HomeMy WebLinkAbout11900-zFORM NO, 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of t_he Building Inspector
Town Hall
Southold, N.Y.
Certificate Of 'Occupancy
NO. Z. J .17.2.5. .......... Date .......... ~ta:r..eh..~ ............... 19 8.3
THIS CERTIFIES that the building .... .~?.e.e..~ .~.a.~..~. ..................................
'1'180 Pine Neck Road Southold
Location of Property ...............................................................
House No. Street Ham/et
County Tax Map No. 1000 Section ... Q~.0 ..... Block ..... 08 ........ Lot ..... 02q ', .......
Subdivision ............................... Fi]ed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
..... .B.e?.~.? .m.b?.~.. '1..~.., 19~..2. pursuant to which Building Permit No ...... '1..q?.0.0..g .........
dated .~.e?.~.? .m.~?.~.. ~.z[ .............. 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 .........
~or a storage shed
The certificate isissued to Richard M. Sherman
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval . .~.../.A. ....................................
UNDERWRITERS CERTIFICATE NO ..................................................
Building Inspector
Rev. 1/81
7
:TOWN
BUILDING DEFARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON TH,E'PREM.:'ISES UNTIL F'!JLL
COMPLEI'ION OF THE WORK AUTHORIZED) ,
N? 119 0 0 Z Oate ...:..:
Perrhissiod is hereby granted to:
..... .~.;.~~..~...~~....
..~..,..:..~,.,.~...~,.,.....L...,
....
,o ........ ~~..~.. ....~ ...~d ...........
..... ; ~:
Rev. 6/30/80
FORM NO. 6
TOWN OF SOUTHOLD
13ui~ding Oeparzmen~
Town Hail
Southoid, N,Y, 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
This application must be filled in typewriter OR ink, and ~ubr~itted in duplicate to the Building Inspec-
tOt wir. h the following; for new buildings or new use:
1. Fine! survey of property with accurate location of ali buildings, property lines, streets, and unusual
natural or tooograohic features.
2. Finer approval of Health Dept. oCwater supply and sewerage disposal--(S-9 form or equal).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buiidings, 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 Beard approval of completed site plan requirements where applicable.
For existing buildings (prior to April 1957), Non-conforming uses, or buildlnes a~d "pre-existing"
land uses: w
1. Accurate sur/ey of peoperty 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. 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
Date .....
New Building . . ~,~ ......... Old or Pre-existing Building(Z) ........ =/Vacant Land -~ ............
Location of Property . ,t .~(~ ................... ~t.~,. ~(..~, ,~,.O,l:~::) ...........
Owner or Owners of Property - .
County Tax MaD No.,1000 Secti~n".~Rl~ ...... Bock . .~.. · '. · Lot
s,~,~o~ ................................. ~i,~ ~-~o...: ....... ~o, ~o..~2~'.
Health Dept. Approval ........................ Labor Dept. Approval ......................
Underwriters Approval .... ~ ............ Planning Board Approval
Request for Temporary Ce(tificate ..................... Final Certificat~ ........ - .........
Fee Submitted S...~,~./. ~.~ ...........
Construction on above described, building a~ pexmqt'~eets~l~p¢~cabl~o~es and regulations.
-'" ,-~*,, .... ,-- ..... .:~,,,. ., ....t~ ¢ ~- ~ -, .': .. . .
· -' .~- ", .. .... *"- ' .... "- .... .~ .-:'..../~,%5. '..." ~ .'-... .: . .,."
FIELD I~SPECTION
FOUNDATION (1st)
FOUNDATION
2.
ROUGH FRAME &
PLUMBING
(2nd)
INSULATION PER N,.
STATE ENERGY
qODE
FINAL
COMMENTS
ADDITIONAL COMMENTS:
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
Approved . ..~-.~.~..../. ~..., 1 .~.~. Permit No.../.4.~.~.~..~
D~sapproved a/c ....................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
Application No..././. ~. ~..~. ......
Date.
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 issued 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, housir I code, and regulations, and to
admit authorized inspectors on premises and in buildingfor necessary....i~n~ec~°ns .~.~.i.~n'~' '~' 'ec 'OhS.n-l(~x.
( 'g ture of applica
(Mailing ad{
1 or name, if a corporation)
~ess of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises ..... L~ ~
/ (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... ~77.. Y ..............
Plumber's LicenseNo .........................
Electrician's License No .......................
Other Trade's License No ......................
1. Location of land on which proposed work will be done ..................................................
...... .........................................................
House Number Street Hamlet
County Tax Map No. 1000 Section ....6~. 7..~? ......... Block .... ~ .~. .......... Lot..c?.~../ .............
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 ......
b. Intended use and occupancy ....... ~.. ~ .......... .. }~:..: ~ ii.. ,... '. ................
3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ..........
Repair .............. Removal .............. Demolition .............. Other Work ...............
~ i ~ (Description)
4. Estimated Cost ..... .~...?~P...~.?.~: ....... F
(to be paid on filing this application)
5. 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 type of use .....................
7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ...............
Height ............... Number of Stories ........................................................
Dimensions of same structure with alterations or additions: Front ................. Rear ..................
Depth ...................... Height ...................... Number of Stories ......................
8. Dimensions of entire new construction: Front ............... Rear ............... Depth ...............
Height ............... Number of Stories ........................................................
9. Size of lot: Front .......... : ........... Rear ...................... Depth ......................
10. Date of Purchase .......... : .................. Name of Former Owner .............................
1 1. Zone or use district in which premises are situated .....................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: ................................
13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No
14. Name of Owner of premises .................... 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 number or description according to deed, and show street names and indicate whether
interior or corner lot.
STATE OF I511~ YORK t
C..O.U. ..Nvr~~~...~S.~~~ being duly sworn, deposes and says that he is the applicant
above named.
He is the ...................... ...................................................................
(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
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 forth in the application filed therewith.
Sw°rn t° bef°re me thi~.~ ~
........... /.~...L: .'. .... day of ~
~ P~ublic, . ...... ~ .... ~ ~
NO. 52.8125850, S~fol~ ~
Term E,xpftt~ M~tch 30~ ~
County tx ,~ c~
' \ ~ (Signature of applicant)