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HomeMy WebLinkAbout11908-z - ' FORM NO. 4 TOWN OF 5OUTHOLD BUILDING DEPARTMENT_ Office of _the Buildin§ Inspector- Town Hall $outhold, N.Y. Certi (icate O[ 'Occupancy THIS CERTIFIES'that the building .-... ~.qc..e.s.a.a.~ ..... ~ ........................ Location of Property 590 Ha3rara'bers Drive Cu-bcho~ue County Tax Map No. 1000 Section .... fl.O...¢ ..... Block ..... 0.~. ........ Lot ..... 0.3.2 ......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated September 9 1982 pursuant to which Building Permit No. flfl908Z dated . ............ 1~2.. ,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 ......... l~or a s~ora~e shed (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .~.,f,4. ..................................... UNDERWRITERS CERTIFICATE NO .......... ~.,f~, ..................................... Building Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 119~)8 Z Permission is hereby granted to: ,~ ...~ .Y./~.~...~;....~/~.,..~.. ....... ~~. ....... z~.....~.~. .............. _ · ..~ .~.~.~.~.~.7..../~...~ .% ...... ,o ............... ~~***~ ...~/~**~......~,~. ...................................................... .......................................................... .................. i ..................... at premises located at ..~..(~,,,..~.~d~..~.. ..... ~. ...................... ~ ................................. ...................................................................................................................... ~..~c~..~.....~z.Z/..¥ County Tax Map No. lO00 Section ...ff.~.....~... ....... Block .0....~.... ......... Lot No...~..~.d ........ pursuant to oppJicafion dated ..~.~..~.~/~'~'~'~'~'~'~'~~...-.~.......~ 19....~..e~.~ and approved by the Building Inspector, Fee $../~... ............. B ti ~n In ector Rev. 6/30/80 FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, 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 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 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. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topo§raphic 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, z Fees: 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 NewBu dng ~.~.. ~' Old or Pre ex stn Bu ' ........... - ' ',g ik~ing(~;) ........ ; --~ Vacant Land County Tax Map No, 1000Section"~: ~ ..... Block , Subdivision ................................ ,Flied Map No , ,Lot ~ Permit No..~4~.~ate of Permit. ~ ........................... Health Dept. Approval ....... .~/.~ .......... Labor Dept, Approval ...................... Unde~riters Approval ..... ~/[~ ............. Planning Board Approval .............. Request for Temporary Certificate ..................... Final Certificate ........ - ......... FORM NO. TOWN OF SOUTHOLD Building Depar~menz Town Hall Southold, APPLICATION FOR CERTIFICATE OF OCCUPANCY 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $%00 $5.00 New Building ..., .~. ....... OM or Pre-existing 8uJldin X) ........ =/Vacant Land .......... Hou~ No. ~(reer Ham/er Owner or Owners of Property County Tax Map No..1000 Section ./~ ,~ ..... Block ..... ~.~:~ . Lot .... ~.~.~. Subdivision ................ ~ ............ ,..FiLedMapNo...: ....... LotNo. ,.'.. ~pp ~ p~ He~h Dept. rov~ ..................... L~bor De . row~ ......................... Unden~d~ers ~pprov~ ...... ~ ............ P~nn~ng Board R I C [tiff ' equestfor emporary e cate ..................... FinaICerdficate A ¢ .... ...¢. ....... Rev. 10-10.78 Instructions This application must be filled in typewriter OR ink, and subn~itted in duplicate to the Building Inspec- tor with the following; for new buildings or new use: 1. Final sunJey of property with accurate location of all buildings, property Fines, streets, and unusual natural or tooograohic features. 2. Final approval of Heaith Dept. of water supply and sewerage disposa --(S-9 form or equal). 3. Approval of electrical installation from Board 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 buiIding. 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: 1o Accurate sups'ay 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. O. ate of any housing code or safety inspection of buildings or premises or other pertinentinforma- tion required to prepare a certificate. ' / · FIELD,~NS~,.EC~ION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & FLUMBING INSULATION PER N. STATE ENERGY qODE COMMENTS FINAL ADDITIONAL COMMENTS FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL,: 765-1803 ..... , (Building Inspector) ~PPklC~IIO~ FOB BHILDI~G Application No.(./~...~... ........ Date ............ ,19 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 issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throu~aout 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 her~in-~t~ibed. The applicant agrees to comply with all applicable laws, ordinances, bull~d~ing-qod~, housirlg, code, and r~lations, arid to admit authorized inspectors on premises and in building for necessary ~[n~p~cti~)n)~.,/~/ ~,~ . ~ -kx (Signature of apph'~ant, or name, if a corpo~tion) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. ....................................................... Name of owner of premises .......................................................................... (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 ........ .--?.~...~.. .......... Plumber's License No ......... .} ............. / Electrician's License No ..... ~ .............. / Other Trade's License No.. ;/Z. ............... Location of land on which proposed work will be done .................................................. .. ........... . ....... .:. x. . . ; . ,/._ House Number Street Hamlet County Tax Map No. 1000 Section ..... .~.O..~. ........ Block ....O..~.. ......... Lot ~'~'~ Subdivision ....... 2 ..... ~. ...................... Filed Map No. -"-'--' Lot ...... ~ (Name) State existing use and occupancy of pr~mises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... /...~. :.~.?./.~'..~..~... ~../:.~/..~';..~z(~.. ........................ b. Intended use and occupancy ...<~ .~.'.7~'.'.~t~,/-~. ~.... ~2~>.. ~..~-~ ............. 3. Nature of work (check which applicable): New Building ....... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... 4. Estimated Cost .......... '. · ~ ......................... Fee .................................. (to be paid on ~ing 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 ............... tteight ............... 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. I)ate of Purchase ............................. Name of Former Owner ............................. 1 1. Zone or use district in which premises are situated ..................................................... 12. I)oes 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 .. 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~number or description according to deed, and show st.~reet names and indicate whether interior or Corner lot. ,~/,~',,1/~,'~ ~, ~ STATE OF NEW~VO~,~, , ~ '- ~ country 11.% .... .../-~C~." C.. ~'.. ~ ~ ~ { ~ ............. being duly (Name of individual signing contract) above named. sworn, deposes and says that he is tl~ pplicant 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. Sworn to before me this ...... 7 ................ day of...~~: ....... , 19~..)-''~ Notary Public, ~..~ .r'"~~. ~t--~-~~ ~~--~ NOTARY PIJSLIg, Sta e of Ne~v Yorl~ ~ -(~ignature of, hcant , Ro. 52'4524711 -(~ignature of/a~] ' ) .Go/nmlssioi~, sx~ r? Marc~ 37 lSS 7"