Loading...
HomeMy WebLinkAbout11857-zFORM NO. 4 TOWN OF 5OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ..... g. 1. 4..4.2.0. ...... Date May 20 1 ~.6.. THIS CERTIFIES that the building d e c k a d d i t i on Location of Property 245 Grigonis Path Southold House No. Street fi~/niei County Tax Map No. 1000 Section ...6.3. ....... Block ....... .7 .......Lot 13 Subdivision Hep vest Homes .Filed Map No. .5.3.3..7..Lot No.. 15 conforms substantially to the Application for Building Permit heretofore filed in this office dated ....A .ug.u.s..[..1.2. ....... ,19 .8.2. pursuant to which Building Permit No .... ! .~ ~.5. 7. .Z ........... dated ..... .A.u.g u..s .~. fi. 2. ............ 19.~.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 ......... Deck addition to existing one-family dwelling. The certificate is issued to . ANTONE & ELEANOR SKWARA .................... ...................... of the aforesaid building. Suffolk County Department of Health Approval N/A UNDERWRITERS CERTIFICATE NO ........ N/.A ................. Rev. 1/81 Building Inspector TOWN OF SDUTHOI,~D BUILDING DEPARTMEN'I TOWN HALL SOUTHOLD, N~ ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON, THE. PI~E~IS~S UNTIL ~ULL COMPLETION OF THE WORK AUTHORIZED) ' ~ N°. 11857Z Dot~ ...;., Permission is hereby granted to: ......... ~..~..<~ ..... .~....~...z~...~:.~.~......~__....i ......~..~~.~ ~ ~'~i: . ......... at premises· ocoted at .~.~.....~..~,~.~... .... ~-~..:.~;) .J~"'~"' .................... COUnW T~x Map No. 1000 Section ..... ~........ Blink L..Z.~.....[]Lot No, .~l~:. ....... pursuant Buildln~ / Fee ;$.: ............. .".... Rev. 6130/80 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 typewriter OR ink, and submitted i ~ 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 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. 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 $5.00 2. Certificate of occupancy on pre-existing dwelling $15.0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 x5/ .~/~ ~ 5.Updated C.O. $15.00 Date ---./, New Building ..... V~.. ..... Old or Pre-existing Building ............ Vacant Land . Location of Property .... L/~.. EI, .¢,./. 0 .q .'-5'. ............... ~. ...... House No. U Street Ham/et Owner or Owners of Property ......................................................... County Tax Map No. 1000 Section .... (~.~ ....... Block ...... '~..I ...... Lot ..... 1.~.~ ....... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... / Request for Temporary Certificate ..................... Final Certificate .... .~. ................ Fee Submitted $ ........................... Construction on above described building/~t meT~all applicable codes and regulations. ~'O':~JF ~:::1Lr]/~c~(O Applicant ~/----~'~~' '~c,: ........................ FIELD fNSP~CTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER ~. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS: ]'65-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING REMARKS:~ ~']~ FINAL / Antone Skwara 245 Grigonis Path Southold, N.Y. 11971 TOWN O~ S©UTH©LD BUILDING DE?ARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-180;3 Examined~7 ~..(-~.~'' i'"~'~'., 19Z.~. Permit No. Approved ................... Disapproved a/c ........ (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No.. ~'(' '~ '~'! ...... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted ~ 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 or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. 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 necessap~inspections. ,~ ~ (Signature of applicant, or name, ft' a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ ~. d~ .~..~. ..~Z. ............................................................................. Nmne of owner of premises ./7...L?.?.'7 .~...~2./.~..~.~,q..~..,~.. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .... ~.,e../,/.. .............. Plumber's License No? ........................ Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done...~...~.~.~ ...... .~ ..................... Iiouse Number Street Hamlet County Tak Map No. 1000 Section ~9 6"~* Block . .~?~. ......... Lot ~)Z/'~ Subdivision .~..~.F..0 f~c.?-.. ~.....~?..: ........ Fited Map No.' . ~-'-~.~.. '7 ..... Lot.../. ~ ........ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . ~.~.~..~.....~'-...'f~....' ................................... b. Intended use and occupancy .. ;,Z,(.C.~. Fd .,2/.~'. ~ .... :.~ ....:..' .............................. 10. 11. 12~ 13. 14. Estimated Cost . /J t/~. Fee ................................. (to be paid on filing this application) If dwelling, number o f dwelling units ............... Number of dwelling units on each floor ................ If garage, hum bet of cars ..... ................................................................... If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure w!th alterations or additions: Front ................. Rear .................. Depth .................... :.. Height ...................... Number of Stories ...................... Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ Size of lot: Front ....................... Rear ...................... Depth ...................... [)ate of Purchase ........... ' ................ ,. Name of Former Owner ............................. Zone or use district in which premises are situated ..................................................... Does proposed construction violate any zoning law, ordinance or regulation: ............................... Will lot be regraded ......... : ................. Will excess fill be removed from premises: Yes No Name of Owner of premises ...i ............... Address ................... Phone No ................ Name of Architect ......................... Address ................... Phone No ................ Name of 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 inumber or description according to deed, and show street names and indicate whether interior or comer lot. ~F. l ~ O gl t~.y STATE OF NEW/~;bRK, ,/_ COUNT ? ,'./...,;x/.%. ZT. (.h ...... ~. '~~,~, ........ being duly sworn, deposes and says that he is the applicant (Name of individual si~ing cont~) above named. He is the ............. ~ ................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have perfomed the said work and to m~e and file this application; that all statements contained ~ this application are true to the best of bis knowledge and belief; and that the work will be perfomed in the manner set forth in the application filed therewith. Sworn to before me this : .......... 7 .... day of. Notary Public ........ ............... ~ ~~:r, ' ~ignaturo of applic~t) /