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HomeMy WebLinkAbout12760-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z.q. 3..5 ?) .......... Date ....4u.n..e..a.7.. ..................... !9~..5. THIS CERTIFIES that the building D e ¢ k Location o f Property ..... & 2 5. ~.P. ~ ~ ?.~.q o..cl..L.a.n..e ................. ? ,u ?,c, h..o ,g,u. e. ......... House No. Street Hamlet County Tax Map No. 1000 Section . l 3.6 ........ Block ..... 1 .......... Lot 1 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... Sep.t,.. 9 ......... , 190.}. pursuant to which Building Permit No..~ .2.7.6..0 .Z .............. dated ............ N.o.v.,. ?.q ........ 198.3.., 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 ......... .... p.e.qk..addition to an existing one family dwelling. The certificate is issued to JOYC E MONK (owner, ~,,~X of the aforesaid building. Suffolk County Department of Health Approval ....... .N/fi. ............................... UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 l~ou~ NO. ~ TOWN OF $OUTHOLD BIJlLDI~IG DEPARTM~HT TOWN HALL SOUTHOLD, H. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12760 Z Date ... ~..~....~...... ~ ~. ........... , Permission is hereby granted to: ,o .... at premises located at ...L~...~...~....~..~..~......~.~,~~: ...... County T~'~;;'~ No. 1000 Section .... l...~,,,,~. ...... Block ......... ] ........... Lot bio ......... ~. .............. 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. 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. C. :'Fees: 1. Certificate of occupancy $5.00 / 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 ~and .C.O. $ 5.00 .......... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ................. '; ~. ........... (~., .~ ~ ~ Hou~ No. Street Hamlet Owner or Owners of Prope~ · .~'~ ~ .~ .... ~ ................................ County Tax Map No, 1000 Section .......... Block ............... Lot ............... Subdivision ................................. Filed Map No ........... Lot No .............. Health Dept, Approval ........................ Labor Dept, Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate.....................FinalCertificate ...... ................ . Fee Submitted $ '~"'~ Construction on above described building an~d per, mit meets all applicable co_des and regulations. Applicant...'~.-7 ;";;'¢'-.-.?!".~.~ .'~. W.. J~O:~,Z~ .............. FIELD~IN~J~ECTION FOUNDATION FOUNDATION 2. ROUGH FRAME & FLUMBING (1st) (2nd) INSULATION PER N. Y. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS: COMMENTS New York State Department of Environmental Conservation NOTICE Permit No. Expiration Date The Department of Environmental Conservation (DEC) has issued permit(s) pursuant to the Environmental Conservation Law for work being conducted on this site. For further informa- tion regarding the nature and extent of work approved and any Departmental conditions on it, contact the Regional Permit Administrator listed below. Please refer to the permit number shown when contacting the DEC. Regional Permit Administrator Daniel J. Larkin December 31, 1984 NOTE: This notice is not a permit FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined .~...IUO-'q~.....~...~].., 19 ~.~ Approved .~....~t~....I/t~....&J.., 19~. Permit No./. .~.?.~..~.. ~ Received .......... ,19... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERI, lIT 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 Southoid, 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, bull~ing code, housing code, and regulations~ and to admit auth°tized inspect°rs °n premises and in building f°r necessary.~g°lti°ns' ~5~ ~_~C,r_X--~x ~ · ' (Marling address of applicant) State whether applicaqt is owner, lessee, agent,, architect, en~neer, general contractor, electrician, plumber or builder. ...... .G. ..... ...................... Name of owner of premises ........................................................ (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 ..... 1 .~).. ................. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Locatio~ of land on which proposed work will be done .................. House Num her Street Hamlet County Tax Map No. 1000 Section ..... ~..a.~9 ....... Block ......... 1 ........ Lot ...... ) .... .~ ....... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and in, te. nded use and occupancy of proposed construction: a. Existing use and occupancy .... .~..10..~. ..... b. Intended use and occupancy ....................................... - ............................. 3. Nature of work (check which applicable) New Building .......... Addition .. ~. · · Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... ~ , (Description) 4. Estimated Cost ............. .................................. i (to be paid on filing this application) 5. If dwelling, number of dwelling gnits ............... 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 ............... Rear .............. Depth ............... Height' ............... Nun)ber of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. r)epth ...................... 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 .......... : .................. Name of Former Owner ............................ 1 1. Zone Or use district in which premises are situated .................................................... 12. Dogs proposed construction violate any zoning law, ordinance or regulation: ............................... 13. Will lot be regraded ........ ~ ................... Will excess fill be removed from premises: Yes No 14.Name of Owner of premises .. i ................. Address ................... Phone No ................ Name of Architeot ' 'fi'a a'a ............... Address .............. Phone No. Name of Contractor.,.~ .-.-~. ........ .~:.~p.k)..~..~ ' . Address k[ ...... .~.~. Phone No ........... 4~..~ ~ .-.-~ PLOT DIAGRAM Locate deafly and distinctly al! buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and blocklnumber or description according to deed, and show street names and indicate whether ~r~ interior or corner lot. STATE OF NEW ¥'~K,]/,,~/ o o COUNTY OF, E,. ~ .... '. ........ (~.G.~'~.~..~r.7( !~..~4..'~?.~ ................. being duly sworn, deposes and says that he is the applicant , (Name o~individual sig~ing contract) ' above name'd. . He i~ the ......... - ............................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have perfo~ed the said work and to m~e and file this application~ that all statements contained in this application are true to the best of his ~owledge and belief; and that the work w~l b~ perfomed in the m~ner set forth in the application filed therewith. Sworn to before me this~ ............ [..~,...T:day of...~ .... , . . . ,, ..... ' ......... . ~~, ,~01~ ~/ ~ (Signature of applicant) FEE: ..t.~', ~ BY: ~, ~.~- NO~)~LJILD~NG DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR ~HF FOLLOWING INSPECTIONS: 1. FOUNDATION - ~O REQUIRED ~. ~ ..... . r-,'~k?q?:~ ~-~.'.-N MUST ? ......... TF c-OR C. O- ALL C ..... m!CTION SHALL ,ME~F THE RFr"~7'~-':.~,~ENTS OF THF_ N.Y. STA'rF CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS.