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HomeMy WebLinkAbout11619-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ..... Z 1 .4.4.3.3 ...... Date ....... H~¥..2~7. ................... 193.6.. THIS CERTIFIES that the building ....... a~t.4 J. t; ;[~x~ ............................... Location of Property .... 3:1.(1 ........... C~ta ~.e.n. ~ on.ct. L ar~e. ............. 9 ~.i.e.~ ~ ..... House lye. Street Hamlet County Tax Map No. 1000 Section ...2 4 ....... Block ........ 1 ....... Lot .... 1 ............ Subdivision ............ × .................. Filed Map No...× ..... Lot No .... ,~ ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ·.. H~nch. 2.3 ........ ,19 &Z pursuant to which Building Permit No ..... .1.1.6 ] 9.Z .......... dated ..... A.p~. ±1..1.6 ............. 19 82., 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 ......... .A~dd.~ion..to. e~is ~£~g. d~.e. 1 lin~ ............................................ The certificate is issued to ............. ~ A ~/(..&. T H 024 A S, K,A ~//~ g A,~ J $/i N. ............... (owner, t~e~rx~/~j~~ of the aforesaid building. Suffolk County Department of Health Approval ............... i~/~ ......................... UNDERWRITERS CERTIFICATE NO ................... ~ 6 5.8.5.~ 5 ....................... Rev. 1/81 Building Inspector ,TOWN OF $OUTHOk~ i::. BUILDING DEpART~E ~T TOWN HALL SOUTHOLD, N,. ¥~ No. ~6~9 Z Perr6ission is hereby granted to: ........ ~.~.~.~. .... BUILDING PERMIT -(THIS PERMIT MUST BE KEPT ON THE'PREMISES uNTIL FULL COMPL~'rlON OF THE WORK AUTHORIZED) Date ....... at p~emiseS located O, ....~':.,.:...= ......... ..'.'.'.'.'.'.'.'.~.....~'..'.~./.~.e~., '~'".:~".~.-~'~:~;'''', ..................... CO~4W To~ Map No. 1000 Section ...~..,..~ 81~k .}~..~E..,..~~ No. ~.~ ......... pursaant ~ ~ppllc~Hon d~tod ...~~....~.~..~...~;-..., 19~,~ ond ~pprovod by tho Building Ifispector. , : ~ F~e ~.....~ ............... Re*. 6/30/~80 nSPecto~ FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in Wpewriter OR ink, and submitted m~,,,,-=~m 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. Finat 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 sEnilar 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. 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. 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 5. Updated C.O. $15.00 $15.00 .... ....... New Building Old or Pre-existing Building Vacant Land 310 Oyste~ Po~d Lane Orient Location of Property ................................. ~ ............................... House No, Street Hamer Owner or Owners of Prope~y ...... ~ 9n~ ~homas ~~9~ County Tax Map No 1000Section .,. ~.~ , Block i Lot.. ~ Subdivision ................................. Filed Map No ........... Lot No .............. \\ ~ l~ '-~ Date Applicant Permit No ......... of Permit ............................................ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ..... .~ ................. Fee Submitted $..5,..0..0. ,v(. ,~..~...(~..~...C~. .......... Constr,uction pn,_above described building and permitJ:ne~M-~3~appl[c, ab_J~_cegles_and~la~ons. Rev. 10-10-78 FIELD IN~SPEC~ION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ODE FINAL ADDITIONAL COMMENTS: 8CC ? T Y OF OCCiJ? N,CY PE~&~T INCLUDES APPROVAL TO REMOVE EXCESS F¢_L FROM ABOVE PREMISES BY REGRADtNG LOT, DRIVEWAY CONSTRUCTION CESSPOOL CONS'f RUCTION CELLAR CONSTRUCTION OTHER :3 ~ o oYs~'£R Po,~,D5 ) il APP~©V~D AS NOTF-~) DATE: B.P. ~ .... FEE: BY: NOTIFY BUILDING DEPARTM, Ff??A-~ 765-]802 9 AM TO 4 PM FOR TF!E FOLLOWING INSPECT!Ot','S: 1. FOUNDATION - TV/q REQUIRED FOR PO~ED CONCRETE 2. ROUGH - FRAMIN~: & PLUMDING 4. FINAL - ('~'J'::~',?L~'~qN MUST BE C':~m ~-"'F FOR 'C. O, .... ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N. Y, STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR D~IGN OR CONSTRUCTION ERRORS. D...T- LL;T,,I I ... · . ORrENT'- :'- .. ,~.--... _~' .:-] ; . : ,.-. .,t * . ~.... ,.. '" -' '-' ...?...,_ :. -: t.:.i.;; ? '- '*"-" '*" ' " "- ':..(.~,....: ..... ', ,:, .'- .- . ~ c~c¢ = = I- 0 ~.x~ Zo' t...E40 6q'~ P~TI~ Ii//-/~t FOI~M NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Permit No. //~'/~:::~ ~ Application No. /./~,~..