Loading...
HomeMy WebLinkAbout10790-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPM~TMENT Office of the Building Inspector Town Hail Soufltold, N.Y. Cerli icafe Occupancy THIS CERTIFIES that the buildin~ ................................................ Location of Property .6.0.q ............ ~..m.it.h. Drive South Bout;hold Hou~ No. Street Hamlet County Tax Map No. 1000 Section . .0.7.6. .. ..... Block . 03 .. .... Lot .024.001 Subdivision .... .G. qg~.e' .q9 .c.k ............... Filed Map No. ! .6.6.3....Lot No. 5.8...P,..5.9. ~..6.0 conforms substantially to the Application for Building Permit heretofore f'ded in t~, office dated .... ,79~1~.. 1.1 ......... ,19Qi). pursuant to which Buildin~ Permit No .... ~ 0..7 ~.0..Z -dated ...... ~.u.l~r· ~ .............. 19Q0., was issued, ~nd conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... : ~ gqcog.e, aad~J,l~.i,.pla t~i) prt ~xtstip~ d~elltng. The cerfificate is issued to...Charles...... ...O. & Ol.o.r. ta .B.. Retttg of the aforesaid building. n/r Suffolk County Department of Health Approval .......................................... n/r UNDERWRITERS CERTIFICATE NO .................................................. P Building Inspector FOF~M NO. 2 TOWN OF $OUTHOLD I~UIL.DII~G DEI~ARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N? 10790 Z Permission is hereby granted to: / ~'~ ........ .. 7w..o.L,g~.~,~..... Z-~,~.......(.... ...... ..~.~.,..~.~.o~.../..~..,...%, ............ ... ~o ..... ~cz.~.~2.~c,r-z.~......C-,-/,~v~a~F_ ...... ~.~.~.~.~..~......../..---.o ....................... at premises located at ........................................... ~..~,..-~...o. ~.. ~....-.. ~ .... .~.~..//~ ............ ~~ .......... ~..~z ........ ~.~.....~....~. ................. pursuant to application dated .... .~..~.~f....('../ ............................. 19..~..~.., and approved by the Building Inspector. Fee $....~.~..~ .... / BuF/ding Inspector FORM NO. 6 TOWN OF SOUTHOLD 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 [ocation of all buildings, property lines, streets, and uousuel 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. 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. 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 Prerexis~j~ng Building . .~ ........ Vac~ Land ~. ''1 ........ Location of Property ....... .~.~,.~..~, . .~. ~l~.ll.~.~. ............S"~. ....~ .~,.~.~. , .~ ..... House No, ~, ~ ~ Street~ -- Hamlet Owner or Owners of Property .~ ~.~..~. · ~.~.~. · · ~. ~.{ ~ ............. County Tax Map No. 1000 Section . ~..'[. ~' ....... Block ... O. 3 ....... Lot .O.~. ~ .O.O.i.. Permit No./.~ .~.~.Z Date of Permit ~/~.~/~.Applicant .~, .~..'~~.' Health Dept, Approval ........................ Labor Dept. Approval ........................ Unde~riters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ..... ~ ............. $ .... .................. Construction on above described building and per~it meets all app~icabte~ c?~e~, and ,regulations. Applicant.. ~, ./~rt.~,'<~ ~t,¢ ,.,., .... ,;";..J~Z ?;.~ ¢ .................. C.O. lOq , FIE~D INSPECTION COMMENTS FOUNDATION 2. ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY COD~E FINAL OCCU?A~HC¥ OR USE IS. I.INL~VJFUL OF OCCUPJ~HC¥ 4 i~s AP,PROVED AS NOTED .._, ', ;~,~ NOTIFY BUILDING DEPARTMENT AT :~'~ ~5-~80~ ~ ,M ~o 4 .~ ~oR THE --. f~l I ~1~ mr~orCT!ONS; -- .1, FOUN~ATIO~- ~0 REQUlRE~ 2. ROI]OH - FRAMING & PLUMBING 3. IN"" !LAT!qN 4. Fh",,','.l - C©NSTRUCTION MUST BE C"*'r)!.f-TE FOR C. O. ALL CONSTRUCTION SHALL MEET THE REOUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1803 Approved .&.¢..Ue it Disapproved a/c --~-' - , ...... Application No.. ~..~..7...~..