Loading...
HomeMy WebLinkAbout10824-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N,Y. Certificate Of Occupancy No... gJ-.J. 35 7 ...... Date ..... ]) e.c.e.r;.b.e.~..~. ¢., .............. 19 ~3~. THIS CERTIFIES that the building ................................................ Location of Property .. 8.3 5 0..~qr~ t,.oja, b~p..e. ~. ~.o.u~t~b 9 ~_.d. ............................. House No. Street Hamlet County Tax Map No. 1000 Sectton. 05.6 ....... Block .0.4 ............ Lot .Q.27.-.Q~9 ........ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated g.L~gU~t ~, ....... , 19~0 pursuant to which Building Permit No...1.QB..2.4.Z ............. dated ...P~u. g.u~.h. ~_ .3_ ............ 1982.., was issued, and conforms to all of the requirements of the applicable prowsions of the law. The occupancy for which this certificate is issued is ......... c.qn~tr, uct~ .d.e.~l~. ~.dd$.~.~.qr~ .~.o..e.¥i.s.t.i.ng..d.w. 9.1.1. i.n.g ........................... Tile certificate is issued to . . .'7 Zq t~ o r' .R, . .C.i.p t~ 1 :L.o. ,.. p ~.u 3, i 0 .e .C. ~. 0 r~Y. .................. /owner, N~s~-~¢.) of the aforesmd building Suffolk County Department of Health Approval ...... N/.g- ................................. UNDERWRITERS CERTIFICATE NO...N//~ ............................................ Building Inspector Rev. 1/81 N©. 10824 .7 Permission is hereby gron, ted to (THIS PERMIT MUST BE KEPT ON THE P~E~IS~S UNTIL,,ULL COMPLETION OF THE WORK AUT RIZED) Date ....... /./~. 19. ....... ..... ¢ a ~.~.. ~.¢~'.c~.....~ ~/Z~...., ........ ,.~.~ premises located at ....... ............................................................................................. t'"'~ ................. 000 SOCflon ..... . BlOe~ L .... kOt NO.~ ~.~.~ CO ~ P ~ ~ ,: . ~ · ......... ~ __ __un T~x Mo ~o 1 pursuant to ~pplcoton d~t~d ~ ....... ~...~...., 19 , on~ ~pproved by the ~i dln~ Inspector. Rev, ~6/30/80 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 ail build{rigs, 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 braidings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Pranning 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 sur~ey of peoperty showing all property lines, streets, buildings and unusuat 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 buddings 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 BuildingC~) ,~.~.~"~ ~/Vacant Land ............ s soo s Location of Property .... ~ ~ ~ O House No, Street Ham/et Owner or Owners of Property . .~.l.~..~.~..~ ~' . .C'~.~.~, .~, ~.0..i..?..~.. ~.~. ,~.i ~ .~...(~..~ ..~. ~ County Tax Map No. 1000Section ..O..~i..L[ ...... Block .. g,,L~ .... Lot..,C~.'.,~,.'?,.,~-.,(~,.' Subdiws~on ................................. Filed Map No ........... Lot No .............. .ermitNo./.O.~.~YZDateofPermit ~,,/Jl,/~O Appiicant.,~J..~.~3~-O~~- C~ ~-~,\(D ... Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. Underwriters Approval ........................ Planning Board Approval .............. ' ....~ ,. ~ Request for Temporary Certificate ..................... Final Certificate ........ - ......... · Fee Submitted $.. i 0 Construction on above described building and permit-meets all app4~cable~codes and regulations. TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-I 802 Applicant Thzs is to advise you that the job under Building Permit No. ~ issued to ka ~ In order to complete this file, it is necessary that a Certificate of Occupancy be mssued. Please fill out the enclosed form(s), return same to the above office wmth a check for $5.00 payable to the Town of Southold. Please indicate to whom the Certificate of Occupancy is to be mailed, and arrange w~th thms office for an inspection date. Thank you for your prompt attention. Very truly yours~ Victor Lessard Administrator VL:ec Enclosures IELD INSPECTION FOUNDATION ( 1 St ) FOUND^TION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY CODE FINAL FOR POURED 2, ROUGH - FRA/~ 3. tNCII!-A 4. F~NAI C"qN ALL CONfi T'RUC THE REOL]F~E~E~ STATE CONSTRU CODES. NOT ;TRUCTION MUST FOR C, O ON SHALL [TS OF TI-IF N Y ]TION & ~,ESPONSIBLE 'RUCTION ERRORS ~ FORM NO, 1 ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No./~.' .~.C~...~. ....... 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 o£ 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 alt applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections· .,.., (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises..~.~.D .~.1.~...~.. A.... ~.~ Y.l...~.[.~J.'~...~....~ ...CI.~.L~. .~.. ..... (as on the t~fx roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ........... ~[/.~.. Y..~.' .%~,\.~ .'/ Plumber's License No .......... ]~./.'~. .......... Electrician's License No ......... ~./~. ......... Other Trade's License No ........ ~./~ ......... 1. Location of land on which proposed work will be done .................................................. ..... .... ........................................ House Number (6350 St eet Hamlet County Tax Map No. 1000 Section ..... .Q.~..c/lT. ...... Block ...... O...(Q.. ....... Lot....~..7...'7. g.-7. ~7. ..... Subdivision .................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .~--'" "-'- .~..~..~...~.~J~.... ~. l~~. ................................ b. Intended use and occupancy . .~.~. ..... 0{/../..D~'C:~.. t~.F.)..~.t... [~-~O.D. ............... 3. Nature of work (check which applicable): New Building Addition Alteration Repair ............... Removal .............. Demolition .............. Other Work ............... ~ t~t~)~) ..._. i ~ ~' (Description) 4. Estimated Costl[..c< ......... ~ ........................ Fee .. [..~.~. .... ~.,~ .................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... Number of dwelling units on each floor ................ If garage, number of cars ..... ~ .. ................................................................. 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 Stories ....o..~.~ .............. I. ................... ~ .............. Dimensions of same structure with alterations or additions: Front . .[~. ............ Rear .[(o. .............. Depth..'r2~... ............... ~. Height ........... [ ........... Number ~f Stones ........ ~., .,~.~ ......... 8. Dimensions o[ entire new construction: Front .../.~. .... Rear... 1~ ........ Depth f..,Z.~).. .......... 12. Does proposed constru~tip~.violate any zoning law, ordinance or regulation: .. N(~ ............ . ............. 13. Will lot 'be regraded . A.'q.~... i ..... '/' ........... Will excess fill be removed from premises:[q/A Yes No 14. Name of Owner of premises Address ................... Phone No ................ Name of Architect .......................... Address ................... Phone No ................ Name of Contractor .......... ; ............... Address ................... Phone No ................ Locate clearly and distinctly all .b~ildings, whether existing or proposed, an& indicate all set-back dimensions from property lin~s. Give street and block riurnber or description according to deed, and show street names and indicate whether interior or corner lot.! [~. [. SZAZE OF NEW Hol*.Toa's b^d* coul,rrY OF..~. S.S ......... ; ................... ~ .................... being duly sworn, deposes and says that he is the applicant .(Name of individual sign~g contract) above named. He is the.. ~ ................... . ................................................................... (Contractor, agent, corporate offi¢er, etc.) of said owner or owners, ~d is duly authorized to perform or have perfo~ed the said work and to m~e and file this application; that fll statements contained ~ this application are true to the best of his knowledge and be~ef; and that the work w~l be perfomed in the m~ne? set forth ~ the application filed therewith. Sworn to before me this ............ ~ .......... day of ...... ~ .... 19... Nota, Public, .~. ~5 ~~. County . ' . ~ub ~c, State, of New ~ .... Nota~o nq~A953 suffolk Count~ .~.~ .' ......................