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HomeMy WebLinkAbout12147-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector · Town HaH Southotd, N.Y. Certificate Of Occupancy No .... Zl.Z458 ....... Date .......... ~...ay..2. ................. ]9 .8.4. THIS CERTIFIES that the building addition Location of Property .... 2.1..5 ................. Oak Street Greenport House No. ' .....'S't/e~i ............................ Hamlet County Tax Map No. 1000 Section .... 0.4. 2. ..... Block ..... 0.1. ........ Lot ...~ 6, ~[ .......... Subdivision Est. 9f Thomas F. Priee~FiledMapNo .85.1. LotNo. 961) & 97 Sr. conforms substantially to the Application for Building Permit heretofore fded in this office dated ·..J.~DpAz:7. ~.l ....... , 19. [3.3pursuant to which Building Permit No .... 1. 2. .1.4.7.. g. .......... · dated ..... Fcb~.ual:7..8 ........... 19. [33, was issoed, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... an addition to ,existing one-family dwelling. The certificate is issued to .. . EUGENE MAZZAFERRO .................. ?o¥.'o'r, ...................... of the aforesaid building. Suffolk County Department of Health Approval ...... n..o.t2 .r.e. qg.~.r.e..d ...................... UNDERWRITERS CERTIFICATE NO .......... N 620133 Rev. 1/81 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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 ResiSences 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 peoperty 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 $5.00 / 2. Certificate of occupancy on pre-existing dwelling land use --Pre-E×±s t±ng C.O. $15.00 3. Copy of certificate of occupancy $1.00 Vaca~l, and C.O. $ 5.00 New Building ~ZP~. ~F-/.¢/c~ Old or Pre~existing Building ............ Vacant Land ............. Location of Property .. ~..~.'~. ....................... ~.dT..K~. .................. %?.~,.(..-~..M.P.~..~.'/~' House No. Street Hamlet Owner or Owners of Property , ~..C~.~,~.,,, ./~.~.~.2. :~ .F'.E'.~R. ~ ................................... County Tax Map No. 1000 Section ..... .~..'~'..~.~.... Block ....47/. ........ Lot., .c~..~..~., .¢~.~ , , , Subdivision ~'S.?... ,'~. ~S.. ~..~J .L?., , .~'..~. .... Filed Map No...~..~./ .... Lot No...~.?....?.../¢.'~F Permit No./.~..~?. ,~.., Date of Permito.,..,...~-~¢--~ ,Applicant . .~. ,¢-;~, .E'./¢.. ¢....~, ./?.~,, .~..',~, .~,,8.(~. .... ' .%._¢ Health Dept. Approval ...... ?'il .i*']~ ............Labor Dept. Approval ....... ;Cf, ........... Underwriters Approval..~. (~ ,~ ,~:I ~ ~¢' . .... Planning Board Approval .. '.~. -.~'~.¢[ Request for Temporary Certificate ..................... Final Certificate ........ ~ ............ Fee Submitted $ .... ~.¥..¢.-~0,, , . V.//.. ,¢7..'~,'..~. .... Construction on above described building ~.~-)~ermit~s all ap ,p/~c~ ?ble codes and regulations. Applicant ./?. ........................... F<I E~i )~INSPECTION FOUNDATION (1st FOUNDATION (2nd ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY qOBE FINAL FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined ................ , 1 Approved .~.'~. ?. .....~. ..... , l~.~Jf. Permit No...4 .c~?..~..~..~ D~sapproved a/c ...................... ..... f.~ ....... ............... .......... / (Bffildin,, Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No..fS~.f..~.//~... ........ Date ......... /./.~/ ...... 19. ~. a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ~ets 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 >r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :ation. 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 ~hall 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 ~hall 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 t dmit authorized inspectors on premises and in building for necess~% (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .. ~ .~.~.c-..~ .................................................................................. Name of owner of premises . .