... ~.,,~,, .o.,d *,~,o~.~ ........................................
Request For Temporary Certificate ........................................ Final Certificate. .........................................
Fee Submitted $ .............~... .......... ~ ........
Construction on above described building ~~egulations.
Applicant Z.~~ .......................................................................
Sworn to before me this
................ day of ............................................
Notary Public .................................... County
(stamp or seal)
FORM NO. 6
TOWN OF $OUTHOLD
Building Department
Town Hall
Southold, N.Y, 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. 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
natural or topographic featu res.
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-existing"
land uses:
I. Accurate survey of property 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
3, Copy of certificate of occupancy $1.00
4.Vacant Land C.O. $5.00
$15.00
Date.. /~. ,~, ,~.//. ....
New Building ............. Old or Pre-existing Building ............ Vacant Land .............
Location of Proper ty . ,~..~..~.~. ................... .~/'..~.:/~./.'~...~../~, .................~?. ~.~. ,/-, .?.~'/~
House No. Street Ham/et
Owner or Owners of Property . - ..................................
County Tax Map No. 1000 Section ............... Block ............... Lot ................
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No ........... Date of Permit .......... Applicant ..................................
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 ....................................................
FORM NO, 6
TOWN OF SOUTHOLD
Building Deparzment
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and sub~ tted in dupWcate 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 topograoh c features.
2. Final approval of Health DenT, of water supply and sewerage disoosal--(S-9 form or equal).
3. Approval of electrical instaliation from Board of Fire Underwriters.
4. Commercial buildings lndustria buildings, Muir p e Resi?nces and.similar build~e~ and installa-
tions, a certificate of Code compliance from the ArchJtec, or Engineer responsible fir 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-existing"
land uses:
1. Accurate survey of peoperty showing all property lines, Streets, buildings and g;nusual 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. / .
C. Fees:
t. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or land use $5.00
3. Copy of certificate of occupancy $1.00
Date ,.
~"-' Pre-existing ' -'
New Building ......... Old or Building(X) ......... =/Vacant Lend
Hou~ No.
ow. , o, Ow .r, of ....... ,. .....................
County Tax Map No..~000 Section ............... ~loek ............... Lot ................
~ubdivision ................................. Filed MapNo...: ....... Lot No ..............
Health Dept. Approval ........................ Labor Dept. Approval ......................
Unde~riters Approval .......
................. Planning Board Approval ..................
R t f T y C tiff '
eques or emporar er cate ..................... Final Certificate ......
Fee Submitted $
Construction on above described build/ag
Ap¢[icant
Rev. 10-10.78
and p,A~it'r~ee~,~, ail appl/,cable~codas and reaulations.
17 41 16 17
S~RVIC~ E)~CX3f~ECT S E R V I C E
~otors= I-I/2hp
Smoke Detectors
14.4 Elec, Furnace
O~ CC, CC)ND.
2/O
Goodal.e
RR I ~ox I~A Nsln Rd.
~lttltuck, N.Y. 11952 LIc.7~]E
. !
~is tutti,ate must n~ ~ olt~ed in.any monner~ ~u~n ~ t~ ~ff~ of t~ Board if incorr~.
Per
may
Ii,sir c~ldenti.ls.
coPY I CoPY OF ClRTIFICATt
TO~VN OF SOUT~2OLD
OFFICE OF BUILDING INSPECTOR '
P.O. o ,
,~OX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL. 765-I 802
_ - =pp-l~ant
D ear'N~/~ ~ ?L~2£~.~_ _:
T,his is to advise you that ~ ~
Permit No. ~,ttJ , · ' , ~.:~ jv~ unu~r ~u~ng
a fxnal/inspect~o~ n~s -' - "1'~ 4 ~mp!~*ed and
- . ~ ~ nas n&z~ been done,
In order to c
o.,~..ete this file, it is necessary that
a Certificate of Occupancy be issued Please r~ oh~
.... 11 out
enclosed form(s), return same to the above office with a
check for $5.00 payable to the Town of Southold. Please
indicate to whom the Certificate of Occupancy is to be mailed,
and arrange with this office for an inspection date.
Thank you for your prompt attention.
Very truly yours,
Victor Lessard
Administrdtor
VL:ec
Enclesupes
TOWN
.................
IN~U~IffiS
O' .~is ~icatiffi
b. Plat plan s~ing I~otion of lot
areas, and givi~
c. ~e w~er~
d. Upon a~al of ~is a~l~tim, ~e Buildin~ Ins~*or~ill issue ~ Bud ng Permit to the applicant. Suc~ permi~
shall be kept ~ ~e premiss a~ilable ~r in~tiffi ~ffit t~
, ~.,, No ~ui!ding sh~ll be ~cupi~ or u~ in ~ole or in ~ for any pumose whoever until a Ce~ ~ cote of ~cupanc~
snail n~e peen granted ~ the Building Insp~tor -
APPLICATION IS HEREBY MADE to the Building Department for the ssuance of a Bud ng Permit pursuant to the,
Building Zone Ordinance of the Town of Southold, Suffolk County~ New York, and other appl cab · Laws, Ordnances or~
Regulations, for the construction of buildings, additions or alterations, or for remova or demo tion, as here n described
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t~
admit authorized inspectors on premises and in buildings for necessor), inspections.
