HomeMy WebLinkAbout9692-zFORM NO, 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. Z13780
Date August 16 1 5.
TH IS CERTIFIES that the building .... a d d~k5;i om ....................................
Location of Property ~1 550 Bailie Beach Rd. Flattituck
House No. Street Hamlet
County Tax Map No. 1000 Section 99 .Block 3 ..... Lot 'q q ' 9
X X
Subdivision X .Filed Map No ........ Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
...A~.r. $.1..2.&. .......... 197.8.. pursuant to which Building Permit No. 9692Z
dated ...................April 2~ .... .....19.7.8.,wasissued, and conforms to all ofthe requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is .........
ADDITIO~ onto a one-family dwelling.
VITO & CAROL MAGGIO
The certificate is issued to ..................... [o~,'e;~ .....................
of the aforesaid building.
Suffolk County Department of Health Approval ..........................................
UNDERWRITERS CERTIFICATE NO .....
Building Inspector
Rev. 1/81
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, Iq.. Y.
BUILDING i>ERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 9692 Z
Permission is hereby granted to:
et premises located at / '~ '~ 0 ~ / L / Z~~ ~ £~/q(/-/ ?~0~ J.~
pursuant to application dated ........................................................ , 1 ........ , and appraved by the
Building Inspector.
Fee ......
Building Inspector
FORM NO, 6
TOWN OF SOUTHOLD
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 is ~ to the Building Inspec-
tor with the following; for new buildings or new use:
1. Fina~ survey of property with accurate location of all buildings, property ~ines, 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:
1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or
topographic featu res.
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 $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
New I~uilding . J; .......... Old or Pre-existing Building ............ Vacant Land .............
Locat,on of Property 1 i~.~.. · .~.,~ .... ~.~, .[, .L,I.C
House No. Street Ham/et
OwnerorOwnersofPropertyV. : . +. .... ........................
County Tax Map No. 1000 Section .... ~.~. ....... Block ...~. .......... Lot...././: ..~ ........
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No.~.~.~-.,... Date of Permit ~.).~.~ .~. ~.Applicant...~,! .~..'~-0 .... ~.~[~ .~ i.~-,~ .....
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approvat ......................
Request for Temporary Certificate ..................... Final Certificate
Fee Submitted $ ....
Construction on above described building and permit,q~,ef~ts all applicable codes and regulations.
~-~,~,:~31'~)~)~ .Applicant ,~...~ .~. d ~'~ ' · ·
................. (j(j ....................
Memorandmn from o..
BUILDING INSPECTORS OFFICE
TOWN OF SOUTHOLD
TOWN HALL, BOX 728, SOUTHOLD, N.Y. 11971
765-1802
July 10, 1985
Dear Mr. Maggie:
! am writing to you regarding your application
l'or a Certificate of Occupancy.
You filed for two C.O.'s
B.P.9692 4/24/78 this one does not need
an Underwriter Certificate because no ad-
ditional electric work was done.
B.P. #8900 10/6/76 need~an Underwriters
certificate as electric work was done.
The electricians name was Frank Mince.
Please send us this so we can issue ybur
C.O.'s.
Thank you.
IrO~M NO. 1
TOWN OF ~OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Exam,ned .........
....................... ........... ........................................... c
.......................................................................
................. ...................
{Suildino In~ctor)
APPLICATION FOR BUILDING PERMIT
Date ............. 9 · ,,
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink end 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 Iocotior~ of lot and of buildings on premises, relationship to adjoining premises or public streets or
areas, and giving o 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 o Building Permit to the applicant. Such permit
shall be kept on the premises available for inspection throughout the work.
e. No building shell be occupied or used in whole or in port for any purpose whatever until o Certificate of Occupancy
shol~ hove been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of o Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for removal or demoJition, os herein described.
The applicant agrees to comply with oil applicable lows, ordinances, building code, housing code, end regulations, end to
admit authorized inspectors on premises end ir~ buildings for necessary inspections.