~. ..... APPLICATION FOR BUILDING PERMIT 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 detmted 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 inspections. ..... ,/, ......... (Signature of applicant, or nmn~ if a corpora) . ,) (Mailing address of applicant) State whether applicant is owner, lessee,,agent, architect, engineer, general contractor, electrician, plumber or builder. .................... ..... .............. ................................. Name of owner of premises .~7~.h~//~.'. .~..~...~.~.~.(.aJ~n. ~h~~r '~t'e~t' ~) ......................... If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .... .%~....O~. ............ Plumber s License No ......................... Electrician s License No . . Other Trade's License No ...................... ~ f 1. Location of land on which ~ 'rm~o~work will,be don~./~/~'~.. ~..~... ~. '~ .~. ?...~....~.C~ ........ House Number Street Hamlet~--/-'D ~ ~ County Tax Map No. 10~ ................. Block .................. Lo~..~... ~./ ~0 ..... Subdivision ...... ...~~ame~.)./~--~_... Filed Map No. Z.'~.q?/~.~.... .... Lot~.~.~.. i.~' ~;~..~. 2. State existing use and occupancy of premises ~ ~x and2cupancy o f proposeS construction: a. Existing use and occupancy b. Intended use and occupancy .............~ ~'~"-- ~):~. ~..~...?~...~. ;~: .~....~.. .... , 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Remoqal .............. Demolition .............. Other Work ...............  ,~ . (Description) 4. Estimated Cost ........... .0.'°'9.: ..O. 9. ............... Fee.. .............................. ' (to be paid on filing this application) 5. If dwelling, number of dwelhng umt.~L ............. Number of dwelhng units on each floor ............... If garage, nmber of cars ...... i/..~...~..~.( ....................................................... 6. If business, commercial or mixed !occupancy, specify nature,and extent of each tyoe of use ..... :x: ........ /... 7. ~ D~mensmns of existing structures, ff any. Front ..... '<~'.6 ....... Rear . .~.~ ......... Depth ......... Height ..... ~..-'~. .... Number of Stones ......... ./ ............ d .................... ~' ............ Dimensions of same structure with alterations or additions: Front ...?.~. ........... Rear ...~.~.7 ............ 8. D~mens~ons of In,ire new constructmn: Front .... /.7..~. ...... Rear ../... ~.. ....... Depth ~./tr..~.~. ...... 10. Date of Purchase ...... /..q..7~... ................ N~ae, of Former Owner ............................. 1,1. Zone or use district in which pre ,miNes are situated ..... .~..d~X/~.r-?..~.. ........ ~.... ...................... 12. Does proposed construction v~l~t~any zoning law, ordinance or regulation: .....~..q .~..~---~.. ............... 13. Will lot be regraded ...... ,~/~'-'_ 7~'~''~' ' u''''~A~.':L' ...... Will exoes~fill be r0moved from premises' Yes Name of Architect ........ ; ............... .'. Address ................ Phone No ................ PLOT DIAGRAM Locate c!ea~Iy and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block ~umber or description according to deed, and sho~ street nmnes and indicate whether interior or corner lot. ~ c-r-,. ~N~ STATE OF NEW r~¢~/,x~ 2' ~--~!/, COUNTY,OF..'~.~. f: ~ ~i. ~.... ~'~ ......... ~7¢~"ZJ' '~¢' ~fi¢~: ......... being duly sworn, deposes ~d says that he is the applicant ~ame of indi~d~al signing contract) above named. .. ~ He is the ................... ~./~ ~zr~ .......... ,~-. .... , .................................. ' (Contractor, agent, corporate officer, etc.) of said owner or owne~, ~d is duly autho~zed to perform or have perfomed the said work and to m~e and file this application; that all statements conta!ned ~ this application are true to the best of his ~owledge and belief; and that the work will be perfo~ed in the m~ner set forth in the application filed therewith. Sworn to before me this ........................ aay ot ..... ~ .......... Npt$~qbli , ... ~x .~, ...... 7~ ~ .... ,. :~.. ~... Coun~y~ 7~" ' " ; ' ".t " ~ ~gnarure or appncanD ¢ ,~' ,,, NOTARY PUBLIC,$tate~ork .~ / ~lgna' ' , ~ '~- No 52-8125850, Suf~f~ounty ~ - ~' Term ~xplresMarch 30, 19~