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Home My WebLink About11847-z~ - -_ F~ORM NO. 4 TOWN OF SOUTHOLD BUILDING-DEPARTMENT Office of the B_uildin§ Inspector Town Hall 5outhold, N.Y, Certificate Of Occupancy THIS CERTIFIES that the building . g.acOS~q.~nTy .................................... Location of Property ..6,50. ...... Cardinal Drive Hatti~uck ~ Ho.se No. ' ................. County Tax Map No. 1000 Section ....':1.5.5. .... Block ... 0.z4- .......... Lot ,...0.2.1 ........... Subdivision ..... Na'~'C~_;~.~c.k...E.~.~.8..~.e.s. ..... Filed Map No../! ~.153., .Lot No...5.~ ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ·...gugus.tl. 5 ......... 19~.~. pursuant to which Building Permit No....'lfi. 8. q?.~. ........... dated ... g, ugus~..9 ............... 19 .~.~, 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 ......... ...... a~ .ac¢.e.s.~oT~T..~. 9.~.o,g.e..~.13, e..d.: ........................................... The certificate is issued to ...... 40~/$J...~:..~.R,Q .g.g3.3.,.. ~.R....&....E.~.~...~.?,E. ................. of the aforesaid building. Suffolk County Department of Health Approval ......... ~.a ............................. UNDERWRITERS CERTIFICATE NO ................. ~.~ ............................. Building Inspector Rev. 1/81 ~er~issio~ is TOwN BUILDINGS, (THIS pERMiT MUST BE KEi~T ON, ;~H,;E PI~IS $ IjNTIL ilULL COMPLETION OF THE woRI( A~TH~RizED);: I Z Date ..~. ~ ........... , 19. at~ Fremises located at ~6uhty T~X Map No. lO00:Section p~rs[uant To application dated , · . ~ ~e !$.L..~... ............. No.; ,~.Z-./ ........... approved by the ,,=,,., 6/30780 FORM NO. 8 TOWN OF SOUTHOLD Building Depar~rnen~ Town Hall $outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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 topograchic features. 2. Final approval of Health Dept. of water supply and sewerage dispose --(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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings ahd "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topograph[c 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. / Fees: · 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling cfr land us= 'P/b/$5 00 3. Copy of certificate of occupancy $1.00 ~ ~ · ' Date .. New Building · .~.~.q-'.??~.~."l.. Old or Pre-existing Building(X) ,. ....... ,/Vacant Land - . ...... Hou~ No. S~r~er County Tax Map No..1000 Sectfon .............. Block ..... ~ ...... Lot ............. Subdivision ................................. Filed Map'No ........... Lo~ No. ' .......... PermitNa. I.I.~H.2.. gate of Permit ..~l?J~;N.Applicant ~h~.~ · . ... . ........¢., ....... Health Dept Approval ~, ......................... L~bor Dept. Approval ..................... ..,.. Underwriters Approval Planning Board Approval . Bequest fer Tem~oraw Cerdficare ..................... F~nal Certificate .............. . . Fee SuDm~tted S .................... Construcdoa on ~bove described buildin~ an~ ~erm~r'meets aH a~cabl~o~es and re~u~ations. TOWN OE SOU~OLD OFFICE OF BUILDING INSPECTOR · P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-I 802 P~-~ ,,o_ ~ uo am~,~oe you ~hat the Job und=r a izal ~ ~~ ~ COmD ~em and ....... ~ nas no~ oeen done. ~r4~'~ c ., ~ this fi!e~ it is necessary that O~rc~,~y be issued. Please ~ ~O,m(S)~ Pe¢UF~ same to ~=~ ~ ~bove ozfqce with a check fop $5.00 payable to the Town of Southo!d. Please IneiCaCe to whom the Ceptificate of.Occupancy is to be mai~ed, Thank you for youu prompt attention. VL:ec Enclosures Very truly yours, Victor Lessard Adminis tr~tor FIELD NS~.ECTION FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & ?LUMBING INSULATION PER N. STATE ENERGY ~ODE FINAL COMMENTS ADDITIONAL COMMENTS: N c~i F:~, - BDi LO1 N~S DEPA~F/~E NT- 765-1802 .9 A~ .............. TO 4 PM FOR THE~.~.~ FOLLOWING iNSPECTIONS: ~ FINAl . C~NST~U~i.,~ ,< SOUTHOLD, N.Y. 11971 TEL,: 765-1802 .... Approved~.~ ~...., J ~..~. Permit No. ·///(Zq~./Y Disapproved a/c .......... . (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No.../'fZ~. .......... Date ...... ~.~. · .~../, 19 ~...7--' a. This application must be completely filled in by typewriter or in ink and submitted .~:~.L.'._at_,- to the Building Inspector, with 3 sets o[ 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 buildings for necessary in~pec ions. admit authorized inspectors on premises and in ry~ ~Z~~[ , ........ .... (Mailing address of app/'icant) State whether~l~plicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 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 ...................... 1. Location oftand on which proposed wj~rk will be dg&e ..................... .~ .... , ........................ ..... .............. .............. . .,,i2Z .................. House Number Street Hamlet County Tax Map No. 1000 Section .... /~.. ~ ....... Block ..... 0..~. ........ Lot...~....~. ( .......... Subdivision...~/~:~..'..~....O~.'......~..~..~.~ FiledMap No...~..~..?...':~... Lot...~.~.¢ ....... (Name) 2. State existing use and occupancy of~7 and intended Use and occupancy of proposed construction: a. Existing use and occupancy ..... ~Z~_..,ffT:.;~Z..~..: ............,. ~ .... -.. .............................. b. Intended use and occupancy... ~/. ~.~ .~.~,cx.. ~y"~' ~/.' ~. ' "~. ',.-~.. ~..t~. Z .............. 4. Estimated Cost ............................ Fee .................... ! (to be paid on filing this application) 5. If dwelling, number of dwellinglunits ............... Number o£ dwetling units on each floor ................ If garage, number of cars .... ? ................................................................... 6. If business, commercial or mixed occupa.n, cy, 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 ent.ire new consffUction: Front .../~. ......... Rear .... /~. f. ...... Depth .... ~. · Itelght .../.49 ......... Number of Stones .............................................. 9. Size of lot: Front ..... /.7.%~. i ........... Rear ........ t.~..o. .......... Depth ...................... 10. Date of Purchase .......... [ .................. Name of Former Owner ............................. 1 I.Zone or use district in which pr~m~ses are situated ..................................................... 12. Does proposed construction vi.eye any zoning law, ordinance or regulation: .. ~..c) ....................... ~ 13. Will lot be regraded ...... ~4<'~.~. ................. Will excess fill be removed from premises: Yes ~/~ 14. Name of Owner of premises .. ! ................. Address ................... Phone No..c~.c~ ~ 7 .~'..~.~-. · .~. · ·. Name of Architect ......... i ................. Address ................... Phone No. b..~.-...&.~fl. ~ .q.b..Qi~ 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. i STATE OF ~NEI~-~RK,..,- ~ S S F_..,,(Name of indivFcFual signing clJhtract) above named. being duly sworn, deposes and says that he is the applicant He is the ~ug~rrt co~porate officer,' , etc.) of said owner or owners, and is du!y authorized to perform or have performed the said work and to make and file this application; that all statements contlained 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 , ................ ~ ....... day.o~..: .~.... ~ ~"$r~':... :, 19