HomeMy WebLinkAbout10476-zFORM NO. 4
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
5outhold, N.Y.
Certificate Of Occupancy
No. Z9894
MarCh 10 80
Date ................................. 19...
THIS CERTIFIES that the building ................................................
122.5 Gull Pond Lane Greenport, N.Y,
Location of PropertyHouse .............................. IVo.
County Tax Map No. 1000 Section ............ Block ............... Lot .................
Subdivision Fordham Acres .Filed Map No.
conforms substantially to the Application for Building Permit heretofore fried in this office dated
November 13 19 7..9. pursuant to which Building Permit No. 10/~76Z
dated....N°vember............ ·....14 19..., 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 .........
Two Car C~g~; ~,ccessory Building
Shirley and Ralph F. Crocker
The certificate is issued to ..................... [d~,n'o'r,'~ .....................
of the aforesaid building.
Suffolk County Department of Health Approval ..........................................
UNDERWRITERS CERTIFICATE NO ..................................................
Building Inspector
Rev 4/79
TOWN OF $OUTHOLD
~UILD[[qG DEPARTMEblT
ToWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDI~'iG PERMIT
(THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL
cOMPLETION OF THE WORK AUTHORIZED)
N? 19f176 Z
Permission is hereby granted to:
· .~,~f~...~.d,;:C.~.c4:,a../T..~ ..........
...~.~,~..~.~.~'. ~.% ..~. z~. Z, ..........................
....c/o_,..<,¢-,.
~o ..... .~.a.~.~...z:.~.~..~....r.~.....~..`z.....c.z:~..c.~..~z~.~..~...`d~¢~z:...~/...c:.....~ ...........
.......... ~2~. r..k,..,.~L, br.~. ........................................ __.~,. .............. :, .................... ~ ...................... :::.... ,,
~.xc~.~.~..,..xZ-~.:.-..,.., ....... ~...?.. .... ...-....,(.~..x-..~...../.~.. .....................................
pursuant to application dated ~L~..-~..~.~.~/x~,-.../....~', ............. 19~..~..., and approved by the
Building Inspector.
Fee $..f..! ..................
'"i~~'1 Burlding Inspector ~"
FORM NO. 6
TOWN OF SOUTHOLD
BU tiding 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
natura~ or topographic features.
2. Final approval of Health Dept. of water supply and sewerage disposa]-(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 peoperty showing all property lines, streets, buildings and unusual natural or
topographic featu res.
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 or land use $5.00
3. Copy of certificate of occupancy $1,00
Date ~/'4'~& ~ ~t ''~ /~g~
New Buildin§ ............. Old or Pre-existing Building ............ Vacant Land .............
Location of Property . ./..~..~.. ?7 ..... .~.~..e~..L..~.. i~. e.~../.)...4. ,~../~..~' ....... .~. '.j~../~.=./~./V/~..~..~..~.
House No. Street ¢ Hamlet
£ cp..4 .............
Owner
or Owners of Property ......... /. ......... ..
County Tax Map No. 1000Sectlon .~7 '-~ .~.~... Block ..... ~. ........ Lot .............
Subdiv,sion..~..~..~..?.~.0.~.~... j~.~. (e,..~..5. .......Filed Map No. ~;5.-./..~...Lot No .... ./.~.~. ......
Permit No. /..~.L/~, 7~'. Date of Permit L__ ..... ~..Applicant. ~/~ .~..~ ~-- .(~. ,t~..~.~/g,~.fi'.~ .~.
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certflicate. ~.-. ..... ~. ........... Final Certificate .......................
Fee Submittad ............................
Construction on above described building an_fl-f~mit meets al~c~able c~j:jes and r,e~ulations.
(
?IELD I~PEC~T ION DATE COMMENTS
1.
ROUGH ~ a
PLYING
INS~TION P~ N.Y.
STATE E~GY
cop
FINAL ~
ADDITIONAL COMMENTS:
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 7654803
Approved .kt. . . . . /. ..... l ?ee it No. Io.¢. .Z
Dmpproved a/c ......... '..'~ ....... '~ .......
................. ..... 'd' '" .d/
APPLICATION FOR BUILDING PERMIT
DatW~..~.~. .... ./.~. ......
Application No...t(~). · .~../7..~ .......
19 ?~.'
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and sabmitted 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 detailed description of layout of property must be drawn on the diagram which is part of this appli-
cation.
c. The work covered by th~s application may not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Bmldmg 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
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 kerein described.
The applicant agrees to comply with alt applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in buildings for necessa~ inspections.
~' '~bSgnature of applicant, or name, ~f a corporation)
h'"~p.~..r< s .p.a. '.F.n'.,.57,,~.T./t,,.~..,4.,..,g. ....
....... iI~l'ailing add'ss of applicant) /
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
....... D. ~. t¢.~. ...........................................................................
Name of owner of premises
(as'on the tax roll or latest deed)
If applicant is a corporabon, signature of duly authorized officer.
(Name and t~tle of corporate officere)~
Builder s L~cense No.. · ~.ey....~.~...~.../.~-~c./~.tS>
Plumber's License No ......... ./ ..............
1
Electricmn's License No ...... .). ..............
f
Other Trade's License No ......................
1. Location of land on which proposed work will be done ..................................................
.. 1..'g. ~55. ............ .~.~ .t..c..p~ .,.,. ~../, ~ ~.~ ............ ~£~ .~p~..r-. ~ ..............
House Number Street Hamlet /
.County Tax Map No. !000 Section . .O..~_~. ......... Block ....q. ............. Lot ..... ? ...........
Subdivision..~..f~..~./.~..~.' .t~....~..¢..t~.~'.~. Filed Map No. ~.,5.-./.~. ...... Lot../,~. .........
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ... C/q./.~..'~....~.... ~'O..(~.t~.~Z ./'-t4. t~( J~ -/////
and occupancy ~ ~/~ t~ ~;'~*tZ~;~:'~ &'~(f~e;~:~SJ-~.~..~
b.
Intended
use
/
/
3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ..........
Repair .............. Removal .............. Demolition .............. Other Work ...............
.~.g/f/.~..O.O ~ ~/d9 ~ (Description)
4. Estimated Cost ..... , .................... Fee .......................................
(to be paid on filing this application)
5. If dwelling, number of dwelling U_nits ............... Number of dwelling units on each floor ...............
If garage number of cars ,7~..t~ ~ ~'~3 .............................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ....................
7. Dimensions of existing structures, if any: Front ~.~.~. ......... Rear .............. Depth ..............
Height ............... Number of Stones .......................................................
Dimensions of same structure with alterations or additions: Front ................. Rear .................
Depth .................... i' · Height ...................... Number of Stories .....................
8. Dimensions of entire new construction: Front ............... Rear ............... Depth ...............
I-[eight .... /. ~. ?.'F, ....Number_of Stories ...O. ~ ~' ................................................
9. Size of lot: Front .../..~. ~ '. ~...~ ........ Rear ..... /. &t~. t. ............ Depth_ ~t',~.y..~.~ I~.n~ ~/7'..~...
10. Date of Purchase ........... ! .................. Name.o.f~ormer Owner'S47'.//. ~'..P~.~.7'.~.~..'IP.v. ~r.ff.~..~. 3'. ....
1 1. Zone or use district in which premises are situated... ~..-7...$~J~.~.. ( .~.~=.-~-?;r.t.,'? .,~--. .........................
12. Does proposed construction violate any zoning law, ordinance or regulation: ., .A('.~ ..........................
13. Will lot be regraded ...... '~ 'i ................... Will express fill be removed from premises: Yes No
14. mameofOwnerofpremises~'~/O~.~.~...~.~.~.~.Address .t~.~..~.2~..~f~..~..~.e.T.A(...PhoneNo ..... ..~...6;:~..-'..
Name 0f Architect ....... ~/'~.L. ~. ............ Address ................... Phone No..._...
Name of Contractor ...... ~..1../'. ............. Address ................... Phone No.
PLOT DIAGRAM
Locate clearly and distinctly ail! 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 Yfl/RK,
COUNTY OF. ~ i~'~
(Name of indiv~¢ual sig~ing 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 manner set forth in the application filed therewith.
Sworn to before me this
......
NOTAR'~UBLIC. Sfa're of New Y rk · --,~ .... ~ ..........
~. s~-~s2~0~, s:,~ol~ co,,~v ,.~TJ (Signature of applicant)
Two
/
/
E
USE IS i Nk^ ¢FIk
OL§CCUPAN,CY
2, X¥'% q' oc
AS NOTED
NOTIFY BUILDING DEPARTMENT A~
765 1802 9 AM TO 4 PM FOR THE
FOLLOWING I "4s,r~ECT/ONS.
I. FOUNDATION - I~VO REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMING 8, PLUMBIN~
3 INSULATIDN
4. FINAL - CONSTF~UC, TION MUST
BE COMPLETE FOR C O
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N Y,
STATE CONSTRUCTION g ENERGY
CODES. NOT RESPONSIBLE ,gO~
4&~SIG~)~ CONSTRUCTION ERRORS,' '
L c~T t ~ .
k,,T., sT.~