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HomeMy WebLinkAbout12056-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildin§ Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.Z.! 3.5.0.q .......... Date ..... .F.e.b.p..u.a?.y...2.5 ............... 19 .S.2. THIS CERTIFIES that the building .e.n..c.l.qs..u?.e ..................................... Lnc~tinnnfPrnn~rtv 2580 Deep Hole Drive Mattituck House No. Street Hamlet County Tax Map No. 1000 Section . . .1.2.3, ...... Block ...0) ........... Lot ....0.1. 1. .......... Subdivision....X ........................... Filed Map No...~ ...... Lot No..~. ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated .... D..e.c~,m. b..e ?..q ...... , 198..2. pursuant to which Building Permit No .... 1..2.0.5.6.. Z. .......... dated .... D. e..c:e...r~b, e. ?...4.. ........... 198.2.., 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 ......... .. aC..~q~.9.s, ure..qr...e.x.~:s..~.ip.g .pp?.qh. .... u.n..h.e.~.t.e..d.).. ......................... The certificate is issued to ........... d.g~l~S..I~, ~ .&..~ .U.Tkl.. F. ,..B./~ R. ~ ..................... (owner, of the aforesaid building. Suffolk County Department of Health Approval ... P./?. ................................... UNDERWRITERS CERTIFICATE NO ........... r~/.E ................................... Rev. 1/81 Building Inspector TOWN OF ~OU'rHO~D BUILDING D£P~RTMiN'r TOwN:HALt. $OUTHOLD,' N. Y. BUILDING pERMIT (THIS PERMIT MUST BE KEPT ON THE PRE/~IS~S UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? -1205§ Z Permission is hereby granted to: ro .................................................... ~F ....... ~ ................ i'"':7'"" ......... [ ........... 7 ...... ................................................................... = ......... :' '"'r'"~L'~"~""t:'""~ ......... ~"~ '"t ' "~'"'"~ .......... ............................................................................... ................................ ~ ...... 5~.... ~-~ ............... ............... ~ .................................................................... ;; .......... ~ ....................... / Coun~ ToX ~op ~o. 1000 S~ction ............... ¢ ........ 81~k ..;....~ ............... ~ ~o. ~ ....................... pumUant to app ication aat~ .................................................. ,...., .....~.., PP , Buildlng I~*pector. ........................ Building ~tor Rev. 16/30~80 ' '~ ~ ~ ~ ~ FORM NO. TOWN OF SOUTHOLD Building Depar~menz Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and subr~itted in duplicate to the Building Inspec- tor with the following; for new buildings or new use: 1. Final supzey of property with accurate location of all buildings, property lines, streets, and unusual natural or tooograohic features. 2, Final approval of Health Dept. of water suop v and sewerage disoosal--(S.9 form or equal). 3. Approval of electrical installation from Bo'ard of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar building~ 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 peoperty showing all prooerty lines, streets, buildings end unusual natural or topographic features. ' 2. Sworn statement of owner or previous owner as to use, occuoancy and condition of buildings. 3. Data 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 or land use $5.00 3. Copy of certificate of occupancy $1.00 New Building ............. Old or Pre-existing Buildin~(:~) , ~ ..... ZVacant Land" ?_ %,~o Location of Property .., ................. House No. Owner or Owners of Property Hamiet County Tax Map No..1000 Sect or~: ,\.~/.. "~ ~r ............ Bloe. ............... Lot ..... Subdivision .... ,,~ ............................ Filed Map'No, · ·: ....... Lot No, P,rm tN .OS ........... ............. Date of Permit '. ,Applicant ~s ~, Health Dept Approval ......................... Labor Dept. Approval ...................... ,.. Unde~vriters Approval ..... ~/~- ' . ........ Planning Board Approval .................. Request for Temporary Certificate ' . ~, · · · ·: ................ Final Certificate ........ - ......... Construction on above described building and ~er~i" ...... ' ..... ,.~.,o.,~.~~. ~ ~ ._. '~,(~.~ ..... ' ..... :. · Ji', .'7 · . . .- FIELD INSPECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING COMMENTS INSULATION PER N. Y. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 · ' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined. ~...-~--. q ...... , 19 Approved .ff..-~.~...~.... .... 19. ~,~--Permit No. Application No./<~Q~.'~. ~.?.~.... Disapproved a/c ..................................... (Building Inspector) ' : APPLICATION FOR BUILDING PERMIT Date ~e¢, t 19~Z' · 'iNsTRUCTIONs ' ' a. This apphcatlon must be completely filled in by ~!