(Signature of appficant, or name,~f a 4~rporotion) --
(Address of applicant) / / ~ '~//
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
· .· 4~d~V.~.~' ......
If applicont~corpomte, ~i~ature ~ outhorized officer.
'"7 .... ~'~i~;~';' ~;~i"~i~i¥
Builder's License No .....................................................
Plumber's
License
No.
___
E~ectric~on's License No...~.'.~.~..~...~.~-
(~her T~de's Ucense No...../~...! ......... /~.......~... ....... '..~
1. Location of land on which proposed work will be done. Map No.: ....... ~.....~ ................. Lot No .......................
stre.t and Number ....... ~.C ....... C..~....~.....~.~..~..~ ...... L(~.~.~).i ........ ~..:.~.'.~. .............
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed 'construction:
a. Exisiting use and occupancy .................................................................................................................................
b. ~ntended use and occupancy ......... R~eC.~./...C~ ............................................................................... , ........
3. Nature of work (check which applicable): New Building' ...... Addition .................. Alteration ................
Repair .................. Removal .................. Demolition .................... Other Work .....................................................
9.~_. ~ (Description)
4. Estimated Cost ................................................... Fee .......................................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ....... 0~....~.... ....... Number of dwelling units on each floor ............................
If garage, number of cars .........~-~.~..~-....CU./d.IO.I~J(/.~.~ ................................ .~--.:; ........ ........................................
6. If business, commercial or mixed occupancy, specify nature and extent of each t~/pe of use ............................
7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth ....................
Height ........................ Number of Stories .................................................................................................................
Dimensions of same structure with alterations or additions: Front ....................................Rear ............................
Depth ................................ Height ............................ Number of Stories ................................
8. Dimensions of entire new construction: Front ....... --'.~..~ ..................... Rear ..... ~'..~ ............... De~pth ......~....'~. ...........
· q .
He~aht ......~.. ........... Number of ~,~enes ....J..?~'.. ................................. ~ ................................................ ... ..............
9. Size- of lot: Front ........... ............................ Rear ......... ..~.~ ...................... Depth ...~.1...'. ..............
10. Date Of Purchase ...... ::...L'. .............. ; ............................ Name of Former Owner ........................................................
11. Zone or use district in which premises are situated .....................................................................................................
]2. Does proposed construction violate any zoning law,. ordinance or regulation: ........................................................
13. Will lot be regraded ......~..~ ........ WilJ excess fill be removed from promises: .(
)
Yes
(
Nome of Architect .............................................................. Addre~ ................................ Phone No .......................
· ,,~....~....~..~;~Zf,~ tZ X/J1 A r ..... "
Name
of
Contractor
~..,... ............ ...~...¢~%e~. ;;.j/..~ .~,, ..... ess ...... ~1~ ......... Fllone I~1o ......................
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 Y~Rj<~/'~/~/, ~, ~ S S , ' :' ~ -, ' ' '' ~
COUNTY Q ........................ ~' ' '
.................... ~-~....~....;..~... .......... ....1~. .................... be,ng duly sworn, deposes and says that he is the applicant
(N~e of individual 'signi~ ~ntrac~ ~', - '
above named.
He is the .......................... :....~.~.&.~ ...........................................................................................................................
~ (Contractor, agent, co,orate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file
th s app cat on; that all statements contained in this applicgtion are true to the best of his knowledge and belief; and
that the work will be performed in the manner set fo~hjn tH~' a~plication filed therewith.
Sworn~to b~ dayof ~~....., 19..~me this ~ ~,/~ . , ~~ /~ ~-- ~
....... .........
....... .........................
~ JUDI~ T. TER~ ~ ~ (Signature ot applicant)
Nota~ Public, State of N~ Yo~
No. 52-03~9~ Suffolk ~un~
~mmission ~pires March 30, ~/~
F R 0 N T ~ ELLF_Y ATION
APPROVED AS NOTED
DATI~ ~
?
P~t ~'~- ~ BY: ~
NOTIFY' ~UILDING DEPARTMENT AT
Y~66~ 9~ ~ 4PM FOR REQUI~
oRE'~R ~'ELEVflTION,
FLOOK
CE L LA P.,
-I
I;
FLO.O
.'L o 2., c. 4.
P'LA kl ,,
PL.A it.
/,
C
>-L
.-%
~.%,ff, co..14eal? ~.
SUFFOLK COUNT~ ~ALTH DEPA~i'~ENT
~)~:,~, FEB 2 b 1978, o. ~. :~j" ~ ' ~ -
Chief o~ ~o~efal Engineerln~
%'6. /,/gT~