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HomeMy WebLinkAbout12457-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N,Y. 'Certificate Of Occupancy THIS CERTIFIES that the building Jk00:ES£O~Z. .................................... Location of Property .,2~.5~,. We~dc~ha.Z±a. P~c[ ..... ,lV~a 'c~:£~cl,tck. ....................... ~ouse lye. Street Ham/et County Tax Map No. ]000 Section ,..,..fl.'[~ .... Block ....... d,O ...... Lot .... 20 ...... ~,..~-' Subdivision .............. ' ....., ............ Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... ~Ltl'~ .20~ ......... 19.83pursuant to which Building Permit No. '~ 2~..57. Z .............. dated ...... Au~n.~s-~..fl ............. 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 ......... An Accessary garage , The certificate is issued to . ,EDFiL~D. &..G~.OR..~ · ~D.A.C~OLC~5 ............................ ~owner, /es~ee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ................................... ~ ...... - UNDERWRITERS CERTIFICATE NO ' Building Inspector Rev. 1181 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 12457 Z Permission is hereby granted to: ...... ~.~r~.~ ......~~_~.....~ ....... ~.....~~ at premises located at ' .-~ ......................................................................................................... County Tax Map No. 1000 Section ..... /..(...'ff.. ........ Block ...~..~ .......... Lot No...~ ........ pu~uan, ,o application dated ..... ~.~.~....~ ................. , ,C~, and approv~ by the Building Inspector. Fee $../~....~... Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, 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 topographic features. 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 surve'~/ of peoperty showing ali 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. Fees: 1. Certificate of occupancy $5.00 ! / 2. Certificate of occupancy on pre-existing dwelling ~/r land use $1b-/ $5.00 3. Copy of certificate of occupancy $1.00 ~ -..?.: / Date .................... New Building . y,~. S ....... Old or Pre-existing Building ............ Vacant Land ............. Location of PropertyHouse ~ ~. ~z~.~. .No. .... .~.).~S. .["~.~. .... ~ ~. ! i .~.-. .... IZ-s,reet'~: . . .)..~.Y]..r'tT?.~ .~. ~.~.J'~ ......... ~ ~.~ ~. ...... Ham/e, Owner or Owners of Property. . . . . .~c~ W\ .~.~. .~. ~ .~. .I.~.C. i;'~- . .~'.'?~ .~\~.~. .~. . . . . . . . . . . . ............ County Tax Map No. 1000 Section .../.J.~ ......... Block ...[.0. .......... Lot .... 0..~.O. ....... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. /.'.~. ,~,5~?... Date of Permit . ~..,;l.; .~..?.Applicant . .~.~ ~...~. y.O.~. ~; .(~-t~ ~'.~; .c~.. ~C.??~...~. ?.~ z~ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ .5.~. .0.0 ....................... Construction on above described building and permit meets all applicable codes arid regulations. ............... Rev, 10-10-78 FIE L~D I~FECTION COMMENTS FOUNDATION (~st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: P.'SA D '75.( :0 · FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved X}i: .~..~. ....... ,19~..-~eermit No..ff.~...~..,<).~../Tf Disapproved ---~' ~~ APPLICATION FOR BUILDING PERMtT INSTRUCTIONS a. This application must be completely filled in by Wpewriter 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, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary, inspectiong. ~ (~ ~ ~ (Signature of applicant, or name, if a corporation) (Mailing address of applicant) l tq.~~'~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (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 ...... ~.~Er~.~.--~. ........... Plumber's License No ......................... Electrician's License No....,~..O.' .~./:;~.~.....~ ........ 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 .. IJ. l ............ Block . .I.o .............. Lot...~.0. ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Ex,st,ng' ' use and occupancy .... 0..~..C..'... b. Intended use and occupancy . .0.1'~.~...q,~,. ~l)0..~.~.¢.c~.h'~.c~. .~.C.q..c] ~. .............................. 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... ~ /(~ ~ ~Descfiption) 4 ' ' .~500 ' · Estimated Cost .................................. Fee ..................................... (to be paid on filing thi~ ?plication) 5. If dwelling, number of dwelling units ...... ~ .... Number of dwelling units on each floor·. *:..... ......... If garage, number of cars .. J ............................................... 'i , · 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .... s~dn f isting strut if any Front Rear Depth .~ ............ 7. Dimen so ex cures, : ............................. ~ ...... Numb of Stories ' ' Height ~.'~ ............ er ........................................... ~.; ......... Dimonslo~nl~.of_same~ructure with alterations or additions: Front ................. Rear .............. Depth'. ....... :. i ........ J.. 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 ............................. 11. 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 .. 'i ................. Address ................... Phone No.~2~--.~l[(~ ...... 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 N~E~'(~)RK,~,~..,/~ S S above nam -''' ('2~ ed(Name of in~ivi~a£signing contrac~ ....... being duly sworn, deposes and says h~is the applicant e 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 ~d file this application; that all statements contorted h this application are true to the best o~wledge and belief; and that the work will be perfo~ed in the m~ner set forth in the application filed therewith. Sworn to before me this /. ............ ..... ..... 1~. ~/ .~/ ~ ~uUic, · ...... ~ ..... · . County . a0~v ~tk%~3~.~ vm (Szgnature of applicant) OCCU?ANC¥ OR USE iS UHLAWFUL V~ITEO~J'i' C[R'11FICATE OF OCCUPA~¥ ~AppROVED AS NOTED FOLLOWING iNSPECTIONS: I, PoUNDATION - TWO REOUI~,EO FOR pOURED CONCRETE 2, ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRLICTION MUST BE c©MPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF T~E N, STATE CONSTRUCTION & ENERGY CODES. NOT REsPoNSIBLE ~J~o