................ ............ ,. ........
...... (Signature of applicoat, or n~me,~4f.~ l ~p corporation)
DATE:
State whether opplicont is owner, lessee, agent, architect, engineer, general controc-~gG, electricii~9, plurjnti~/~or~uilder.
If applicant is a co~orate, signature of duly authorize T95H C!l IT.' RT ~,'.'~::~
(Name and title of co~orate officer) 3. 5~FOP-5
Plumber's License No ............. 5. ALL COtY~
............................................ AN ;~ ....
Other Trade's License No ...............................................
]. Locot on of end on wh ch proposed work w I~.be dgne. Map No.: ~ ............................. ..~ ...... Lot No .........................
Street and Number ................................... .~.,.~_..7~....L;...L...~.-. ...... .,~...L.~....~. ~.~.~...[(~J......!'.~,...~..~6.,~,~ .............................
Municipality
2. State existing use and occupancy of premises o~l intended use an._dj,~ccupancy of proposed construction:
a. Exls~tmg use and occupancy ..................... ~k .~'~L .... ..~ .......................................................
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 ............. ~,..~'~.O.(~ .............................. Fee ......... /..~. ...........................................................................
'~ (to be paid on filing this application)
5. If dwelling, number of dwelling units ........... J ................ 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 ............................... ~.NI.I~. .......................................................................
Dimensions of same structure with alterations or additions: Front .......... ?.Cq:.~,~:.¢= ....... Rear .....
Depth ................................ Height ............................ Number of Stories ................................
8. Dimensions of entire new construction: Front ................... , ................ Rear ............................ Depth ........................
Height -r .................. Number of Stories ..............:~..a...,,.T.~ ....................................................................................
--,)V/VII- ,- II r'~ :, ~_ ~ /
9. S,ze of lot: rFron{ ................ (~,.~.~ ~, ................................ Rear ............. ~IZ) ......................//-- _ __ . ,,Depth ......... J.~...J .............
10. Date of Purchase ................. 'J"(J"7'"~'" ...................... Name of Former Owner ......... ..-/&./../~.~,¢~.~/_..~..~..:~./~. ............
11. Zone or use district in which premises are situated ..... (jx..~T¢~..~ ................................................................................
12. Does proposed construction violate any zo. ning law, ordinance or regulation: .................. ~!.Z_~ .............................
13. Will lot be regroded . ........ /~.).~..~ ....... .~. Will excess fill be removed from premises: ( ~)---Yes ( ) No
14. Name of Owner of prem ses ,... _ .~..,_~J.2..,i.~ ~/.\ ;.~-~.'...4..~ . Address ~,b r. ~,.,, J.. t~.; ~., .~u~.lPhone N~ .~,.~.~F,..,¢...'~
Name of Architect .............:~.:l/.,!~:,'....:~'t/~'.fm>.i,~,,],(".: ..... Address ...:!..u..'.~!:'~l.?...!:~:;:~oTPhon, No ......
Name of Contractor 4: ........ l'~.-'~"/~'l~)'"k"[~"'"tl~J.~ ........ Address Y~:~'.,-,t ............. '.;..,.. I~hone No.
PLOT DIAGRAM II 9 o I
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-I~ck dimensions from
property lines. Give street and block number or description according to deed, and show street names and in~Jicote
whether interior or corner lot. I ~'rf/i/~-*'~Z~
I
STATE OF NEW YORKI ~¢ ¢(
COUNTY OF ................................ f~'~
.......................... .~..I....W...(. ............ j~.l..~.(¢.~,.....O...:; .................. being duly sworn, deposes and says that he is the applicam
(Name of individual signing contracw
above named.
He is the .............. ~.1~/~[.~ ...............................................................................................................................................
~ (Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke 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 performed in the manner set fo~h in the application filed therewith.
Sworn to before me this
.............. ............. : .......... .......................-_. .......................