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Home My WebLink About10474-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.. Z150~6 Date November 5, 19 .86. THIS CERTIFIES that the building Enclosed existzng patio Location of Property 620 Platt Road ' Orient~ N.Y. County Tax Map No. 1000 Section 18 .Block 05 .Lot 22 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated · ~ .o y.e.m.b..e.p..8. ~ ........ 19 79 pursuant to which Building Permit No.. 1 04 74 g dated .· ... , . . . . . ................N o ye m b e r 1 3 ~ . 19 .7.9., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which ttfis certificate is issued is ......... enclose existing patio The certificate is issued to Constantzne & Rosalie k. Bondarchuk ..................... .................... of the aforesaid building, Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO .................... .N/.A. .......................... Building Inspector Rev, 1/81 FOR~I NO~ 2 ?0~ OF $O~THO~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10474 z Permission ~s hereby granted to: ..... ~Zo.~.~,~..,<.... ~. ~. ~zrc~..,< ..... ~. z.~.......~.,.-z......~,~. ........... .... C2.~..~..~.....-....AK...:....c/.. .............. ~o ...... ~.~.. c z. o.. ~.~ ...... ~. r=..~¢. ~ cf ...... ..P..~/..-.z.o.. :..-.......('¢.~z,,~ ~ ~..~.~) at premises located a .......... ./.. ....... pursuant to application dated ~..~...~.~./~./~'~---~.--...~ ,....., 19Z~..., and approved by the Building Inspector. Fee .................... FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y, 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ~a ~ to the Building Inspec,. tor with the [ollowing; 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 d|sposel-(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 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4~Vacant Land C.O. $5.00 5 ~ UpdaLed C.Oo $15.00 $15.00 Date .......................... New C ohs t.~,uc tion ...... Old or Pre-existing Building . ,/ ......... Vacant Land ............. Locadon of Propertv .................... ~, ~ ~ ~,./.~ ~ ........ Owner or Owners of Property ~ ~Z~~'( .~., ~~.~ 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 $ ............................. Construction on above described building a~t n~ts a~es and regul~ons. ^ ,,ca -- ........ ........ Rev. 10-10-78 FIELD INSPECT~0N FOUNDATION (~st) COMMEN~TS FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N.Y. STATE ENERGY COpE FINAL ADDITIONAL COMMENTS: · ]-iglSNQdSZI~t J.ON 0 D "dOzl FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 7654803 Examined .~..~...., 19 .~.~. Approved ~/~/4V-'/~ /' ~ ., 19 .'.~. Permit No...~..~...~.l.~'~ Disapproved a/c ~...i_~.:._._.L.. ............. ,~ .... iS (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No..l~.'..~. ~..~. ...... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate 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 detaded 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 issue 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 Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the constructmn 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 buildings for necessaw_ inspections. · .... (Signature of applicant, 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 of premises~.~.~..~....~0~.~.~... ~j~ .... '~&4~(20~.. ¢~..~.... ....... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Plumber's License No ....... Electrician's License No ..... Other Trade s License No ..................... 1. Location of land on which proposed work~...~1~...~.~ .... (_~~ ........... House Number Street Hamlet County Tax Map No. 1000 Section ....~?~..~. ......... Block ...~..?--. ........... Lot..~. '.~...27T .......... Subdivision ..................................... Fred Map No .............. Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended use and occupancy ................................. ~_~..~ ..... 10. 11. 12. 13. 14. Nature Of work (check which applicable): New Building .......... Addition .. ~-/~.. Alteration .......... Repair .............. Remo~ai ..., ........... Demolition .............. ~Other Work ............... ~ (Description) Estimated Cost ............................ Fee ........................... ~ (to be paid on filing this application) If dwelling, number of dwelling ~nits...~'1~ .... Number of dwelling units on each floor If garage number of cars l~,f,-ga ................. If business, commercial or mixed! occupancy, specify nature and extent of each type of use ..................... Dimensions of existing structures, if any: Front ............ Rear .............. Depth ..... ~.. ~ ...... Height ............... Number of Stories ........ ~ ............................................ Dimensions of same structure with alterations or additions: Front ...~...a.~,~,:~... ....... Rear .................. Depth .................... ... Height ...................... Number of Stories ...................... Dimensions of entire new construction: Front . ~, ~t. ~ ......... Rear ............... Depth .... J'~. ...... Height ............... Number of Stories ............................................ t ........... Size of lot: Front ......... /.~ .' ....... Rear ....... /.~'Z~ J .......... Depth .... /.~'% ............ Date of Purchase ,.. l.q~.~.. ?,. ................ Name of Former Owner /~)~ .~f..~7,~ ..... Zone or use district in which premises are situated ..................................................... Does proposed construction violate any.. zoning law, ordinance or regulation: .... ]~ O. ....................... Will lot be regraded ....... ~. ~ .... ~ ~,...,~ ...... V~i~] exc~.s~Afill be r~er~oved from premises: Yes Name of Owner of premises ~. ],~A'~~ ~./~)Jo4~Phone No.~_2.. Name of Architect .......... ,~. ......... Address ................... Phone No ................ ' ~ Address Phone No Name of Contractor ......... : ............................................ PLOT DIAGRAM Locate clearly and distinctly all ibuildings, whether existing or proposed, and. indicate all set-back dimensions from prope~y lines. Give street and block: mmber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW f'~RK, COUNTY 0~.. ....... being duly , t~ame oI lnUlVlOUal s~gi~ng contracD above named. 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 manner set forth in the application filed therewith. Sworn to before me this ........... ~,./~ ....... day o!... Nota.~.Public, . ..... ~_< ....... '~v.,---v · .... .......... NmARY PUBLIC, State ,?!.~/Y. or~ . (Signature of applicant) No, 5:~-8125850, Suffolk County_ Term Expires March 30,