HomeMy WebLinkAbout12749-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
5755
August
No. Date . . . 9 ~'.".
addition.
THIS CERTIFIES that the building ................................................
Pvt. Rd. off Sound View Ave. Southold
Location of Property ...............................................................
House No. Street Ham/et
County Tax Map No. 1000 Section 5~) .Block <) . .Lot
Subdivision ...... :c :~
......................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
October 25 19 ~..~. pursuant to which Building Permit No. ~ 27~9Z
dated ..... .~9Xe. m..~.e?.. ~..~ .......... 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 .........
Addition to existin~ one-family dwelling.
The certificate is issued to Pd~V. DONALD W.
..................... ......................
of the aforesaid building.
Suffolk County Department of Health Approval ..........................................
UNDERWRITERS CERTIFICATE NO ..................................................
Building Inspector
Rev. 1/81
FOBM NO. g
TOWN OF SOUTHOLD
BOILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N~ 12749 Z
Permission is hereby granted ~ , ~
...~.L~.....L ..kf..~ ................
,o...~.~~.......~.a.~....~/~..... · ...... ~ ...... ~..C..~...
........................................................................................................
at premises I~ated at .[~,~,...~.,...~.~.~..~.~za....~.~.,.~~. ....
Cou,~ T~ M~p No. 1000 S,~t~o, .... ~.k~ ........ ~l~k ..... 9.9 .......... Lot No....~.~ .............
pursuant to application dated ...~..~......~ ............... , 19.~, and approv~ by the
Building Inspector.
Fee $.. · .~..7.: ..~..-~... .......
Building Inspector
Rev. 6/30/80
FORM NO, 6
TOWN OF SOUTHOLD
Building Department
Town Hall
$outhold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
DEPT.
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 featu res.
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:
1. Accurate survey of p~operty showing all property lines, streets, buildings and unusum natura~ 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.
Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling
3. Copy of certificate of occupancy $1.00
4.Vacant Land C.O. $5.00
$15.00
D ate .........................
New Building ......... ~,.. Old or Pre-existing Building ,. ~ ........ Vacant Land .............
Location of Property ...~..r~,!?~.tt- t~-~' O1=~-. ~.~..~,,'l~-?. ,~1 ..
House No. Street Hamlet
Owner or Owners of Property ..... /ViC .~. ! ,~ .~..~.~ "~
County Tax Map No. 1000 Section ............... Block ............... Lot ................
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit NoJ .'/Y..-)..~'.~... Date of Permit .......... Applicant ..... .~... ..... .~.t~..?. ? .............
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $ ................... 5~. ...... ~
I /
Construction on above described building and permit meets all apl~l~le codes and regulations.
O'O'~=Zz ~c,c~'~ Applicant ....... ~ ..... ~ ,~"".. ~ .....
..............
Rev, 10-10-7e
FIELD'~INS~ECTION
FOUNDATION
COMMENTS
FOUNDATION
2.
(2nd)
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
~ODE
FINAL
ADDITIONAL COMMENTS:
¸,3
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N,Y. 11971
TEL.: 765-1803
Examined ~..~..?,~... [ .{0..., 19~'.~.
Approved .1~), ,e~. YO, ,~,. ,l.~..., 19~.3. Permit No ............
Disapproved a/c .....................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
a. Tkis application must be completely filled in by Wpewriter 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 Se 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 Pen'nit 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 insp~ctions,~ ,r~
..... ./4'. . :. .......................
(Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
(as on the tax ro~l or latest deeo~
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. Locationoflandonwhichproposedworkwilibedone...~.Q(.o.~..~....~...~..'...(~I..~...~J:L~'..~..~.,~. ....
ttouse Number Street Hamlet
County Tax Map No. 1000 Section ...O..~.~ ........... Block .... ~ ............. Lot..2.5(...
Subdivision ........... ~.'. ........................ Filed Map No ............... Lot ......... ,/.~ ...
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
E i ti nd pa cy .~.~w~ ~
a. xs ngusea occu I1 . · ......................................................
b. Intended use and occupancy . 0.,.%-...~..a.t~..:!,~..~.~.~? .~. ~...-.~: ..............................................
3. Nature of work (check which applicable): New Building .......... Addition. ~ .... Alteration ..........
Repair .............. RemoVal .............. Demolition .............. Other Work ...............
(Description)
4. Estimated Cost ..... .o..r~..
5. If dwelling, number of dwelling units .... ./ ........
number of cars .7-.
If garage .................
Fee g2'7, &~z_h
(to be paid on filing this application)
· Number of dwelling units on each floor ................
6. If business, commercial or mixed occupancy, specify nature and extent of eac~ type of use . -- ..........
7. Dimensions of existing structure~, if any: Front ..~)~ . Rear c/..~., .
b
Height ............ Num er of Stories ........................................................
Dimensions of same structure with alterations or additions: Front .~/.5~ ........... Rear . ~.? .........
-6~c~ ~ H' O
Depth ,.. · 7 .............. ~.. eight ...-~ .................. Number of Stories .... /. .................
8. Dimensions of entire new constrFction: Front .. ?.'~ ..... ... Rear ...-~./, ........ Depth ./.~'~. ...........
Height: .. ,/~ .......... Number of Stories . / ................... ~ ..................
9. Size oflot: Front .,..~2~2 .............. l~;i'ii.~,,~t~iill , Depth ,.]..bT. ................
10 Date of Purchase Name of Former Owner
11. Zone or use district in which premises are situated .....................................................
12. Does proposed construction lolate any zoning/aw, ordinance or regulation: .~/~; ............................
13. Will lot be regraded ... ~}o.... .................. ; Will excess fill be removed from premises: ~ Yes ~ No
14. Name of Owner of premises ~ .~.J,.~..g~e.~ej... Address ................... Phone No. 7.{ ) .'.F.~..~.~. .....
Nmne of Architect ... '.'-~ .....
.~.t~.w~..: 15¢~.Si i i i i i i i i i i i Address ................... Phone No ........... z- ....
Address ff~.¥. :Il [~. ,~..q~J... Phone No. ~t[ .~.'..~.~?..~ .....
Name
of Contractor
PLOT DIAGRAM
property lines. Give street and block:
interior or corner lot.
Locate clearly and distinctly all lbuildings, whether existing or proposed, and, indicate all set-back dimensions from
mmber or description according to deed, and show street names and indicate whether
STATE OF NEW/SrJDP,,K/~,~ jr, e
c°uNTY.
.... being duly sworn, deposes and says that he is the applicant
He is the
agent, corporate Officer, etc.)
of said owner or owners, and is dulY authSnzed-t-6 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 ~n the mtmne, r set forth in the application filed therewith.
Sworn to before me this
......... ~..~ ...... dayoi....~.. ~ ....... 1~.
NpC-r~%P.u bloc ............... ounty
.........................
NOI~t~'~I~B-IJI~, State of ~lew ¥~f~ :' (Signature of applicant)
Termi Ex,)ires MBrch 30.
AP?RC,:%D AS NOTED,
FEE: ~"~. ~0 _BY: ~/, ~ J,..
NOTIFY BUILDING DEPARTMENT AT
765-1802 9 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
]. FOUFJr~ATION - TWO REQUIRED
FOR P'qURED CONCRETE
2, ROUGH - FRAMING & PLUMBING
3 [NSULATIC)N
4, FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C. O.
ALL CONSTRUCTION SHALL MEET
THE REOUfREMENTS OF THE N Y,
STATE CONSTRUCTION & ENERGY
CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
If copper tubing is used
For Water'distributing
system; piping shell be
of types ~or L only
t~