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HomeMy WebLinkAbout12789-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z-15308 Date February 26, I987 ~ THIS CERTIFIES that the building CHIMNEY & WOOD BURNING STOVE Location of Property 50 South Harbor Road & 47130 Main' Rd. Southold, N.Y. h;~5~; ~iol ....................... '~'~;e~i ....................... h~d~iel County Tax Map No. 1000 Section 069 . .Block 06 .Lot 010 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated November 21, 1983 ~ pursuant to which Building Permit No. 12789 z dated December 6, 1983 ............................. 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 ......... CHIMNEY ADDITION TO EXISTING DWELLING & WOOD BURNING STOVE 4. The certificate is issued to ALLAN S. & THERESA A. CONNELL ..................... ?o¥.'o;-, '~,~'~' g~Xtir;,~Vr ..................... of the aforesaid building. Suffolk County Department of Health Approval N/A UNDERWRITERS CERTIFICATE NO ..... N/A PLUMBERS CERTIFICATION DATED: N/A ( Stove must have heat shields as per Rev. 1/81 manufacturs instruction. FO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL ' COMPLETION OF THE WORK AUTHORIZED) N? 12789 Z Permission is hereby granted to: ..~ .~ ~ .... ~.~.z.~..~.~.....=..~: ......... /.~.z./. .... , ot premises located at ...~..~ ......... .~.~.....'~.~'.~...~......~r~. ~.. ........................................... .......................................... ~.~.. ...... ~..~.~.......~.. ............................................................. ............................................................................ ..2~..~./.~. ~. County Tax Map No. 1000 Section ...~.~..'~...(~.. ..... Block ....~..'-~. ........ Lot No... -~.~..(~. .......... pursuant to application dated ...z~..~..'~.........~..*../.. ..................... , 19.,.<]LZ>....~, and approved by the Building Inspector. Rev, 6/30/80 FORM ND, 6 TOWN OF SOUTHOLD Building Department Town Hell Southold, N.Y. 11971 76.5 1802 TOWN APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ,., aaa=~.=~ to the Building I nspec* for 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-(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 unusual 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 Dwelling. S25.00, ^ceen,~ory t$10.O0 I~uel,ean $50.00 2. Certificate o! occupancy on pre-existing dwelling $ 50. O0 3; Copy of cert~ficate of occupancy $ 5.'00, over .5 yeare $10.00 4.Vacant Land C.C. $ 20.00 5.Updated C..O. $ 50.00 Date , · 6. ~%lteratlon $25.00 New C oas t ~ uc t i on ...... Old or Pre-existing--" ''- '~8uildmg ............ Vacant Land ............. Location of Property.. .~.~O,... . S qJ'F/J¢ .'t'(/~,~.~,~..O. ,/~.. House NO, Street Hamlet Owner or Owners of Property ...... ~ ............. '. · .' ........................ 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 ..... Requast for Temporary Certificate ..................... Final Certificate ,,,...~. ·, .............. Fee Submitted $....;~..~'~.~.~. .................. Construction on above described building and permit meets all applicable codes and regulations. Applicant ..... ~..~/..~~.~. ~ ............... ~ELD~INSPECTION COMMENTS .... ~ .3, FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY q~DE ADDITIONAL COMMENTS: N w+u $ PLAN IIq~l APPP, O¥~D AS HOTED NOTIFY BUrLD!NG DEPARTMENT AT 765-]802 9 AM TO Z PM FOR THF FOLLOWING fN?ECTIONS: 1. FOUNPAT~ON - TWO REQUIRED FOR POU~ED CONCRETE 2. ROUGH - FRAMING & PLUMS!NG 3. INSULATION 4. FINAL - CON%TRUCTIQN MLJST BE COMPLETE FOR C. O. ALL CONSTRUCTION 5HALL MEET THE REQUIREMENTS OF ~HE N. Y STATE CONSTRUCTION ~ ENERGY CODES.~ NOT RESPONSIBLE FO~ ~N e~ COnSTrUCTiON ~O~S qqgo 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING /~/~ ] FINAL REMARKS: DATE, ~ ?~''~ iNSpECTOR, TOWN OF $OUTHOLD OFFICE OF BUILDING INSPECTOR ILO. BOX 7~-8 TOWN HALL SOUTIIOLD, N.Y. ! 