HomeMy WebLinkAbout12612-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No...Z-15248 Date ....F.e.b.r.u..a.r.y..4.2. 1987
THIS CERTIFIES that the building ADDITION TO ACCESSORY BUILDING
600 King Street Orient, New York
Location of Property ...........................................
House NO. Street ...............
County Tax Map No. 1000 Section 026 .Block 02 ..... Lot 036
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
....................... pursuant to which Building Permit No. 126 ! 2 z
September 8, 1983 ......................
dated.......................September 16, 1983 ...... , wasissued, 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 ACCESSORY BUILDING
MICHAEL & CATHERINE BOGDEN
The certificate is issued to .......................... .................................
(owner,/~.mYeJt li,~l{~ X X X
of the aforesaid building.
Suffolk County Department of Health Approval N /A
UNDERWRITERS CERTIFICATE NO. N / A
N/A
PLUMBERS CERTIFICATION DATED:
Rev. 1/81
~OElt~ NO. ~
'tOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
12612 Z
Permission is hereby granted to:
..... ...........
.................
,o...~.~ .... ~ ~.~ ~ ~ .......~ ...... ~
at premises located at ..... (~..~-)~ .......... .~.~.~....~ ......... ~~.: ......
County Tax Map No, 1000 Section .,,...(~.,.~....~, ....... Block ..... .,~..~ ..... Lot No.....,(~.....~.....~. ......
pursuant ,o application dated ..... .~~~....~. ....... , 19..~3.., and approved by the
Building Inspector.
Fee $..J.....;. ..............
Btlllcling Inspector
Rev. 6/30/80
The
New York Board of Fire
underwriters
is in the process of issuing a certificate o~
compliance for the etectrical inst¢~at~on
as covered in an apptication noted
below.
rtificate will providCdCail of the
and certilied to be in comp
National Electrical Code as o! that date,
(Application Number)
(Inspector)
/~.~(Rev. 01/96) ~
FORM NO. 6
TOWN OF $OUTHOLD
Building Department
Town Hall
$outhold, N.Y. 11971
765- 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
FEB 3 - 1981
Instructions
A. This application must be filled in typewriter OR ink, and submitted ... ~ to the Building Inspec-
tar 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 Residelnces and similar buildings and installa-
tions, a certificate of Code compliance from the Architect or Engineer respon.s!ble for the building.
5. Submit Planning Board approval of completed site plan requirements where apphcable.
For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate ~urve¥ of p~operty showing all property lines, streets, buildings and unusua~ 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 Dwelllng,$25,00. Acee.~.sory ,,$10.00 BusJ. ne,~s $50.00
2. Certificate of occupancy on pre-existing dwelling $ 50.00
3. Copy of certificate of occupancy $ 5.00. over 5 >,ears /~10.00
4.Vacant Land C.O, $ 20.00
c.g. , o.oo ate ......
· ~lteration $25.00
NewCons truction Old or Pre-existing Building Vacant Land
Location of Property ....... ~.... ~'-~'.... ........ ~. '
/louse No. Street
O.nerorO.nerso, P,operty ....
County Tax Map No. 1000 Section .... ~ ........ Block ............... Lot ..... ~-,~.. ......
Subdivision ................................. Filed Map No ........... Lot No .............
Permit No. . Date of Permit Applicant .....
Health Dept. Approval ........................ Labor Dept. Approval .......................
Underwriters Approval Planning Board Approval ..........
Request for Temporary Certificate ..................... Final Certificate ......................
Fee Submitted $...,,/.d~. ~,, .................
Construction on above described building and permit meets all apPlicable codes and regulations.
n~v. 10-10-78
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN }/ALL
SOUTHOLD, N.Y, ! 1971
TEL. 765-1802
'l'hJs is to advise you that the job under building
parfait no. ~126~2~ issued to Michael Boqden
on --3./1~/_8~____ for _~3~c_~essory is completed and
a fi. hal ~n.,pection has '~----~'has not ( X ) been done.
rD order to complete this file, it' is necessary that
a Certificate of Occupancy be issued. Please fill out the
enclosed form, return same to the above office w~th a cheek
for $1D.O0 payable to tile Town of $outhqld. Please indicate
to Whom tile Certificate of. Occupancy__La_ to be mailed, and
arrange wlth t ~l~s office for an inspee~on date
Occupancy or use in unlawful without a Certificate of
Occupancy. Plnase. help u~ to clear up thls~ matter so that
legal action does not have to be taken.
Thank ye, for your prompt attention.
Victor Lessard
Executive t~dm[uistrator
VL:gar
enc].
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O, BOX 728
TOWN IIALL
SOUTHOLD, N,¥. ! 1971
TEL. 765-180~
'rhJs is co advise you that. the Job under bu[ldlng
permit no, ~ issued to Michael BocTden
on .9/1~_83___ for _~.sory is completed
a final ~nspectiOn ha~, ( ) has not ( X ') been done.
and
in order to complete this file, it' is necessary that
a (;ertJficatc of Occupancy be issued. Please fill out the
enclosed form~ return same to the above office w~th a check
for $10.00 payable to the Town of Southold. Please indicate
to Whom the Certificate of Occupancy ia to be mai[ed, and
arrange with this office for an inspection (late
Occupancy or rise is unlaw£ul without a Certificate of
Occ,pnncy. Please. help ,, ~o clear up ~hia; matter ac ths~
Je~nl action does not bays to be taken.
