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HomeMy WebLinkAbout10002-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. zi5595 Date Al2ril 6, 1987 THIS CERTIFIES that tbe building Accessory Location of Property 1350 BAYSHORE ROAD GREENPORT h~ds~ hiol ....................... 's'tie~i ....................... h~r~iel County Tax Map No. 1000 Section 53 . .Block 4. .Lot 33 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated May 4 ~ 1978 pursuant to which Building Permit No. lO002z dated Oct. 31, 1978 ....................... ....... 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 garage in rear yard. The certificate is issued to GRACE BANCROFT ..................... ?o¥,,'o;, ~'~X ..................... of the aforesaid building. Suffolk County Department of Health Approval N/A . UNDERWRITERS CERTIFICATE NO. .P.e.n.d.i.n.g ............. PLUMBERS CERTIFICATION DATED: N/A ~ng Inspector Rev. 1/81 FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N• 10002 Z Date ......................................................... 19........ Permission is hereby granted to: / ................................................................................ ................................................................................ G� C?C CC2�e c . I- to ................................... ...........................I................................................................................ ...... ............................................................................................ ................ ...... .. ......................................................... at premises located at ............................................................................................................ ..... �......'................................................. .. .. . pursuant to application dated ....................... .1.....1............ 19......... and approved by the Building Inspector. Fee $........................ Z.-Z Building Inspector FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 3 10002— Examined ................ ....... .. 19....... Application No. ................................ Approved ............ .. .. .,00 Q ;~.���..... 19.�ll. Permit No. . .: ... �� Disapproved a/c .................... ....................................... ............................................................. ................... ..,............................... Z..:p .......L. :................ ........... (BuildingIns ector) APPLICATION FOR BUILDING PERMIT Date ......... .........�..................... 19.d.v... INSTRUCTIONS a. This application must be completely filled in by typewriter or' in ink and submitted -in triplicate 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 of areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this application. 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 issue 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 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 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 buildings for necessary inspections. 01 �. ............... ........................................... ........ ........................... (Si nature of applicant, or name, if a corporation) ( ddress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. PLC!tJL. '........................ ....................................................................... APPROVED AS NOTE D.A . to.—. -.. Name of owner of premises .... !P A.0 4 13Y: If applicant is a corporate, signature of duly authorized officer. NOTIFY BUILDING DEPARTMENT AT 765-2660 9AM to 4PM FOR REQUIR. AV-- ......... ED INSPECTIONS: (Name and title of corporate officer) 1. BEFORE ACKFILLING rOUNDA. -(*-- ( 4_3:7 TION OR START FRAMING Builder's License No. ..................................................... 2. FRAMING INSPECTION Plumbers License No. 3• BEFORE COVERING PIRES OF ANY KIND ................................................ 4. FINAL WHIN JOL, COMPLETED v Electrician's License No. ............................................ NOT RESPONSIBLE FR DESIGN OR CONSTRUCTION ERRORS Other Trade's License No. ........ 5• ALL -CONSTRUCTION MUST MEET' .................... ............... 1. Location of land on which proposed work will be done. Ma o.• REQUIREMENTS OF LIt4tYk�I�TATE.. P P p K . .... ...... ,IRE E....... c C4®8....... Street and Number .....� �! '7Q.��...../��, ......... , /.�? 7" ... /..C.:: fG CODE Z®N1�8C..... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: .a. Exisiting use and occupancy ................................................ b. Intended use and occupancy .... ................................................................................................ J 3. Nature of work (check which applicable): New Building-...... ......... Addition ......k.......... Alteration ................ . Repair . Removal Demolition ....... Other Work .................................................•.... 0 e)....0....... :... o (Description)" 4. Estimated Cost ........�.J..�........a...............................Fee ..... .....:. ......................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................Number of dwelling units on each floor ............................ Ifgarage, number of cars .... .1107,. .............. ............................................................ . ........................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures if any:. Front ......:..................... Rear ................................ Depth ... ,. ........... Height ........................ Number of Stories ................................................................................................................. Dimensions of some structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................Number of Stories ................................ 8. Dimensions of entire new construction: Front ........ Z...................... Rear ........:..Z........... Depth ...../L............ Height ....—R........... Number of Stories ......./............................................................................................................. 9. Size of lot: Front .............7:5.................................... Rear .......7.5............................ Depth ...... A�............. 10. Date of Purchase ........................................................NNoome of Former Owner ........................................................ 11. Zone or use district in which premises are situated L1 � .` �!?'• � ............................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: .c ............................................ 13. Will lot be regraded ......�lo............... Will excess fill be removed from premises: ( ) Yes M No 14. Name of Owner of premises 1 �.!'.C' .%� �.! r� .<. Address Nameof Architect .............................................................. Address ................................ .Phoney No. ....................... Nameof Contractor ............................................................ 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. ! ^6 �etd F f I 0 T STATE OF NEW 4(K e- a S.S .... .... ...tn�raci; .... .................being duly sworn, deposes and says that he is the applicant (Name of individual signing above named. He is the ................ .. ................... ....................................................................................................................................... (Contractor, agent, corporate officer, etc.) 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 in this application_'are true to the best of his knowledge and belief; and thaT the work will be perfor d in the manner set forth in the ap cation filed therewith. Sworn togbee this ............ .... day of aryu ic. .......... .. .. ... ....... .. .... County ............ ... XZ_1. ?................ .. .................... ............................ (Signature of applicant) PAMELA J. INELLpR NOTARY PUBLIC,So-for of Now York No.4664300 Qubliflod In Suffolk Counl C) Commission Expires Mrrch 30.'f � ' FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ~ ~ 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 disposel--(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: 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 informa- tion required to prepare a certificate, C. Fees: 1. Certificate of occupancy New Dwelling $25.Q0, Accessory ,,$10.00 Business $50.00 2. Certificate of coupancy on pre-existing dwe,ing S 0.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date .......................... NewC°nstructi°n ...... Old or Pre-existin§ Building ............ Vacant Land ............. Location ofProperty ! ~'b /~,,~S ~.¢r-~ ~'~ .'~.'C~.¢.~. './.~.:~. House No. Street ~' Hamlet Owner or Owners of Property .~.<q~¢.~. ,~<%'w~'~ .~'. County Tax Map No. 1000 Section ............... Block ....~. .......... Lot ............... .~. ~ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No../.dJ.O..~.~,~... Date of Permit ...Applicant ~.'.~f.: ............ Health Dept, Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $....~ ..... /.7; ............ Construction on above described building~/~rmit/~eets all applicable codes and regulations. App,icant. ~/?.<~-v~. A~--, ~ ............................ ~.xamined .........................................19 ........ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. h~pproved ' ' ................. ~ ...................... , 19 ........ Permit No ..................................... Disapproved a/c ..................... ; ...................................................................... (Building Inspector) Application No. mD"a o,~d, C,O. ~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter o¢ in ink and submitted in triplicate 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 af buildings on premises, relationship ta adjoining premises or public streets ar areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is par~ of this application. 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 issue 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 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 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 buildings for necessary inspections. ' ....................... ...... iS'i~n'~¥~'r~'~"~'l~'l~licant, ~r name, if a corporation) ' ................................ .............................. " Name of owner or premises ..... ;;~;~ ...................................... .~. ................................................................................................ if applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. Plumber's License No ................................................. Eleetncmds License Na ............................................. Other Trode's License No ............................................... 1. Location of land on which proposed ~qrk will be done. Map No.: .............. Street and Number ..... /..,L,/....,'....Y.-.~/...../..L../."...Z(..Z ...... /.:.-4.). ......... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of'proposed construction: a. Exisiting use and occupancy ................................................................................................................................ b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building'. ...... : .......... Addition ......., ........... Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................ . .... (Description) 4. Estimated Cost ........ i ........... ; ...... L ................................ 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 and extent of each type 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. Dimension,s of entire new construction: Front ........ ~...4 ...... , ................ Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ..............: ......................................... Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. 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 . ........................... Will excess fill be removed from premises: ( ) Yes ( ) No Name of Architect .............................................................. Address ................................ Phons N~. Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate dearly 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 ir~dicate whether interior or corner Iol .... STATE OF NEW YC('F~[~,, ///. d.~/I c S ...... , - .'F.x.;./~..'..4:¢..~..~....../...L.~U..~..'../.../L.'~:'.~.~;.~_~..~.~r..~../. ................ being duly sworn, deposes and says that he is the applicon, (Name of individual signing cbr)tracf) above named. He is the .................. L~...'~..~-......'~..~ ............................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; thai' ali statements contained in this application ,~re true to the best of his knowledge and belief; and thor the work will be perform¢8~in the manner set forth in the apB44cation filed therewith. Sworn to b,e~/o~e/j~e/~/, this ............... · ~'r.,,.. ~,"-~d Y "1' NatoW ¢'ubli¢:,~. ....... ~;-:..2..¢.~}~....~ .......... x' County ";'"'"~"?" ............ ;~k' .......... ?;;"';;'~"'"";'"'"/'; .............................