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HomeMy WebLinkAbout12716-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Cerfificnte Of Occupnncy No. Z12443 April 30 1984. ............ Date THIS CERTIFIES that the building ~pa±r & ~larg~nt o£ ~xistJ_ng ~o~ah. Location of Prnnartv 780 Haywa%ers Road Cutchogue House No, Street ~ie~ County Tax Map No. 1000 Section Z Z Z .Block 01 .Lot 016 Subdivision..~qgP.~q.~Z.~.~q=.FQedMapNo. ~.~ .... LotNo. ~6 & 27 . conforms substantially to the Application for Building Pe~it heretofore filed in this office dated Ju~y 28 ~ ~2716 Z .................... ,19.. ursuant to w~ch B~Iding Permit No ...................... · dated ..... O.q~9~.~. ~ ~ ........... 19 ~., was issued, and conforms to a~ of the requirements of the applicable provisions of the law. ~e occupancy for w~ch this certificate is issued is ... ~ ..... =epaKr to and enZargement o~ an exKs~nq porch. ~e certificate is issued to PRAN~ B. CUR~N of the aforesaid building. Suffolk County Department of Health Approval ..... ~[~. ................................. UNDERWRITERS CERTIFICATE NO ............. ~ / ~. ................................. Building Inspector Rev. 1/81 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, ~ndustrial 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 ail 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/. land use --Pre-E×±s~±ng C .0. $15.00 3. Copy of certificate of occupancy $1.00 '~acanl; 3, and C,O. $ 5.00 j Date ..... Z/..-..I.].'7.'.~.. ....... New Building ............. Old or Pre-existing Building ............ Vacant Land .......... Location of Property .............. ?, (,~,~'/,~ .............. House No, Street Hamlet Owner or Owners of Property ...... ,~ ............ ; ...................... Cou.tyTaxMap.o. 1000Section ..... /.LI. ...... BIoc ...... l ........ _ot .... /..b ......... r Subdivision..~.. ~..~)~-~-...~. t~.Filed Map No: ~.~. ...... Lot No....~....~..~r'..~.. Permit No. ~. ~.~J .~. I.~... Date of Permit ~.".~.~. ~-..~. · .Applicant .~'~... i~'. ~¢~.~. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on ab ore described building an d~a~ i~'~odes a nd re gu latio n s. Applicant .~.~ ~ .... Rev. 10-10-78 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ,proved (~4~... ~ ....... 19~.~. Permit No.../.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 s 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 areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appll- .ion. 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 dl 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 dl 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 ilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or guiations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. e applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulatioa_s.~, and to mit authorized inspectors on premises and in building for necessary inspections. .... y/. o. .b.. . . . ..... (Signature of applicant, or name, if a corporation) (Mailing address of applicant) ate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................... c ..................................... une of owner of premis.¢}-h. .~../~.~..'~.~...~.,..C/M'.r .Z~.~;~..~. ............................................. / /~ (as on the tax roll or latest deed) of~uly authorized officer. / Builder's License No. - ::~- ' ~.~ ,,~__7~, .~ ,'_ Plumber's License No...~. ~.~,.-.. Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done...~.~. ~..z~.ff..~.~.~.~'....~..d.. 7...~./~.' .~.~.~....~'&'~..O..~..~ fi;~;i h; '~i?'¢~fi .................................... Street :' ....................................... Hamlet n . .LZl ............. mo~k .../ ........... Lot... 1~ ....... County' k Map NO21009~ectio ....... '~ ~ ~ ~ (~'a~e/~ ............ State ex~ ~se and occupancy of premises and i'ntended use and occupancy of proposed construction: a. Existing use and occupancy ........... .. ~'~ ~-.... ................ b, Intended use and occupancy .............................. c;~(:,~tl,ue. ,,','t~3~ ,~ .............