HomeMy WebLinkAbout12798-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEP~TMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z19154
THIS CERTIFIES that the building.
Date JUNE 19~ 1990
ADDITION
Location of Propert~ 1285 CALVES NECK ROAD
House No. Street
County Tax Map No. 1000 Section 63 Block 07
Subdivision Filed Map No.
SOUTHOLD
Hamlet
Lot 36
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated DEC. 1r 1983 pursuant to which
Building Permit No. I2798Z dated DEC. 13~ 1983
was issued, and conforms to all of the requirements of the applicable
previsions of the law. The occupancy for which this certificate is
issued is GARAGE ADDITION TO AN EXISTING DWELLING.
The certificate is issued to
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
PHILIP & KATHRYN VAN BOURGONDIEN
H016319 JUNE 6~ 1990
N/A
Building Ins~ctor
Rev. 1/81
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETIO~ OF THE WORK AUTHORIZED)
N? 12~9~ Z
Permission is hereby granted to:
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............................................................................................................... :~::~.~..=.~.....Y.
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Building Inspector.
Fee $..,l.~....~....~'
u cl ng nspector
Rev. 6~30~80
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hail
Southold, N.Y. 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANdY
Instructions
This application must be filled in typewriter OR ink, and submitted .= ~ 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 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 Unde~writers.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa-
tions, a certificate of Coda compliance from the Architect or Engineer responsible for the building.
§. 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 property 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 D~eltinll.$25.00, 'accessory,.$10.00 tlush~e,~.~ $50.00
2. Certdmate o! occupancy on pre-existing dw Iling $ .50. 0 0
3. Copy of certlflcate of occupancy $ 5.'00, over 5 years $10.00
4.Vacant Land c.g. $ 20,00
~/ /
5. U~dated C.O.
6. )%iteration $25.00
New C on s t ~ u.c ~. i__on ~ . ~..~O d or Pre-existing Building Vacant Land
Location of Property ...........................................................
House No, Street Hamlet
Owner or Owners of Property ............ - ....................................
County Tax Map No. 1000 Section ............... Block ............... Lot ................
Subdivision Flied Map No Lot No
Permit No.~.~7.?..l~'..7-... Date of Perm[} ......... Applicant ..................................
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .....................
Fee Submitted $ .~.,.0. q ......................
Construction on above described building and permit meets all applicable codes and regulations,
..................
FIELD I~SP~CTION
FOUNDATION { 1 st)
FOUNDATION
2.
(2nd)
ROUGH FRAME &
PLUMBING
INSULATION FER N. Y.
STATE ENERGY
~DE
FINAL
iDATE COMMENTS
....
ADDITIONAL COMMENTS:
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST I- ] ROUGH PLBG.
FOUNDATION ZND [ ] INSULATION
FRAMING ,r. ~INAL
DATE //3~/~q
75-$-02031
Unauthorized alteratlon or addition to this survey is a violation of
seol or embossed ~eal sho[l net bo cons~der~*d to be a vohd copy
SURVEY FOR
C. g. VON BOURGONDIEN, INC.
AT SOUTHOLD'
TOWN OF $OUTHOLD
SUFFOLK. COUNTY, N.Y.
SCALE: I'% 40'
,JUL Y 8, 197'5
N.Y.
FORM NO, 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
E amiued ......... ,
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Received. /.2:./.77..., 1 9.~.~.
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 regu!ations, and to
admit authorized inspectors on premises and in building for necessary ins:p~ions.. .
... ..........
(Signatt~e ~'f applicant, or fl/amc, if a corporation)
· .~.d..t~.o~. iAt. t .... Sq~ .-C.~¢.q .~../~/,.k../.t ?.7! .....
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises . ?./.~.t./~. L ~..~,..~//~ .~.[../.~.0..C! (~.~. ~..A/.~.././.¢~..~. ..................................
(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..8.~ .~..O. ~ .~. ..... ~. ~(~C~J2~-~){ ~,)~
Plumber s License No .........................
Electrician's License No...~.: ~(~.~-]~. ,'
Other Trade's License No ......................
1. Location of land on which proposed work will be done ..................................................
................... : . . N ...... I~b. . . .
· I~ SS' C/~t.v'l£~ -~cl~ ......................................................
House Number Street Hamlet
County Tax Map No. 1000 Section .¢.~.,..-.7.'."..~.~. ..... Block .................. Lot ...................
Subdivision ..................................... Filed Map No ............... Lot ...............
(Nmne)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy . . ~.d./.~ .~. ...... t~./kd.~.~....~.~t'.(~..~... ,. ...........................
(
b. Intended use and occupancy ...~'~4. fl../4.6-..~..../9..7~..,q.c...t4fi'..b ...... ,,<7~Z2 ./-/~. / ~.~.. ..................
3. Nature of work (check which applicable): New Building ... i ../.... Addition .. ~ ..... Alteration ..........
Repair .............. Rembval .............. Demolition .............. Other Work ...............
(Description)
4. Estimated Cost ................ Fee .............................
(to be paid on filing this application)
5. If dwelling, number of dwellinglunits ............... Number of dwelling units on each floor ................
If garage number of cars
6. If business, commercial or mixeld occupancy, specify nature and extent of each type of use .....................
7. Dimensions of existing structures, if any: Front..~..ll~q" ' ". .... Depth .~-.~ ~. ~.'.~ ....
.......... Rear . ~. ~t. .....
Height .... d,l, II ........ Number of Stones ... o'~ ...............................................
Dimensions of same structure With alterations or additions: Front . ~o~.~ .~':'. ....... Rear .~.d, .....
Depth .2~ t.. ].,,. .....
...... ~.. Height ..... 41,0 .~ ............. Number of Stories...,2, .................
· ../.~ .jr.,.,. Rear ...1. '.d..~. ....... Depth .~ ../0 ........
8. Dimensions of entire new construction: Front . , ,' .. , 0 ,, r
Height .... ,gq '. ........ Number of Stories ..... 1. ............................... ,.
9. Size of lot: Front ..... ligS',lL~['.7. ........ Rear .../~.og.,.~. ~. ......... Depth . ./g.l.5~,. ~?. .............
10. Date of Pnrchase .. $//.P2~../..F{I~.. ............. Name of Former Owner . ~R/I/A .C.o~,g-I ,.q Ot~( ..........
1 I. Zone or use district in which pr~mises are situated .....................................................
12. Does proposed construc, tion violate any zoning law, ordinance or regulation: ./5/.0. ............................
13. Will lot be regraded .. ~"~$ ...................... Will excess fill be removed from premises: Yes
14. Name of Owner of premises~., 17~p/.~.O ~.t~ ~.~ ~.lKo~Addressl~Sy..C.~..V~.,$./ff .~'~;4f/l~Phone No. J.g...)-.-/.~..5'~ .....
Name of Architect ......... i ................. Address ................... Phone No ................
Name of ContractorPJA~l~.. 150t~..q-I¢O~t~ ...... Address ~PtC,.f'~'L .(/-/J,~q.~o.~'U. Phone No. '7. ~..-g.x .~.O..~.~...
PLOT DIAGRAM
Locate clearly and distinctly al! 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 NEW J~ORK, ,,,
COU Y, ~F ¥~Z/....*.~ K,._J- . ~ ~'~
above named.
being duly sworn, deposes and says that he is the applicant
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 conthined 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 :
Notary Public, .~-~'>~°/fz*'c~ ~J' ~ .... ,'., .,'.]~ County~.~ 0..~