1971 TEL. 765-1802 This tn to advi~e you that the job under building perm½~ no. .~7~9.Z~_ issued to ~ Connell on ;_l..2~6.~3 .for ~%_~qn is comple'~ed and a final ~ns~-t~.on ha~ ( ) has.-uot ( x' )'"been do~e. in order to complete thie file, it is necessary that a Certificate of Occupancy be issued. Please fill out the enclosed form, return some to the above office with a check for $25.00 payable to thc Town of Southold. Please indicate Lo Whom the Certificate of Occupancy ia to be mailed, and arransc with tills office for an tnspeetlon (late Occupancy or t,,c ia unlawful without e Certificate of Occttpency. l'leal~o help un Lo clear up thle: matter so that leg;il action docs not have LO be taken. Thank you for ynur prompt attention. Victor Lessard Execut iva Administrator VI,: [;ar encl . FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined .../..~.~f~. ....... , 19YY Approved../. ? .~. ~ ........ ,1 ~..~.. Permit No../..~..~..~.. · ·~ Disapproved a/c ....... . ....................... ~ ..... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date..& ( ...... , 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 inspect/.ons. ~ ,-~ ~ .~ (Signature of applicant, or name, if a corporation) (Mailing aWdress of fipph'cant) State/whether applicant is owner, lessee, agent, architect, enodneer, general contractor, electrician, plumber or builder. Name of owner of premises...~4...~....~.'.../~.'.. [ ./.'~..~./{d'..... ~ ..................... (as on the tax roll or latest deed) ~f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Piumber's License No ......................... Electrician's License No ....................... et erTadesLicenseNo...~ ' .~ 1. Location of land on which proposed work will be done..~..q.4'~ . .4~.cc~c .L~..c2%r. .... County Tax Map No. I000 Section ..... . .~...~..~. ......Block ..... ~..~. ......... Lot...~).ff.d_b. ............ 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 .... ~/2~.0-~.~.. ' b. Intended use and occupancy ... ~..~..*d-r< ................................ 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ........... Repair .............. Removal .............. Demolition .............. Other Work..~./.6q.~,4.~/!~... (Descripffon) (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwalling units on each floor ................ If garage, number of cars ........................................................................ 6. If business, commercial or mix6d 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 ...................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ......... , ..... Rear ............... Depth ............... Height ............... Number of Stories ........................... 9. Size of lot: Front .......... ............ Rear ...................... Depth ...................... 10. Date of Purchase /.Z>-2.~.2'~ . . Name of Former Owner .O-'-/q/q~.~. ~.. 11. Zone or use district in which premises are situated .................... . ..... ~i~..~../}.././ 12. Does proposed construction viol~,te any zoning law, ordinance or regulation ........ .A)..~. ..................... 13. Will lot be regraded ........ .g~.~ ......~ ........... Will excess fill be removed from premises: Yes Name of Architect ......... . .................. Address ................... Phone No. ~7~7 .~..?.~..g.~. .... Name of Contractor ....Q-Tt~q.i. ~3 .~./ Address . Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NE~,RK~ / ~ (Name of individual signing contract) above named. He is the .............................................................................. (Contractor, 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 his knowledge and belief; and that the work will be performed in the mann6r set forth in the application filed therewith. Sworn to before me this .......... 2.13q. . .-:-: . .day o . . ., NOTARY/PUD[.IO, State of New No, 6~.8125850, Suflork Cou, n~y, / , ¥~rm 5xplree Mer~h 30, 19__.~c/ / (Signature of applicant)