HomeMy WebLinkAbout12735-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPAP, TMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certi[icate O[ Occupancy
No .................. Date ..... A. PR I L 1
THIS CERTIFIES that the building . .A L T E~R A T I D.~ ..................................
Location of Property ...9~.5 0. S.O] ~ D. ~ E N~.E ..............
House No, ' ...... ~fie;i ' ~ AZ< ~ T ~.C.K.. Hamlet
County Tax Map No. 1000 Section .... 1.Z2 ..... Block .... .0.Z ........ Lot ..... Q5 ..........
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to ~e Application for Building Pe~it heretofore fried in t~s office dated
OCTOBER 1~ ,1983.pursuanttow~chBuildingPe~itNo.__ 12735Z
dated NOVEMBER 7 83
............................ 19 .... was issued, and conforms to a~ of the requirements
of the applicable provisions of the law. ~e occupancy for wMch tMs certificate is issued is .........
...EOR..~ .~OEC. H, ENCLOSURE, .TO. ~N. EX.ZSTIN. G .DW~.[LIN.O. ........................
The certificate is issued to .. Jg.gR~. &..RON~.LD. H&.ZZAFSRR0 ...........................
[owneC le~eo or tenantl
of the aforesaid building.
Suffolk County Department of Health Approval .. </~ ....................................
N682289
UNDERWRITERS CERTIFICATE NO ..................................................
Rev, 1/81
Building Inspector
FO]KM NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PEItMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Permission is hereby gronted~:
,o .........
o, premises located at ....(~...~ ............... ~.~ ............. ; .............................
Counly Tax Map No. 1000 Section ..... ~...~...~. ...... Block .,...C)....~ ........ Lot No ....... .~..-~ .........
pursuant to application dated .... .(~...~,'~..~.~.~.~......[~. ................ 19.~..~ and approved by the
Building Inspector.
Fee $..~.: ...................
Rev. 6/30/80
FORM NO. 6
TOWN OF $OUTHOL[
Building Department
Town Hall
,~,~uthold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted-Jm=duff~to the Building Inspec-
tor with the following; for new buildings or new use:
1. Final survey of property with accurate tocation of all buitdings, property tines, streets, and unusual
natural or topographic features.
2. Final app~_o, val of Health Dept. oi~ water supply and sewerage disposal-(S-9 form or equal).
3, Approval, of e[ectrical 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 Arch tact 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.
Co
Fees:
1, Certificate of occupancy $5,00
1
2. Certificate of occupancy on pre-existing dwelling / land
3. Copy of certificate of occupancy $1.00 ~.
use--Pre-Existing C.O. $15.00
Vacant land ~C.O. $ 5.00
Date
New Building ............. Old or Pre-existing Building . .... /~-. .... Vacant Land .............
House No. Street
Owner or Owners of Property ..~. ,~1~.~...~?... ~..D.J~..~..~ ..... j.~./~; ~.Z...~. ~..~"'..~..~°/~.m./YI
co. nty Tax r~ap No. 1000 Section .../. ~. ?. .... B~ock..~..~.: .~..C). .... Lot...~.~3B..~2.~. ~.
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No ..... Date ....... Applicant ............ ~. .....................
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval .~). ['O~)]~-'~)'~' Planning Board Approval ..
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $ .............................
Construction on above described building and p.p, rmit meets all applicable codes and regulations.
FIELD INSF~TION
COMMENTS
FOUNDATION {1st)
FOUNDATION
2.
(2nd)
ROUGH FRAME &
PLUMBING
INSULATION FERN.
STATE ENERGY
..- qODE
FINAL
ADDITIONAL COMMENTS:
THE NEW YORK BOARD OF F~RE UNDERWRITERS
J~s ~,~e~o~ ~50 S~d Avenue~ ,~,tti~ck~N.Y. :
,c~ ~am.~e~ Febr~ry 28/'1985
James Mazzaferro :: :
9450 SoLtnd. Avenue, 'Box 399 ' -4"-~:~ .... :-:~ '%'-: ' '-'~'=.
~ttituck, N.Y. 11952 Lic.'
