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HomeMy WebLinkAbout12687-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall $outhold, N.Y. Cerli{icate O{ Occupancy No. g. ~L2.2;lO., ........ Date ....Jb..h~.~..R.Y. .2. .5 .................. 19.8.4. THIS CERTIFIES that the building . ACCE S selby .................................... Location of Property ....17.0..oyst:arponcl. 1. urge ................. orient ............. ~touse rye. Street Ham/et County Tax Map No. ]000 Section ..... 0.1.7....Block ..... G ......... Lot ........ ll ....... Subdivision ............................... Filed Map No ......... Lot No .............. conforms subst.antially to the Application for Building Permit heretofore filed in this office dated ·.. OC.TOBEIL:k3 ........ 19 83, pursuant to wtfich Building Permit No... 12t5.8'~ ~: ............ dated ...OCT. OBER..1.51 ............. 19 83., was issued, and conforms to all of the requirements of the applicabl[ provisions of the law. The occupancy for which this certificate is issued is ......... · '.. FOi~. AN. ~%CCE~SORY..BUIL~.I~G ............................................... The certificate is issued to LOUIS g3d~.Y. ECKI of the aforesaid building. · ,N/.A Suffotk County Department of Health Approval UNDERWRITERS CERTIFICATE NO Building Inspector Rev. 1/81 FORM NO. 2 TOWN OF SOUTHOLD BIJILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PER~IT CT'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~ 1268~ Z Permission is hereby granted to: /~) , ~ ....~..~.~..~..,......~.~.,. ......................... ~o ..~.~....~.~.~.....~..,.~......~...~.. ~'""~~"~.~.~ ................................................................................................................ ,, ~. ~ ~ ~ at premises located at ..... ........ ~.~..~...~..~.~-~.....~ ........ ..... County Tax Map No. 1000 Section ...... .~....~. ......... Block ......... .~/ .........Lot No .......... I...I .......... pursuant to application doted ...... .0..~.....~..~ ........... , ,9.~.~,~and approved by the Building Inspector. 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 A. This application must be filled in tvpewr[ter 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. 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 topographic featu res. 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. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 ~ /~ ! Date ..... /././/..~/~../74. ........ New Building ,, .,~, ........ Old or Pre-existing Building ............ Vacant Land ............. Location of Property..//. ?..~. ................ ~.\)~ f.~.C.j~.~ J~..~.~ ............ O.C.'.~ .-~. ~).~J~ House No. ' ~reet Ham/et Owner or Ownersof Property .~.~.O....~ .,S .... .¢t,q~, .~., .~..~.~, .~.~.q.~...~, ,(~, ,~,2; .~. County Tax Map No. 1000 Section // .~. Block ~ Lot // Subdivision ................................. Filed Map No ........... Lot No .............. Permit No~.~-¢~/~. ~. Date of Permit/.f). 3. .Applicant ......... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval .... ")~. ,~. ............. Planning Board Approval . fl equest for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $, .k~,' ~...¢~.', ,.V/. .?: ..3.~0.~ ...... Construction on above described building and permit meets all applicable codes and regulations. Rev. 10-10-78 FIELD'INSPECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY ~ODE FINAL ; DATE COMMENTS ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y, 11971 TEL,: 765-1803 Examined .O~.... t.~.., 19~..~.. Approved .O.~..[..~..., 19~..~. Permit No ............ Received .......... ,19.~ .' Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT /,3 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 ~spect~ons. · ............ (Signature of applicant, or name, if a corporation) ]. 7.o.....o..r.s.T~ .~ p..~. ~.v. ~....~&....~..~ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .o..w. r~. ~. l~ ................................................................................. N~me of owner of premises .%~.?.~.'7_.~. c~..<~. ........ ~.v.v.:.- ............ (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. ~ .(~ ;t ( Plumber's License No ......................... Electrician's License No ....................... Other Trade s License No ...................... Location of land on which proposed work will be done.. ,~.©..O .)7...~...O.. ~..~ ........ ' .].'~..0.. ~..~..../j~. ...... 17..o. ............. .... ..O.. ................ House Nmnber Street Hamlet County Tax Map No. 1000 Section [../,,- ..... -..l.[. Block Lot ................... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and ~ccupancy ~f premises and intended use and ~ccupancy ~f pr~p~sed c~nstructi~n: a. Existing use and occupancy ~ t ~ .... .~j ............................. ................ b. Intended use and occupancy .../4..~.. 714. [.V. ..... ~.~ ..O.. t .£-'iB. &2.V:.7.'.'.....?. :.-: ..;. ........... 3. Nature of work (check which a~plicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... 4. Estimated Cost ................................ Fee ..................................... , (to be paid on filing this application) 5. If dwelling, number of dwellin$ 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 ............... Height ............... Number of Stories .................................................. Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth Height Number of Stories 8. Dimensions of entire new const:ruction Front I. '0-..~.~.. Rear 1 .~t'.~...T'... Depth . .I. ~..~...~.... Height ............... Nurober of Stories .... ~,~ .................................................. 9 Si flot F ' R Depth · ze o : ront .......... ............ ear ............................................ 10 Date of Purchase ,: Name of Former Owner I 1. Zone or use district in which p~emises are situated ................. 12. Does proposed construction vi01ate 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 ali buildings, whether existing or proposed, and~ indicate all set-back dimensions from property lines. ' ' G~ve street and blo_~l~_number~oT-fl~-scnp~fion aceordmg to deed, and Show s~reet names and indicate whether interior or corn. er 1o~, above named being duly sworn, deposes and says that he is the applicant He is the .................... ~ ....................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul~ 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 .......... /.*.~-.~. ..... day o~. ~,~..~. .... 1~>.~. N~y~b!ic ...... ~ ',~'~)''' k~~tf~"~t~{C''0unty ,/D .. .......... 1~17~ I'umC. stat, 0~ ~a~v Y0~ (Signature of applicant) No. §2-812§8§0, Suff0lk 1C}~/~ ta~rn Ex~ires March 30,