}~.~ the Building Inspector, with 3 sets of plans accurate plot plan to scale. Fee according t~li~,&~lji~' b. Plot plan showing location of lot and of building~pre,~ises,~re.l.a,¢~)nshim~9~cJjeining premises or public streets or areas, and giving a detailed description of layout of ~q~y I~t ~a~{vr~¢b~}t~l~e ~a~kram which is hart of this annli- cation. ~i~ c. The work covered by this apphcahon may not d. Upon approval of this application the Building Ifiq}~'~J1~ed ~ B;~i~/~ ~k~r~ih~:~ t~applicant Such permit shall be kept on the premises avadable for inspection throaahout~d~ e. No building shall be occupied or used in whole 8~]h p~[J~i~]~.~-~h~fever until a Certificate of Occupancy shall have been granted by the Budding Inspector. ~11 - APPLICATION IS HEREBY MADE to the Building Depm'tment 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 building fOrr0eCessary inspections. xab~ .~....~.... ~...~m....~...~4...: .~../..~.~ ....... u (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................................................... ~PVRO['Cl}' i~'$ NO?gl~ ............ Name of owner of premises ........................................ ~.:./~. P.. ~ ._[~9~.~ .~¢ ..~ ...... (as on the tax rfft[~~)ay: /,~ /// / ,, If applicant is a corporation, signature of duly authorized officer. NOTIFY BUILDING 765-1802 9 AM TO 4 PM FOR FOLLOWING INE?ECT[ONS: (Name and title of corporate officer) ,!. FOUNDATION _ TWO REC! I'V, ED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING Builder's License No.. ~ ................. 3. INSULAT!Or,.! Plumber's License No ......................... 4. FINAL r'"'"qTRUCTV~N M'JST BE CO~.~pI-"~- ~:9R C. O. Electrician's License No ....................... ALL CONe, T?, ,,~-i©N SHALl *"CT THE REOI I'~r~-~,~TS OF TH" ~' y. Other Trade's License No ...................... STATE CON?~-~, ~CTION & r. ~ CODES. N~- PcgPO/~"c'm" -~R 1. Location of land on which proposed work will be done.. DESIGN OR CO.N~.T.R.U. CTL,~.k,...q~ ...z..s. .0 ............ ............. f).! ?.... !! ?. House Number Street Hamlet County Tax Map No. lO00 Section . !.~.~. . ............ Block Sr Lot. [~ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy Ogle, J[ltv~x~:~. %OU.~e b. Intended use and occupancy ........................... k:~ ...................................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .................. Removal ....:. ...... Demolitinrl ...... Other Work ~.~.[.e~¢ 4. Estimated Cost "~ ti, , . . ........... ..................... Fee ../. ......................... (to be paid on filing this application) $. 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 tyl~e of use ............ 7.Dimensions of existing structures, if any: Front...~.0...t:.e.~.~... Rear . .~.q.. '~.~.~.~[... Depth. ~.. Height ............... Number of Stones ........................................................ Dimensions of same structure With alterations or additions: Frgnt . ~ 0...~.e..~-3t .......Rear .~.~..1:?.~.'{. ........ tqA~. sic entire ne n ruct o ......... ea ............ Height ............... Number of Stories ........ ~.: ............................. 9. Size~flot: Front (~.~..~C,~.~.~. ......... Rear. ~.l.0...~.~.~.+. ~.Depth M/....' $ [l;;",~-},.¥:t ..... 10. Date..ofPurchase ~.*$ }3.~.~?..$.~.~.~. .~fi..~.~, Name of Former' . ............................. 11 Zone or use district in wh. ich premises are situated 12'. '. Does proposed construction violate any zoning law, ordinanbe or regulation: .~1..o. ........................... 13. ~ila~l~Otofb;~ng;;doefdp ;~i~ = 14. r s'~.'~,'~'}*'&k'l:, Zi4{' ~moved from premises: Yes No Phone Name of Architect ........ ~.~ ........~:.. ~* . Address ~' '~ ~'. " Phone No. *' " Name of Contractor ...... " ... " ~' Add " *' . ,'.~...'.~ N ." ~'. .................. ross ............ Phone o .............. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions' from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. , STATE OF NEW Y~OR~,/, ,~ / : %S ..... ....... · ~" . (Name of individual sighing contract) above named. ..... being duly sworn, deposes and says that he is the applieant ..... : (Contractor, agent, corporate officer, etc.) ' "' ' of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this 1 ' app ication; that all statements con!ained in this application are true to the best of his knowledge and belief; and that the work will be perform'e~l in the manner set forth in the application filed therewith~ Sworn to before me this, ' ..................... day of ..... ~-~,¢-....-~ 19 Notary Public,~¢X. '.cgm.~.-~(.. .~ ./. ,~..~, .~f,,~ounty ,-, ,, ". , .. rotary ~'u~tio, s,~ato et ~w ¥o~k ' "' ' '" ~ ' '" '" '~"" ............ ; ........... ;" 'ti .......... ~ , , .... . { [ ($~gnature of apphcan_, '\