Thank you far year prompt attention.
Very truly _y~,
Victor Lessard
Executive Adm[nistrator
VL:gar
encl .
FIELD INSPECTION
FOUNDATION (1st)
COMMENTS
FOUNDATION (2nd)
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
QODE
FINAL
ADDITIONAL
COMMENTs:
[ ] FOUNDATION 1ST'"[ ~] ROUGH *PI~BG.
[ ] FOUNDATION 2ND [ ] INsULATi
[ ] FI~.MING ' [ ~ FINAL
REMARKS:
DATE ~"')l ' ') '~ L~ INspECTOR ,\~
FORM NO, 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1802
Examined...5.&~...'~..h..., 19~.~
Approved.....~.. ~. ,~- .~,., 19~, ,~, Permit No..1.' .~.(~ .1..~..~.'
Disapproved a/c .....................................
Received .......... ,19...
(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
Re ulations 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 inspections.
(Signature of 9pplicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
..................... ...............................
Name of owner o f premises . .'~...~.-..~.~..... ~.'/.F~/~/.~. ~ / .... .~ ~...,~ ....................
(as on the tax roll or latest creed)
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. Location of land on which proposed work will be done ..................................................
' ~'~' '~' ............. "' '~'/' ~e'e '~'~°~' ' ' ' ' ' ' '~' '/Z'/' '~' '~/' '~' .....................
t~ouse Number i .... Hamlet "
County Tax Map No. 1000 Section ..... (,~. o~.~. ..... Block .... ..~. ~ ....... Lot....(,~ ~...~. ........
Subdivision ..................................... Filed Map N~> ............... Lot ...............
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ... ~.~1 ...........................................................
...................................
b. Intended use and occupancy
3. Nature of work (check which a plicable): New Building .......... Addition... · .¢~.... · Alteration ..........
Repair .............. Rem. >val .............. Demolition .............. Other Work ...............
, (Description)
4. Estimated Cost ¢/r~lc^o.c~.~'I ......................... Fee ......................................
(to be paid on filing this application)
5. If dwelling, number of dwelling iunits ..... I ......... Number of dwelling units on each floor....--7 ...........
If garage, number of cars . . .-rrx.. . ................................................................. . .
6. If business, commercial or mixed occupancy, specify nature and extent of each ty~pe ~f use .~.._....~.
7. Dimensions of existing structurgs,, if any: Front. ,/0. t. (~.? ..... Rear . . ./. ~...6..~ .... l~epm . ii ~ id'. .-~......[ ~/~ .....
Height . 7. ............ Number of Stones .... ./ ................. ,} .................. ;.._. ............
Dimensions of same structure with alterations o~additions' Front ~. ........... Rear ... '.~.~..t..
/ ! , . .-t-- .....
Depth ...6~. ............. ;.. 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 .... ].q~..~. .................. Name of Former Owner ~.~.¢,~'...~. [O-~ ..........
11. gone 6r use district in which pr~mises are situated...C~ ~ d ~b:,.~o~- .....................................
12. Do~s proposed construction violate any zoning law, ordinance or regulation: ~ ........... ~ ............
13. Will lot be regraded ....~. i ........ aWill, excess fill be removed from premises. Yes
14. Name of O~vner of premises ~ ! .~r~..~..~'. ?..~..~..r!~.~.~dPd~ess ... 6~.o0...~.'~.5..P..... Phone No..~3~.~ .-.
Name of Architect ......... i ................. Address ....... .~.rT..~.. ..... Phone No ................
Name of Contractor ........ ~ ................. Address ................... Phone No ................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, anti. indicate all set-back dimensions from
jro lines. Give street and block'number or description according to deed, and show street names and indicate whether
r corner lot.
STATE OF NE~V~ YORK,, e e
...~6h4~4-. :l .~,~...'. g:..~.o. ~4~ ................ being duly sworn, deposes and says that he is the applicant
I (Name of individual signing contract)
above named.
He is the .... 'e, CxT. ......... ,: i' (Contractor, agent, corporate officer, etc.)
of said owner or owners and is du!y 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 ~n the manner set forth in the application filed therewith.
Sworn to before me this
~.,e.~.~ .day o ~ .~c'.. ., 19
~OI~ARY PUBUC, State o* Ne~'tYor!~ '
No. 4641336, Suffolk C~un y
O~rlrnission Expires ~arct~ ~0,
".i
NO, IF~, ~t i~D NG DEPARTMENT AT
755-1802 9 AM TO 4 PM FOR THE
1. FOUNr4'TION - ~0 REQUIRED
FOo p~URED CONCRETE
/'1.1'¢
10'6"