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HomeMy WebLinkAbout10345-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.. Z11236 .......... Date .. October. 6 ...................... 19 82. THIS CERTIFIES that the bmlding . . . , .. Location of Property . . 4270. l~lew. Suffolk. Road. &. 3720. Gral:h~ohl. Rd,. New. Suffolk ....... House No. Street Ham/et County Tax Map No. J000 Section ...1.1.0. ...... Block . 08 .]Lot 030 Subdivision ............................... Filed Map No ......... ]Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated · .A.ug.u.s .C..3 ............, 197.9. . pursuant to which Building Permit No...1.0.3.4.5.Z .............. dated . .A.ug.u~ .t..3 ................... 19.7.9., 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 ......... · ~lilt. ~h~e rPP.f {~tt.d~.~.i.o,n .~9 .e.x~sting dwelling The certificate is issued to . . . ,lgbri. J,..C9~¢b.. [o~n'o), ~,~, t4~4~'-t.) ................... of the aforesaid building. Suffolk County Department of Health Approval . Iq/A ...................................... UNDERWRITERS CERTIFICATE NO.. N/A ............................................. Rev. 1/81 Building Inspector FOI~V~ NO. ~ TOWN OF SOUTHOLD 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 ^UTHORIZED) Permission is hereby gronted to: 2~ .... ,o ..... of premises 'ocot:d ~..~ ....... ~.~...~ ............... ............................... ::~"~'~'~ ........ ~"~ ..................... 'C ..... .............................................................. Building Inspector. ~,~ ,.Z~ ...... FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. 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 alt 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 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 requirement~ where applicable. B, 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. Fees: 1. Certificate of occupancy $5,00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date ...... New Building ............. Old or Pre-existing Building(Z), _..¥% _ ~ fVacant Land ............ Locat,on of Property ......... Jou~e No, Street ~.t .~ ~.~rnlet Owner or Owners of Property . .'~"~'4,1~..~ .'~..~.~..~O~ ................................ County Tax Map No. 1000 Section .............. Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. ~,~, ,~,1~'~,,. Date of Permit ,~,/'"~h'~ .Applicant. ~t.).~,,, .L. ~,1~ ~ ........... ~.~. ' 0 ~ Health Dept. Approval .................... Labor Dept. Appr val .................. ,.. Unde~riters Approval ...... ~. ~ .............. Planning Board Approval ..... ~ ~ .... ' ....~ ,.~ Request for Temporary Certificate ..... Final Certificate ~ * ...... . .... ., TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR ' P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 - Applicant This is to ~dvlse you that the jo~ upder Building Fermit No. ].p~ issued to'-~A~'~-~~ on ~)~79 for -~~ is completed and a ffnal inspection has~---~ hfs not z~~ been done. In order to complete this file, it is necessary that a Certifzcate of Occupancy be issued. Flease fill out the enclosed form(s), return same to the above offzce with a check for $5.00 payable to the Town of $outhold. Flease indicate to whom the Certificate of Occupancy is to be mailed, and arrange wzth thzs office for an inspection date. Thank you for your prompt attention. Very truly yours, Victor Lessard Admznistrator VL:ec Enclosures ~ ~. ~ ,5 Ai~, DITJf_~t, JAL- FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 ~ TEL.: 765-1802 ~ Examined L~'~K~'-- ~ ,1977 ~ App`icat'°n N°, ./~' '~' '~' · ...... APPLICATION FOR BUILDING PERMIT Date ................... 19... 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 promises 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 apphcation, 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 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. d.d~e~tig~ns, and to admit authorized inspectors on premises and in buildings for necessary' ections..~.. ~ .~..~' (Signature of applicant, or name, i.f a Corporation) .... ~...:~.,.v.. .... ~,?,q.. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engdneer, general contractor, electrician, plumber or builder. ..... .O, .................................................. (/ Name of owner of premises . ...~. r./'7. ~'.-:- ..... (~. ~. ~..~.' .~. .......................................... (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...~~ Plumber's License No.v............../ . Electrician's License No ...................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ....... ~ ./~../~. 77.~.. ~.,.2..~..zQ. .....~/q..~ ........... ... .... o: .o. .......Fo:.. ............................................ House Number Street ~ Hamlet ' County Tax Map No. 1000Section //~..d Block ~.c~ Lot .(~...-'~..~. ' Subdivision ............................. ' ...... Filed Map No ......... ,.. Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... /(..-/..o??.q..c'..~. ................................. Z' .x, ........... b. Intended use and occupancy .... ~..~..~d. ....2~. F~.'~,~:-./..~... ,i~.._.~..~..~. ~. '.... ~.~O .~..~.. ........... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. RemoVal .............. Dem01itlon .............. Other Work ............... ~ ' (Description) 4. E~itimat'ed Cost ........ ~. ...................... Fee ...................................... ---- ~ (to be paid on filing this application) 5. If dwelhng, number of dwelling finits ............... Number of dwelling units on each floor ................ If garage number of cars ~ ' 6. If business, commercial or mixedI occupancy, specify nature and extent of each type of use ......... ' ............ 7. Dimensions of existing structure~,ifany: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ..... Z'. .................................................. Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth J ..................... Height ......... ,Z'.. ! .......... Number o~ Stories ......... .. ;./ ......... 8. Dimensions of entire new construction: Front . ~(7 --- Rear ~.~ t ~ Depth . .~. . .-7. ........ Height.. .............. NumBer of Stories ........................................................ -- 9. Sizeoflot: Front ........... ' ........... Rear ...................... .[le~pth .~-~ ..... ~ ........... 10. Date of Purchase ........... I .................. Name of Former Owner . ..~:...-~.. t(--~.~.~. ...... ... 1 1. Zone or use district in which premises are situated .......................................... / .......... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................. 13. Will lot be regraded ......... ................... Will excess fill be removed from premises: ..... ~i'" N(~.~ 14. Name of Owner of premises ' Address .. Phone No. ' Address Phone No Name of Architect ............................................................... Name of Contractor ......... ' ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctl.y all !buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block humber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW~-yORK, ~, o COUNTW OF ...~~'~-~...~--~ - "~:~' ' ' ' ................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ............ ~ ............................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have perfomed the said work and to m~e and file this application;'that all statements contained ~ this application are true to the best of his knowledge and belief; and that the work will be perfomed in the manne! set forth in the application filed therewith. Sworn to before me this . . .... ,..: ......