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HomeMy WebLinkAbout11673-zr. ORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Trim H~a Sou~oid, N.Y. THIS CERTIFIES that the building ................................................ Location of Propmy ...5.~5 .............. .l~qO ~,..CiCq~9~ .,~V#Rqq ........... CuJ;~.ql~,_~. Hous~ No. Street County T~x M~p No. 1000 Section ...1.G3 ...... Block .. ~3 ........... Lot ... ,0.15 .......... Subdivision... ~. .......................... Filed M~p No... ~. .... Lot No. X. ............ conforms substantiSily to the Application for Buildi~ Pemit Im~tofom flkd in ibis offb d~ted ...l~gy. J.Q ........... ,19~. purmant to which Building Permit No ~.1.67~. ;~ ........... dated ..... ~Y..~l ................ 196~., vms iMued, mi confoems to d ofths r~iuieemmts of the applicable provisions of tho law. The occupancy for which ~ ~ is Mlmld is ......... lhe oeniti~e is iuu~d to .... AUgp~.t,l~..4,. 0X:],I~P. A. ~LLq ,. 0.e. qe ~;L)~q. ~;, ........ of th~ stormdd buiidins. Suffolk CounW DepLqmmt of Itfllth APlXO~! .... ~/.~ .................................. UNDERWRITERS CERTIFICATE NO ............ ~/.~ .................................. IM~. 1ill FOR.~ ~TO,. BUILDING DEPARTMEN~ TOWN HAL~ SOUTH'OLD, BUILDING PERJ~IT: : (THIS PEP, MIT MUST BE KEPT ON THE COMPLETION OF THE WORK AUTHOR ZED) 11673 Z UNT L FULL Building Ir~Spector. Fee $ ........ ~ ............... Permission is hereby granted to.~ / ...... ,,~,>7"""~'~ .......... ~;~"~ ....... "'";: ............... .................... at promiso* Iocatea at ...................................... ,..~..; ....... v'":;'"(": .............. 5""~ ...... ~ ......................... C0u~ ToX ~p ~o. 1000 Soction ................... ..... B!~k .~.... ............ ;..~ .or ~o. ~ ....................... 0ursOant fo appllcafion dated .......................................... t..~,..,~...., 1 ., and 9pproved by the Re~. ,6/30~80 InSpecto~ FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southoid, 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 features. 2. Final approval of Health Dept. of water supply and sewerage dlsposal--(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 dr 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 peoperty showing ail 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. 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 Date ....... New Building ............. Old or Pre-existing Building(X) . _. ,_~.. _ .~/Vacant Land - Location of Property .... . ~,...~. ................................ ..... /'~/"~ST~ C~'~-'~ ~[...~'~;. .................. House No. Street Ham/er Owner or Owners of P roperW /.-.-..,- ~7'/A/'.~ ............... County Tax Map No. 1000 Section ..../~,?'~ ...... Block .... Z. ~ ....... Lot..~../.~,,"~. ......... Subdivision '---- ~ ................................. Filed Map No ........... Lot No .............. Date of Per. it ^p llca.t ,"2,. ' ........... ~..~ ~..~'/.~ ...... ~ ................ Health Dept Approval ~ Labor Dept Approval Underwriters Approval ........ ."~..' .. . .Planning Board Approval ..... Request for Temporary Certificate ...... "- at~ ~"'--- ............... Final Certific .............. Construction on above described building and perm~t'meets ail app~cable_.codes and regulations. Rev. 10-10-78 APP.,ROVED AS NOTED ~. FEE: / .~ BY: ,. NOTIFY BUILDING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: ]. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING :3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C. O. ALL CONSTRUCTION SHALL MEET 'I~HE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FO~ DESIGN OR CONSTRUCTION ERROP~ L FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL PLEASE TAKE NOTICE th our application dated ...... .~.S. ............ 19 .~..~.. Location of Propert~., ..................... .,~,. ~.-,- . . ._. x . V ~ : . . / ....... .k., .6.;... q.~--~. . t:~ ~ r~ouse No. Street / ,~Hamlet County Tax Map No. I000 Section .../~..~.. .... Block ... Z ?. ....... Lot . .~. · .t'.~-~. ....... Subdivision ....... T ......... Filed Map No...'7. ...... ~:. ...... Lot No ............... is returned herewith and disapproved on the following grounds..~..0.(_/~ ~.~.(..'.~. ~..' .~../~.. . . .zz ~, .... ~.. 7;.. ~.~._.,.,, ..... ,,..~.../..~.~.. ~,,..~, ........... RV 1/80 INSPECTION FOUNDATION (1st) FOUNDATION (2nd) 2. COMMENTS ROUGH FRAME & PLUMBING INSULATION PER N. Y. STRTE ENERGY CeDE FINAL ADDITIONAL COMMENTS: FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1802 Disapproved a/c ....... t ............................ '. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled ff~ by typewriter or in ink and submitted in triplicate to the Build 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 strc or areas, and giving a detailed description of layout of property must be drawn on the dia~am which is part o~'this ap cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon apprc.'al of this application, the Bnilding Inspector will issue a Building Permit to the applicant. Such per. 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 Occupar shall bare been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Boitding Department for th~ issuance of a Building Permit pursuant ~o Building Zone Ordinance of the Town 'of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction o[' buildings, additions or alterations, or for removal or demolition, as herein descHb Thc applicant agrees to comply with afl applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in 'buildings for necessa, i~.~~~~n.e.,' spections. ~'it[~ 'c~}t~a'ti~)' ' ...... : ..... , ....... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build Naneofownerofprcmiscs .. .~ .... ,. :..;,. .... . ................... . [as on ine tax reit or latest deco) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ...... ~Y~ ........... Plumber's License Ns Elactricia a s License No.' ...................... ' Other, Trade's Lic~n}~:' · No.' . .'V .................. 1, Location of land on xvhich proposed work will be done ................................................ House Number Street l~l~mlet '~f County Tax Map No. 1000 Section ....... .~..O..~. ..... Block .... ~..~. ......... Lot..~./..,5~. ......... Subdivision .... Filed Map No -"-~ Lot (Name) 2. State existiqg use and occupancy of premises and intended usq, and occupancy of proposed construction: a. Existing use and occupancy . Al,,'" '~' ' '~' t .................................... ' .-.'.,b_. Intended use and occupanc¥..,..,.......~.~-..0.( ¢..?~../~g~(l.; 3. Nature of work (check whicl applicable): New Building .~.. Addition .......... Alteration ........ Repair .............. R, moral . i ............ Dsmolitlon .............. Other Work.. i .......... ~ ~ r ~'- (Description) 4 Estimated Cost ................. ~ ................. Fee ......... ., ....... { / (to ge paid on filing this application) $. If dwellLqg, number of dwellii~ units i .............. Number of dwelling units on each Floor .............. If gnrage, number of cars ........ 5 ............................................. ~- .............. 6. If business, commercial or mixed occtinanev snecffv '~,ture and exten o ac t · . -. ~ .... · ~ ..... ~ t re i~ry~eofuse ................. 7. Du!lensmns of existing structures, ~f ajly: Front..,t/~..~ .~. ..... Rear .. 3..~."¢Z¢¢..... Depth ._~.~, /. ¢'.---.'A'.. Hmght . Nt nberofStories. ....../. .................. : .................. :.... Dimensions'of same~stmcture xwth air,tenons or additions: Front . .t./~.ff.. ......... Rear ._g~./X%.. .... Depth ...... .3.(~/.J~. ......... Hdight ...... : ............. ~. Number of Stories ..... / ........ a. Dimensions of entire new constrt ctio~: Front ..... ~ ........ Rear .... g ......... Depth ............ Heigh t ............... Nam bet o ~' Stories ................ 9 Size of lot: Front ' ' Rear Depth 10. Date 6fPurchase ......... , ...... i ............. Name of Former Owner ..................... ti di hi 1 !~ i i it ' · Zone or use strict in W ¢ t r~ n scs.are s uated ......................... ":. ,2o Does proposed construct,on v, miate an~ ~o.n.i:,~.l~,..v: ~3. }¥iII lot be regrad~d ...... ' I ......................... ........ ,. o~ from premises: ,. Yes (4. Name of Owner of premises ' · ...... ~ . ·: ........ Addr,~ss ................... Phone No~)~'.-5'¢. ?:t~.-.£p.6"..~... Nam'e of Architect ' ' · Address Phone No Nan e of Contractor i i ' Address Phon~ No PLOT DIAGRAM ' Locate clearly ~d distinctly all et 'kltngs, whether existing or proposed, and, indicate ail s~t-back dimensions fro: property lines. Give street and blo~k nuv. Njr or descnpt'on according to deed, and show street names and indicate whetN 'interior or corner lot. /o£." ! ~'TATE OF NEW (F'~ RK,,, ,~.d S S ~-ar~oT~"~c~u~s g c.~--~. -~.-.,'"'"'"'"'"~ being duly s,vorn, ae2os~s aha says that h~ is tim applican above named, q ~ . i '(Contractor, agent, corporat~ officer, etc.) of said 3wrier or owne=, and is dt~dy at tho~zed to perform or have performed thc said work and to m~e and file fl~i a[~plication; flint all statements conitaiaed i~ this application are true to tho best of his knowledge and belief; and that th Work will be performed in the mann,'er set fo?th fl~ the application filed therewith. ~'worn to before me tliis ....... ..... i · .... , ............