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N,Y. 11971
TEL.: 765-1802
Examined..~,~'w~ ,~ .... , 19~.~
Approved ..~..~.~.~..~.., 19t~. Permit No. I..~D.3~ .~.
Received .......... ,19...
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
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 inst:tections.
.........
(Signature of applicant, 6r'da4n~, if a corporation)
State whether applicant is ~ lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
. .~.~..~..~..~ .......................................................................... :.. .......
Name of owner of premises J~../Z..-~..~..,,.~....,~.J./'.C.Z..?-Z).~..~-.~...~(?. 4?.: .?'f./.~.~..~..~../~.. 5[: . .j~...~.Z..~..~..t~..,~ .,~.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 .........................
Electrlman s L~cense No .......................
Other Trade's License No ......................
Location of land on which proposed work will be done ..................................................
...q.¥67..o. ............... ~.~..~./]v~ .............. ./V..4.7r..,.r.v..~..,..w.:/.. .................
House Num bet Street Hamlet
County Tax Map No. 1000 Section . .g.~..~.: .(?...O. ..... Block .. O..~. :?..O. ....... Lot...O..O. ~57.'..O..O..c.'~. ....
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .... ~'.~-..~../~-~'...]~....~..~.Q .'~. ?'... ~ fl~. ..........................
b. Intended use and occupancy . . .~44~ ............................................
3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ..~ ........
Repair .............. Rem!oval .............. Demolition Other Work
4. Estimated Cos · , ...................... 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 ........................................................................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .....................
7. Dimensions of existing structures, if any Front..~..4{../ ......... Rear . ~I:'../c~./. .... Depth . .c~../,~. ~.i ....
Height ...o~.~./. ........ Number of Stories ....c~ ................................................... .
Dimensions of same structure With. alterations or additions: Front . .,~...,~./~..~Y. ......... Rear . .~.?..~'..~7. ..........
Depth . .-~./~/~r. ........... i. · · Height . .~.~./¥.~-. .............. Number of Stories...~./~.ly..o~. ............
8. Dimensions of entire new construction: Front ......... ', ..... Rear ............... Depth ...............
Height Number of Stories
9. Size of lot: Front . .'¥~./...~.( ......... Rear .... -7'i~-T'.....~'. w~./. ...... D. epth . .~.~..~.O..' .......
10. Date of Purchase .'~P.{~..~;T..~../.~. j~o, ......... Name of Former Owner .~.*g&/.~..~.. ~ .~'/,~.~.~.~.~bi~.~.
1 1. Zone or use district in which i ' situated ~.../.~.~.x~. ?..,~./.~ ...........
premises are ...........................
12. Does proposed construction violate any zoning law, ordingnce or regulation: t~..~. ............................
13. W~ll lot be regraded ... ~. 'i ..................... Will excess fill be~removed from premises: Yes (~
14. Name of Owner of premises~44.,~.O .'~.' ~.~.~./.~.~'~/~d'dress ~.r.).O. ~.0..~t.~.~-,. ...... Phone No.
Nmne of Architect Address Phone No
Name of Contractor .......................... Address ................... Phone No ................
Locate ,clearly and distinctly al
property lines. Give street and block
interior or corner lot.
PLOT DIAGRAM
buildhags, whether existing or proposed, and. indicate all set-back dimensions from
number or description according to deed, and show street names and indicate whether
STATE OF NE.~K,//. r~ 'S S
COUNTY OF ~... '
_~/ j (Name of individualCgffnirt~'contract)
above named.
He is the
............................
of said owner or owners, ~d is duly authorized to perform or have perfo~ed the ~id work and to m~e and file this
application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the
work w~l be performed in the m~net set' forth in the application filed therewith.
Sworn to before me this
.. .... ....
o - ......