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HomeMy WebLinkAbout12710-z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, Iq. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 1271O Z County Tox Mop No lO00 Secton ~ ..~ Block Lo o '%~ pursuant '0 application dated ....~..~....~...~. ................... , 19~..~., and approved by the Building Inspector. Fee $.~.;.~ ..... Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Dopartmont Town HaH $outhold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY ! /tl FiB I 3 1987 DLOG TOWN Or': SOUFHOLD Instructions A. This application must be filled in typewriter OR ink, and submitted ~a mammas= 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 unu~al natural or topographic features. 2.Final approval of Health Dept. of water supply and sewerage disposal-IS-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 inmalla- lions, 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)o Non.conforming uses, or buildings and "pre-existing" land uses: . 1. Accurate survey of property showing all property hne% streets, build ngs and unusua~ 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. C. Fees: 1. Certificate of occupancy New Dwe).lJ. ng.$25.00, Acco,sar? ,.$10.00 BuuLne~n ~S0.00 2. Certificate of occupancy on pre-existing dwelling ~ 50.00 3. Copy of certiflcate of occupancy $ 5.'00, over 5 years ~10.00 4.wc t n na c,o. $ 20.00 5.Uudated c.g. $ 50.00 Dale .~ 1./. ,/. ,/. ,/,. ~. · 6, ~lteration $25.00 / '~ / -- New C on s b r u c ~ t on... ~. Old ~r Pre-exi~ting Building .. County Tax Map No. 1000 Section .././~') ....... Block .... /. ........ Lot ..... / ~. ~... Subdivision ............................... .~.Flled Map No ........... Lot No .............. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval Planning Board Approval · ·. Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $. '~..,~.,. ~). ............... Construction on above described building an~mtt me~s alr~?l~)bl~ codes and regulations. _.. ....... ":-','"'"m'"' .......................... _, FIELD IN~EC~ION FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING COMMENTS INSULATION PER N. STATE ENERGY ODE FINAL ADDITIONAL COMMENTS: TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P,O, BOX 728 TOWN tIALL SOUTHOLD, N,Y. ! 1971 TEL. 765-1802 Thls is to advise you that the job under building permit no. 12710Z issued to Andre~...Gal~ano : on ~1~_~8/83 __ for Foundation iS complete4 and ;] final inspection {]as ( ) has. not ( x )' been done. in order to complete this file, it ia necessary that a Certificate of Oecupaucy be issued. Please fill out the enclosed form, return same to the above office with a check for $25.00 payable to the Town of Southold. Please indicate to Whom the Certificate of Occupancy ia to be mailed, and strange with tills office for an inspection date Occupancy or ese is unla~fu! without a Certificate of Occupancy. Please. help us to clear up thi~ matter es that legal action dote not have to be taken. Thank you for your prompt attention. Very truly Victor Lesaard Executive Administrator Memorandum from... BUILDING INSPECTORS OFFICE TOWN OFSOUTHOLD TOWN HALL, BOX 728, SOUTHOLD, N.Y. I1971 765-1802 /,~ 5'0 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:~ Examined O.~..~.~., 19'~.~. Approved ~..--~....~...~.~.., , 9~$. Permit No.J..~."} .J.0 ..~. Disapproved a/c ..................................... APPLICATION FOR BUILDING PERI~/IlT Date .................. , 19... 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 heroin 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 inspections. :: .............. (Signatu~ of applicant, or, amc, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nameofownerofpremises .:~..~...~.7~Pi$~.'ii~.'.~.i ~.' .~.'~31 iii i ii i i iiiii ii (as on the tax r631 or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ....... ~. x. 511 ............. Plumber's LicenseNo ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. ........ · '. . .0. .......... .W. . .7. :: . . .D. . ................. House Number Street Hamlet County Tax Map No. 1000 Section ....... /.[ 3 ....... Block ......~ ........... Lot....(~.'..'.~. ......... Subdivision ..................................... 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 ...... ~. ¢.~.~gL4t ....~...~Lqn. ace~, . ~9 .k~g~.. ,...0~4~ ......... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. RemO, val .............. D~nolition ............. Other Work ............... ~,Ft-~/~,g,-~...j~ ~w.~-o~ ~.t~,~/.~'&c~q~ .l~ C/~./ (Description) 4. Lstimated Cost ~. t/>.~-- ....................... Fee .'.~ .................................... /- (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars ..... i ................................................................... 61 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 .................... i · · Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............. '.. Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ........... i ........... Rear ...................... Depth ...................... 10. Date of Purchase ........... i .................. Name of Former Owner ............................. 11. Zone or use district in which promises 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 14. Name of Owner of pre~hises ...i...' .............. Address ................... PhoneNo ................ Name of Architect ........................... Address .................. ..Phone No.; .............. Name of Contractor .,~-g~.~./..'-~.~/~ ..... Address ~[~ O~/. ;22.d~). ,/~d~P, hone No.~. ~.~../-d..~PO'"~. · · PLOT DIAGRAM Locate clearly and distinctly all! buildings, whether existing or proposed, and, indicate all set-back dimensions from property lifies. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. copper tu[~ing ~s u,~ed Jor water d stnbuh ~g system; pipiffg shall be ~t~ types K 9r L 0n!y rF, r~r-~' '~ "~ NOTED 765-1802 9 AM 'FO 4 PM FOR THE FOL, LOW)NG {N~DEC'TIONS: 1. FOIJNOATION - 'I"WO REQUIRED FOR POU2n'D cONCRETE 2, ROUGH" FRAMING & PLUMBING 3. tNSLH, ,"rm J ..... ,-,,-.. 4. Flb1AL" ( ~" J: ..... ~,ON MuST BE ('.--~,~m '"'i[ FOR C. O. ALL CF?''%r'RrICTjON S':IAdJ. MEET THE RF'-'''tpFMENTS OF Tile N.Y. STNi.r Cf~MqTRUCTION & ENERGY COD[q. NOT RESPONSIBLE FOR D~g~GN Og CONSTRUCTION ERRORS. STATE OF NEw(Y(Y(Y(~RK,., /,/~ ~ S above n~amc °JrmclwidrraI stgning c°nt~ct) being duly sworn, deposes and says th~he is the applicant e is the ~(C ontractor, agent, corporate officer, etc.) of said owner or owners, and is duly 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-hi,s-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 ........... /.'-~ .... ~ubJic, j .,,.~. ~//~, .,,>~ ...... ~founty !