HomeMy WebLinkAbout10205-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No .... Z,.]_.1_.3.7.9. ....... Date December 16 19 82
THIS CERTIFIES that the building ................................................
Location of Property 82.5 .Brzxy..A.ve. nue. ~ncl. 75..Alb.o..Dr ~-y..~ .L~.'4z7~% ............
House No. Street Ham/et
County Tax Map No. 1000 Section .12 6 ........ Block . .. 0~ .......... Lot ... OQ.7 ...........
Subdivtsion ............................. Filed Map No ......... Lot No ..............
conforms substantially to the Applicanon for Building Permit heretofore filed in this office dated
· . Nay 9., ........... , 1979, pursuant to wkich Building Permit No...~O.2.qB..z .............
dated .. Nay. 113 ................. 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 .........
...cons.t. ruc~. high..f, ence..on. ~ide..o.f~. eX~.s.~$~g..~We~.~g..~...a.d.d..~o. .........
existing fence
The certificate is ~ssued to . . . Fr.ank. J... Fl±ss./o'~n'o'r,'/~e'~r't~/l~n't~ .....................
of the aforesaid building.
Suffolk County Department of Health Approval . .N/A .....................................
UNDERWRITERS CERTIFICATE NO...N/A ...........................................
Rev, 1/81
Building Inspector
FOI~M ~TO, ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
CQMPLETION OF THE WORK AUT~-~ORIZED)
N? 10205 Z
Permission is hereby granted to:
-'"- 4- ,2-
...... ..F.-.~..,. ....... /-<..,.x.......~-.. ~.,.~ ........................
...... .................. ,
1
Lz.x/4w~'~ ~ .,,z~..~... ~t/.... ~ ~.. d~.../.~...., zz-..~.,<.~.x:z.~.~.-.?.....~..,E...~. ¢ ~ .......................................
at premises ~o=ted at ~..Z.~...&.X,~'~y..X~... d....~.~...........~..~..__~.,.....__~.,:C~.,.
pursuant to application dated .............. .~......-. .................................. 19.7.2.,, and approved by the
Building Inspector.
Building Inspector
FORM NO. 6
TOWN OF SOUTHOLD
Buiiding 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 w~th 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 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 buiMings (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(X) ........ =/Vacant Land ............
Location of Property ....
House No, Stree~ Ham/et
Owner or Owners of Property ~'W~.,I,~ '~ F~,'~-- -
County Tax Map No. 1000 Section . J~.(~ ......... Block .... (~;~ ........ Lot...O.0~ ........
Subd~wsion ................................. Filed Map No .... ~ ..... Lot No...~ ..........
...............
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~1~ perr~irmeet.~/ll, app~cable~codes and regulations.
Applicant...~.~."~..~..t._ .~...... X ..............................
,.,.,e-,0.,a
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL. 765-1802
RE:
TO WHOM IT MAY
March 9,
CONCERN
1987
Frank J. Fliss
825 Bray Avenue and 75 Albo Drive
Laurel, N.Y.
TAX MAP NUMBER: 126-02-007
The solid fuel burning appliance was
prior to the time that Southold
permit and C.O. The appliance
in 1980.
installed
required a
was installed
THOMAS FISHER
Building Inspector
TF:hdv
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL,: 765-1803
Approved . .~..TT.~..~. ........ 197~. Permit No.../.O., .Z.62..d.
Disapproved a/c ........ 7.~....'~ .~. ...... ',>'7 ..... '"/
................. - ..... -... ....L~. ~./. ~
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Application No.../..~..~..d? 5 ......
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 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 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 regulations, and to
admit authorized inspectors on premises and in buildings for necessary inspgctlons.
.... .....................
(Signature,~rapplicant, or name, if a corporation)
~2yc~ z/~3(fdailing address o f applicant )
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises .~.r.(L~7~..~. :..~.. ~ .~ ~.~ .................................................
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
o. concr .... F.r~n{-, :.~: .¥'7 ~ L%,$ ..............
(Name and title of corporate officer)
Builder's License No ..... ~.~.-~..~..Z?. ...........
Plumber's License No ........................
Electrician's License No ......................
Other Trade's License No ......................
1. Location of land on which proposed work will be done...--.~. ?..-~..'~.../~7...~. · .~. ·
..................... .ex .............. .x/ ...............
House Number Street Hamlet
County Tax Map No. 1000 Section .../...~.~ ......... Block ~.. ~..~r.-.. Lot...~..d..~. '7' ........
Subdivision .......... T. ....................... Filed Map No. ...~F .......... Lot ...............
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction.
a. Existing use and occupancy..~.'tX.Y'~ h .~ .~[...C~UD.e.~.[.~.'r3..~ .........................................
'
b. Intended use and occupancy .. ~.O~.~..,.~x]...O.. ~'Y...UD~ .~.~..~.e33D~-,d...*.O-¢.O.c/..~.\C~ ............
3. Nature of work (check which applicable): New Building ...~. .... Addition ./. ..... ~.,_.. ,A?erati9~l, ....:
Repair .............. RemOval .............. Demolition .............. O[ner work...¥O~.~7~.~..~.t'~e
I ~-- ~c~, (Description)
4. Estimated Cost .......... , ......................... Fee .. ~5,~. .... 7...~.. ~.. ;~ .........
(to be paid on filing this application)
5. If dwelling, number of dwellinglunits ............... Number of dwelling ~its on each floor ................
If garage, number of cars ........................................................................
6. If bus~ness, commercml or m~xe~d occupancy, specify nature and extent of each type of se ......
7. D~ensions of existing structures, if any: Front ..... ~.0 ........ Rear .............. Depth" ~'~ '~" ' ~' ~"
Height ............... Number of Stones ........................................................
D~ensions of same structure with alterations or additions: Front ...~.~ ..... Rear ..................
Depth ................... ¢.. Height ...................... Number of Stories ......................
8. Dimension5 of ent~[e new constructmn: Front q.. )~ ]$.~,.... Rear .............. Depth ~.. ~ .x D ~ .....
Height ~ ~.]~.~ ..... NumberofStones..l .......... ~ .... : ................................ . ....
9. Size of lot: Front ...... ~0~.,:.~. ........ Rear ..... ~ 9.~ ~ 7N '. ........ D~pth .I.~.~-, ~: ~ .......
10. Date of Purchase ...... ~./.¢.0 .... ~ .............. Name of Former Owner .~.~P~>~ . ~: .~$~ ........
11. Zone or use district in which premises are situated .....................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: ~ ..........................
13. Will ldt be regraded ....... ~ ~ ................. Will excess fill be removed from premises: Yes
14. Nme of Owner of premises [rCn.~.~...~l~'~ ~ ..... Address ~ ~ .~¢.~ ~ ~hone No. ~.~..~/.~
Name of Architect ......... ~ .................. Address ................... Phone No ................
Nme'of Contractor ........ ] .................. Address ................... Phone No ................
PLOT DIAGRAM
Locate clearly and distinctly ali buildings, whether existing or proposed, and. indicate all set-back dimensions from
property lines. Give street and bloc~ number or description according to deed, and show street names and indicate whether
interior or corner lot. ~
Ho
STATE OF NEW YORK,
COUNTY OF .................
........
~ .................. being duly sworn, deposes and says that he is the applicant
(Name of individual sighing 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 manher set forth in the application filed therewith.
Sworn to before me thi~
......... · 197..?
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