~../~...~../~.~.. \ . ~A~2..,Z~ .~. (~..M../R-. ~ ........................................ (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 .... -.-~.d.~ '. ............ Plumber'~ License No...~..~.. ~ Electrician's License No.. ~ Other Trade's License No ...................... l. Location of land on which proposed work will be done .................................................. .,,24...,X.5. .......................... . .o.n..r,,.. .... ............ House Number Street Hamlet County Tax Map No. 1000 Section ....... .~..~...~. .... Block ...... ...9..( ...... Lot....~.~-..~.. ?.~... Subclivision ,~'~'~T'~., .0..~...-'./-.~ .~.~,_~ .[~.Pf~.[C(~ .S~iled Map No. ~/ .... Lot .~.q' /.t~./.6~.~..q~ .......... fl ? (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... .~...~../J~..~../~..~ .................................................. b. Intended use and occupancy ....~. !~.~..t~. C~.. ...... ~fl... ~.'~g~-I/C ......................... 3. Nature df work (check which applicable): New Building .... Addition....,~.. Alteration Repair , Removal Demolition Other Work 4. ....... , ........................ ,,, , (to be paid on filing this application) 5. If dwelling, number of dwelling u~its ... ~ ..... Number of dwelling units on each floor...~ .... If garage, number of cars ...... , ........................................... ,~...; ................... 6. If business, commercial or mixed ~ccupancy, spec~y nat?e and extent of each t~pe of ~e . .' '.; ..; ~;'~ . .' ......... 7. Dimensions of existing structures if any: Front ~ Rear ~' · Denth , ~ ~ , ~ ................... r ............. Hmght .~ .......... Numb?r of Stones ~ ~ ................................ D~nensions of)amc structure wit~ alterations 9r~itions: Front .~ .......... 'Rear ..~ ~ .... ~ . . ~; ~ ......... Depth . . ~. ............... ? Height . . ~ ............... Number of Stone~,,/. ~ ................. 8. Dimensions of entire new construction: Front .... ].~ ....... Rear . .~.( ....... '.~. Depth .~.~.~ .... H~¢ht ,. ~f. ......... N~m~, o~ Sto~., ./ .................................... ~ ............. Siz~ ocPt: Front ..... g~ .... ~ .......... ~e~r. K~'". . ........... Depth ................. Date of Purchase . .~ ~... ~ ................. Name of Foyer Owner Zone or use district in which premises are situated..~.~ .................................... Does proposed construction violate any zoning law, ordinance or regulation: . .~ ...................... · ~ , . Will lot be regraded . .~. ·: .................. Will excess fill be removed from premNes: Yes No N~e of Owner of premises ~. tess . ~.~ .... Phone No ................ Name of Architect . .~.~ ............... Address .~~... Phone No. N~e of Contractor . ~.~.~ ............... Address ........... Phone No. 10. tl. 12. 13. 14. 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. ~T..A~ TE OF NEW YORK, ,.., · ~- .':. s,e'~.: .u'¢..z. /.i..~5..a~..r,..~. ¢.-.'7.T. ............... being duly sworn, deposes and says that he is the applicant (Name of individual signin~ contract) above named. ~e is the..,:2.-~..M~..~..':...~v..~..~ ....................................................... ' ' ,i ' (Contractor, agent, corporate officer, etc.) )f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this pplication; that all statements contained ha this application are true to the best of his knowledge and belief; and that the i york will be performed in the manner sbt forth in the application filed therewith. lworn to before me this .......... '~"/~ i ..... jd~y ' . ....19 0r?. Iotary Public, fi .~../. q,~~.. County . . . ....~'/~ .-/"/ u0 ~ (S~gnatnre of apphcant) 7GS.'~802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. ]/FOUNDATION 2ND [ ] INSULATION ~ FRAMING [ ] FINAL REMARKS: DATE 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. / FOUNDATION 2ND ~,,~, INSULATION [ ] FRAMING [ ] FINAL REMARKS: ,/ DATE ~ . I I dO.x ..............