~,, .................. Disapproved a/c ...................... J ...... :~..,~r~ ....................... /.. ................... ................................................. .................. : (Building Inspector) APPLICATION FI'~ BU~I~DL~J~ P~D-M~? )ate ................... , iNSTRUCTIONS a. This application must be completely filled in by typewriter o¢ in ink and submitted in tri~icate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. L~ ~o~(i ~L~ '~ ' , ,)' '- b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty 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 Occupan~:y 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 descr;bed. 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. {Signature of a'pp!~c ,~, o0~ame, i¥ ~ corporatioh~ o (AddKess of applicant) /, 7- ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..~.~...~......~..,...~./~..~(/~..~./:~.~ PERLMIT 'A'F P;'69XJ'-' ..... If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No..~:~....(~L.~ ......................... Plumber's License No ..... .~.......~.....~ ........ TO REMOVE EXCESS FILL . OM ^.oVE .REM,SES .* DRIVEWAY CONSTRUCTION ~ CESSPOOL CONSTRUCTION ./' CELLAR CONSTRUCTION '/_ ,- OTHER -- . -- Other Trade's License No ............................................... .... ~ubd 1¥.i81on _ Location of land on whict~ p~a~osed work will be done. Map No.: ........................................ Lot No ......................... Street and Number .,~/...0......4~..y,.~.~.~.....~..~).~..~...~......~.......~ ....... ~.~.~/.~4~....~...t.....~...~ .~j., ..................... ~ / Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ....... .~.~..(,~.4~.f...~.~.~...C...~...4/.~.......//~.../~...~... ................................... b. Intended use and occupancy Jr II if County Tax Map No. Dist. 1000 Section ~0 Biock~, ~OO Lot 00~,~00 Nature of work (check which applicable): New Building, Repair V~ Removal If dwelling, numbe~ of dweliing unit~ If garage, number of ~:ars .................. Addition / Alteration ...... Demoliti,or, ........ ~ ............ Other Work ............................................ ' ' ~' ~ (Description) ' (to be poid on filing this opplication) .......... ~..(:.~...N/..~.)..Number of dwelling units on each floor ......... 6. If business, commercial or~ mixedl(jccupancy' specifylnature/j, and extent of.c~,~each type of use ........ 7. Dimensions of existing structures, if ar~y: Front ......... .~./..~:... ........ Rear ........... ~..~. .............. Depth ...~....~. .......... Height~!.~.~?.....~.q.~..'? Number of 'aries ....... J...~..~J~']~.)-' .....................................................................................//, ~,~ i ' "Dimensions of same structur~ with erations or additions: Front .......... ~.../. .................... Rear ......~..~.. ................ 8. Dimensions of entire oew const~ucti : Front ....... ,~.~.. ....................... Rear .., ....... /.~.. ............ Depth ...~ ............ 0 of ............ ......................... of Does proposed construct on v~olate/an~ zoning law, ordinance or regulation: ...... ~.~.~ ...................... ~ I ..... Will lot be regradedF.~,.~X~ Will excess fill be remoyed from N me of Name of ~..~.,..~ ~.~.~/~Address ....~ ........ No ~e of Contractor ............¢ ............. ~ ................................ Address ................................ Phone No ....................... 10. ll. 12. 131 14. Locat~ clearly and distinctly ail buildir property lines. Give street and blsck nun' whether interior or corner lot. STATE OF NEW YORK, ~ ~ ~ above named. He is the .......................................... ' ............. PLOT DIAGRAM whether existing or proposed, and indicate all set-back dimensions from or description according to deed, and show street names and indicate ~ ......... being duly sworn, deposes and says that he is the applicom ~cf) T'i '/' ,!' - :! (~ ~eee, agent, ~.) of said owner or owners, and is duly author .,ed to perform '@r 'hov~ performed the said wo~k 'and to make and file this application; that all statementsl contain d in this appH~atio, q:~gre true to the best of his knowledge and belief; and thor the work will be per~ in th;e monna set fo~h in the 6ppl~cotjon filed therewith.~ ~ ' Sworn to before me th~ // [ '~ '* - , r r" ................. , .......... ........ .............. ~ Camm ~s on expires Mar, 30, 19~ J , . ", . {{.x I~To /Ibl~lL-l*-~l'' ~.-.~',~'~ F"IN.~ TO ~ 4~-m't) /~l &'.~.lt- l"~'t.."f' c.. .J . / ~ ~', . "'""-'"'~ .":: :':~L':' / _~ -~:-:-:' k .. ,,,,.,..,.,, ,=,----- ~.,,,, ,.,.,,.,.-,-., ,.,. ~.._ .'~.~ 54655 Main Road, Box 1412 $outhold, New York 11971 I'~, · 516.765.5455