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HomeMy WebLinkAbout12274-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. ~Jfi,65J .......... Date .......... THIS CERTIFIES that the building .. g, ddi¢£on .................................... Location of PropertyHouse' .220©.No../~eyc~on. D~.5.ve ........................ Street ~°uth°'l'd ' 'h3n~iei County Tax Map No. 1000 Section 080 .Block 03 . .Lot 009 Subdivision. Raydor~ .Shot.os .............. Filed Map No.. 42q .5..Lot No.p/o. 4.8-2(3 .fine o c. onforms substantially to the Application for Building Permit heretofore filed in this office dated ...Xp~..±l..9 .......... , 19 S.3 pursuant to which Building Permit No..fl?..27.¢.Z. ............. dated ............................ g.pr±l 2'1 19 .~.3., 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. demk. ad~5~±on .~.o. mn. e.~.5.s~ .in~ · ~lwe.h~±ng. .......................... Charles ~cCormack The certificate is issued to ........ [d~n'e'r,'ld.~sde'Dr't~/~dn't) ................... of the aforesaid building. Suffolk County Department of Health Approval . .l~./.g:. ..................................... UNDERWRITERS CERTIFICATE NO ......... ~./.g: ..................................... .Building Inspector Rev. 1/81 N9 .2274 Z permlssior~ is hereby granted to: TOWN OF SDUTHOLD ' BUILDING DEpARTMi~N~ TOWN HALL SOUTHOLD, N. ¥, BUILDING PEP~IT ~ (THIS PERMIT MUST BE KEPT O~1 'I~HI~: pj~i~MlSl 3 UNTIL ~ULL COMPL~ION OF THE WORKAuTHORI;ZED)~ ; '~,, ~ ~' ...... to Build. lng I~spector. Fee $...~~ at pr, emise~ located .~~..~.'~~. ...................... ~...~.,,.,~.,.~ pu~,Oont t~ application dated .............. .,~,..,.~?,.., Rev. 6/30X80 and Opproved by the FORM NO. 6 TOWN OF SOUTHOLD Building Department 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 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 survey 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. Date of any housing code or safety inspection of buildings or premises, or other pertinent nforma- tion required to prepare a certificate. ~ Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 et Iand u se $/~"/$5,00 Date ..... New Building .. ~.. Old or Pre-existing t3uilding(X) ......... ~ tVacant Land ........... House ~o, ~ Street Hamlet Owner or Owners of Property ........ ~.. ~ ............. CountyTax Map No. 1000Section ..~ ....... Block .... ~ ....... Lot .... ~. ...... Health Dept. Approval ..... ~.~ .......... Labor Dept. Approval ...................... Unde~riters Approval .... ~.~ ............ Planning Board Approval Request for Temporary Certi~te../ ................. Final Certificate .... Construction on above described building and p,~mif meets all appl~cab~Q~d re~gulations. FIELD INSPECTION COMMENTS FOUNDATION FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N. STATE ENERGY ODE o FINAL ADDITIONAL COMMENTS: FORM NO.<~ & TOWN OF sOUTHoLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 "'~[~uilding Inspector) APPLICATION FOR BUILDING PERMIT 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 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 inspe.~ns. (Signature of applica(n.t4, or name, if a corporation) ...... . 7.... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~.';,o.~ . ~:.~..~. ......................................................................... Name of owner of premises..~. ~.~.J.'~..~..~.~.~.. ~ .~.C~9/~, ./t'/~.C~.. .................................... (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 LicenseNo ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location ofland on which proposed work will be done. /~x/~l)/'~/[k~"/qOj~,~ ..................... 7.1/. .~/~ ........ .. .............. .':'. . . . . ,.x.. .................. .,:. ........... House Number Street Hamlet County Tax Map No. 1000 Section ~ Block ~ Lot 7~..~., ~ /~0c~ [- f-'~t ~ '" Subdivision .L .'-~V.. .............. · .................. Filed Map No ............... Lot ............. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy 2¢.F..~4'j b ~ b. Intended use and occupancy . &~. '.k/~. ff...~. (.-~.~...~ ~..~ ................ 3. Nature of work (check which applicable): New Building .......... Addition .~..~c..~2Y~.. i' A~teration .......... Repair .............. RemOval .............. Demolition .............. Other Work ............... (Description) 4. Lst~mated Cost ................................. ...... Fee .................................. ~ (to be paid on filing this application) 5. If dwelling, number of dwelling iunits ............... Number of dwelling units on each floor ................ If garage, number of cars ........................................................................ 6. If business, commereial 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 ................... i.. Height ...................... Number of Stet/es ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Sizeoflot: Front .......... ~ ........... Rear ...................... Depth ...................... 10. Date of Purchase .......... q .................. 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 .. ~ ................. 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 NEWARK J OF 's.s · · · ./(~.~:~.~'.~~: .~. .................... being duly sworn, deposes and says that he is the applicant (Name of ir~qidual signing contract) above named. .... ..................................................................... (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 ail statements cont0ined ~ this application are tree to the best of his ~owledge and belief; and that the work will be perfomed in the m~ney set forth in the application filed therewith. Sworn to before me this .......... ...... dayo~ ..... ~ ...... N~bli?,...;.~..~ ........ ~~ / '~ County z~ ~ ~ .. ~ [EIZAB~ff fl N~IL~ S nature of a hc~t No. 52.81~58~0, SuHolk Cou~ ~ Term ExPires March 30, 19~ ~JLDING and REMODEL. lNG ROBERT L. HYATT, $OUTHOL~, NEW YORK 11971 APPROVED AS NOTED .DATE:~B.p. ,../~ ~ NO'J'IFY BUILDING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: I. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULAT!ON 4. FINAL - C'DF-.'.'STR[!CTION MUST BE CO^4PLETE FC~R C. O. ALL CONSTRUC,'rlON SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY' CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. ~U&LOING and REMODELING RI]BERT, L, HYATT, $OUTHOLD, NEW YORK 11971 (516) 79S-3390 INC.