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HomeMy WebLinkAbout11786-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..g.1.1.501 .......... Date . ??.b..~.u.~.~.,¥..2~. .................. 19.$5. THIS CERTIFIES that the building . .I?e. 9.k..A.d..d.i.~.5..or~ ............................... · 2185 West View Drive Hattituck Location of Property ............................................................... House No. Street Hamlet County Tax Map No. 1000 Section . . 'l..0.7. ...... Block .... .7. ......... Lot .... .'I...Q.O? ....... Subdivision .... X. .......................... Filed Map No..X. ...... Lot No...X ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated · .g.~.~.e...2.2 ............ , 19 .~.2. pursuant to which Building Permit No. dated . . .J.u.Z.~....$ ................... 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 ......... ... ~gr..~..c~e.e.k..~. ~¢~?.~..o.n..~.0..e×~ng, .~.~.t.~C~_~.g ............................ The certificate is issued to ... 0-O&r~O. Fi,. ¢a2.1igg~ .................................. (owner, le~a~ of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE NO. Building Inspector Rev. 1/81 · :: ; (THIS PERMIT MUST BE KEPT ON COMPLETION OF THE WORK AUTHOR zEDi N? 11786 Z ~ate ,..~... Per~n ss on s hereby granted R~V. 6/30?80 at: p~emise? located at · .?~.~. .................................. ....................................... ~..,.,.....,~.. co~ Ta× Map No. ~000 Sect,on/~('~..~..~,,~.~ BU I~lng Ihspector. - , S UNT L~'ULL and ~3pproved by the Inspect:o? ~ FORM NO. 6 TOWN OF SOUTHOLD Building Depar'[men~ Town Halt Southold, N.Y. 11971 APPLIOATION FOR CERTIFICATE OF OCCUPANCY Inatructions A. This appticat on must be filled in typewriter OR ink, and submitted in dupJJcate to the Building Insoec tot with the following; for new buildings or new use: ' 1. Final sunzey of property with accurate location of ali buildings, property lines, streets, and unusua natural or tooograohic features, 2..Final app, ro.va! of Health ~ept, of water supply and sewerage dsposa --(S-9 form or equal}. · ~pprova~ or electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Res[dances 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 buHdinas a&d "pre-existing" land uses: - 1. Accurate sunzey of peoperty showing all prooerty 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 (nspectjon of buildings or premises, or other pertinent informa- tion required to prepare a ce~ificate. '/ Fees: l. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-exiss~ng dwelling or land use S5.00 3. Copy of certificate of occupancy $1.00 New g ..... ng Old or Pre-existing Building(Z] ......... =/Vacant Land ........ .................... ................. 'r' ........ Owner or Owners of Property ~,~ County Tax MaD No 1000 Section '~¢ ~] ~).~.. ' b!oek '~ ' ......... · .......... Lot .... J ~ .D..O. ?¥ .... Subdivision ................................. Filed Map 'No. .Lot No...'. ,~ '~¢1 ~.~ ;~ -/ .s.: ~.z.. ......... ' ......... Permit ...... Date of Permit .' ..Applicant ........... Fie Ith O pt App I a e . rove ..................... Labor Dept. Approval ...................... ,.. Under,vriters Approval . . .~.~. Request for Temporary Certificate .................... Final Certificate .... -. Fee Submitted S ........................... Construction o..~)bove described building and perr~it'meets all appl~,c~able~codes and regulations. ,. -® : ...... :'".- ,' ' - '- :,,....'..y,t~.~.,!?;,...~,.:~...::,.....:~;.......,. , ,~. ~.,:,,":: · .' ~ .' : '. FIELD INSPECTION 1. FOUNDATION (1st) FOUNDATION (~nd) ROUGH FRAME & FLUMBING INSULATION PER N. Y. STATE ENERGY C,.ODE COMMENTS FINAL ADDITIONAL COMMENTS: /_ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c .......................... ~ ......... fi / (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No.././.7.~.~7. ......... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted.~::./A:-.Mc 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 Southotd, 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 necessary inspections. · 'c' .... (Signature ofdppficant, or na~e, if a o p ' ) IS.?. .... (Mailing address of applicant) I I~'~-- State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... ©.~ ~e~. ................................................................................. Name of owner of premises ..~?..~..B.~..E....~.~.:.. ~ .}~..~..L.~ .~'-..~.~. .................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duty authorized officer. a. Existing use and occupancy b. Intended use and occupancy (Name and title of corporate officer) Plumber's License No ....... /( ................. Electrician's License No .... ~ ................... Other Trade's License No. ; ..................... Location of land on which proposed work will be done ....................................... / .......... House Number Street Hamlet County Tax Map No. 1000 Section ..... [..Q~.~.~ ........ Block ....~ ............. Lot..[,..<3..~..~. ........ Subdivision .................. Filed Map No ............... Lot ...............  (Name) . State existing se and occupancy of premises and intended nse and occupancy of proposed construction: 3. Nature of work (check which applicable): New Building .......... Addition..........l/ Alteration .... ..... Repair' . ....... 2:LY' ' ' Rem6val .............. Demolition .... '.dj' ~ ...... Other Work ............... '. '~ .~ (Description) (to be paid on filing this application) 5. If dwelling, number of dwelling hnits ............... Number of dwelling units on each floor ................ If garage number of cars 6. If business, commercial or mixe~l 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 w!th 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 ........... .................. ~me of Former Owner ............................. 11. Zone Or use district in which pr~mises are situated ..................................................... 12. Does p,roposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ......... ................... Will ~xgt~. fj!l,~ r~e~O.y~d,f&om premises: Yes No Name of Architect Address Phone No Name of Contractor ~ Address Phone No Locate clearly and distinctly all property lines. Give street and block interior or corner lot. PLOT DIAGRAM buildings, whether existing or proposed, and. indicate all set~back dimensions from rumber or description according to deed, and show street names and indicate whether STATE OF NE~z/YO~7I~, /2,~ ..... ~~2 .~, .: ........ berg duly sworn, deposes and says that he is the applicant ~ (Name of ind~duaI si~ing contra~ above named. : He'is the .......... of said owner or owners, ~d is du~y authorized to perform or have perfo~ed the said work and to m~e and file this application; that all statements contained ~ this application are true to the best of his ~owledge and belief; and that the work will be perfomed in the m~n~r set forth in the application filed therewith. Sworn to befo~ me this ......... ..~ ....... day o~.. No~,~ublic, .... ~..~... ~.~~ount,, ~, m,v mmc. $me et ~ ye, ~ (SineCure ofappnc~t)