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HomeMy WebLinkAbout12690-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Zq 2028 Date November THIS CERTIFIES that the building . AGCE~SO2tY .................................... Il?5 Oak Drive Southold Location of Property .............................................................. . House No. Street Hamlet County Tax Map No. 1000 Section 080 .... Block 0'~ .Lot 039 ..:..: Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... ~]?~;em. be~?. ~>O · ·, 19 8.3 pursuant to which Building Permit No..'1.2..~?OZ dated Oa~; el>or, q ,~ ............... 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 ......... .... .~.q~...<n. ,~,d, ,d,~A~,o..n' Go...~.~, .e..x.~.s~..n~..~.g .e.e.s,~.o..~7..qa..~.a~e. ................... AN~HOi~Y FIACAI,U~O The certificate is issued to .......................................................... (owner. lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. ~T~.A .................................... N/A UNDERWRITERS CERTIFICATE NO .................................................. Rev. 1/81 FOEM NO. 2 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~ 12690 Z Permission is hereby granted to: I ,~ ........ County Tax Map No. 1000 Section ..... ..~..~..~.. ........ Block ..... ..~...) ........... Lot No......~....~..~. ......... pursuant to application dated ...~.~.~.....~...~.~' ~ ........ , 19.~.'~, 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 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: I. 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 bu ildings. 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 land use --?re-E×±st.±ng C.0. $15.00 3. Copy of certificate of occupancy $1.00 ~ Vacanl; land C.O. $ 5.00 New Building ........... Old or Pre-existing Building ...... Vacant Land ............. Location of Property . ~.~. ?..~. · ..... ........................................ .~..~.~.~.~.' . '~.~Z[~..~· House No. Street Ham/et Owner or Owners of Propertv ;..~.~-.~..A,~. y..~.~,,~.~.$.0 ............................. County Tax Map No. 1000 Section .... .C~...-~.~ .... Block ..... ,~ ) ....... Lot ~,~..~ Subdivision.. ~..~? .......... Filed Map No ........... Lot No .............. Permit No./..~..~.~..O.'.Z=. Date of Permit/.ov~.~.3..Applicant../.~'~'z~...~.~.. ~..Z~. · .~..'~', ........ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ...... .~.~.(..~.~. ......... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....... .~. .............. Fee Submitted $...'~..'.~..~ ...................... Con structio n o ~bo~v~ described bu lid lng ~,nd~~,,~a II a~.~li~~,nd regu lations. .,0,o. ...... BLD~; DEPT. .~O,W,N OF $O[JTHOLD ,,, 765-1802 BUILDING DEPT. INSPECTION FOUNDATION IST [ ] ROUGH PLBG. FOUNDATION"~ND' [ ] 'iNSULATION [ ] FRAMING REMARKS: ~,]~Fi NAL ' DATE INSPECTOR , FI~LD~INS?ECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd 1 ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y, 11971 TEL.: 765-1803 E×amined Approved I~..~.~...Or~.... ! .~.., 19~.3. Permit No. ~ .~,..~ .q.O.~. Disapproved a/c ..................................... (Building 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 shah 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 regtflatiqn_s, and to admit authorized inspectors on premises and in building for necessary ilx~ections. (Signature of applicant, or name, if a corporation) ...... ?/... :.,,z ......... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................................................................................... Name of owner of premises . .~..'4/'./'../~..~.~.....~:~tC.~.Z .~.~ .O ................................................. / (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 License No ......................... Electrician's License No ....................... 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 ..... O.~.. ...... Block ..... O. r ......... Lot...O...,~...~. ......... Subdivision. P~..4~¢] .................. 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 b. Intended use and occupancy ...' .................. 3. Nature of work (check which applicable): New Building .......... Addition .... Alteration .......... Repair .............. RemoVal .............. Demolition ............. ~ Other Work ............... (~.7-~, ~..~. (Description) 4. Estimated Cost . Fee ............................ (to be paid on filing this application) 5. If dwelling, number of dwelling ~ mits ............... Number of dwelling units on each floor ................ If garage, number of cars I ~ ...... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... .... ' . ! '~'" ,9*-~t 7. Dimensions of exmtmg structures, ff any: Front . .~. .......... Rear . .gP( ......... Depth .--t-.-~.. ~, ..... Height /~2.*.~..* ......... Number of Stories ! ........... ; >, ........ · /, ........ ' Dimensions of same structure with alterations or additions' ~'roni /'~ g . I~2:r' )'//~ . .. a~,' ~,t,~ ~ . ' .............................. Depth .................... ~.. Height ...................... Number of Stories...! ................... 8. Dimensions of entire new construction Front /°.~?'' . Rear . ./0.'..7" .. Depth .~ t Height ............... Number of Stories .... I ................................................... ~, 0 ' Rear &~ Depth / '.~. 9 Size of lot: Front 10. Date of Purchase ........... .................. Name of Former Owner ............................. 11, Zone or use district in whlc preMmes are situated. 12. Dales proposed construction violate any zoning law ordinance or regulation: ............................... 13. Will lot' be regraded ......... i: ................... Will excess fill be removed from premises: Yes 14. Name6fOwnerofpremises~,,.~/~.~q~,l/$O. , Address O4/d.~O~. ..... PhoneNo..~.d.~.-.//.~...'~. Name of Architect . ./..~e~ .z~] ................. Address ................... Phone No ................ Name of Contractor ...... D...~.q.~.,~,~, ......, .... Address .O~t~.. O,~.' ........ Phone No..7..dlrT. 7 ~..3..o. ? .... PLOT DIAGRAM Locate clearly and distinctly all i buildings, whether existing or proposed, and, indicate all set-back dimensions from property 1/nes. Give street and block humber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF iNE~.~YORKt COUNTY OF...0:o~'..,Y'q..~. .... i S.S · · ..................... i .................... being duly sworn, deposes and says that he is the applicant (Name of individual sighing contract) above named. He is the ' ' ~f / ~ O-ontracro~r, agent, corporate officer, etc.) of said owner or owners, and is dut~ autho-~zed t~perform or have perfomed the said work and to m~e and file application l that all statements conta~is application are true to the best of his ~owledge and belief; and that the work will be perfomed in the m~ndr set forth in the application filed therewith. Sworn to before me this ........ ~.~ ...... day o:~ .... 19~ Notary Public,. ............ ~.~ ~..,.~ounty ..... '~. ~ ~ ~ ~v ~mlc,i ~ ~ . ~ ~ (Signature of a hc~t Term [x~j ' ,.. ~ ~ ~o, ~ , AP~C'.:ZD AS NOTED NOTIFY Bt.qLD!NG DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE FOLL©X,V F','G P,'$2ECT]ONS: 1. FOU,k.~"~ATI©N - TWO REQUIRED FO'~ ~""!JRS. F) CONCRETE 2. ROU~~4 - ~RAM!NG & PLUMBING ALL C~'~'::~'~ON 5~ALL MEET THE RE¢ .... r~aENTS OF TF~ N.Y. STA~ C~NWRUGTION ~ NOT RES~ONS!BLE FO~ D~SIGN OR CONSTRUCTION