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HomeMy WebLinkAbout10825-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall $outhold, N.Y. Certificate Of Occupancy No ...... ~.~.7.5~ ..... Date .. August 42 198.5. THIS CERTIFIES that the building dsck addition. Location of Property ... ¢.6.0. ................ .~.h..e...C.r. qs..s.w.a.y...........................East Marion House No. Street Ham/et County Tax Map No. 1000 Section ..... 3.©. ....Block .... 2. .......... Lot q 08 Subdivision. ~.eblv~.e.. ~3¢B.c.h..l*~.r.m.~ ........ Filed Map No...6.2..6.6..Lot No...~.q .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated August ~ 19.8.0. pursuant to which Building Permit No. ~08.25Z dated ....A.u.~.u..s.t. ?.q. .............. 19.8.O. , was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which tiffs certificate is issued is ......... Deck addition to e×isting dwelling. The certificate is issued to ........ JACk. LINE. ~,. ~xT~T~I~Z. ~7 ......................... towne~ of the aforesaid building. Suffolk County Department of Health Approval ................... ~/~ ................... ~/A UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 TOWN GF BUILDING TOWN HALL $OUTHOLD, N~ y? ) (THIS PERMIT MUST BE KEPT ON THE PP, E~IS[S UNTIL I!ULL COMPLET 0N OF THE WORK AUTHORIZED} '. , t....~,..../.~ ................. , ~9.. N? 10825 Z Dat. ~ ' -- Permission is hereby granted to: / ..-. __._A~u~../../.~..~,., ......................................... ............................ ~ ........ ,.?...~ ................ ~ ............. ../.. ,~ ~ ~ at premises located at ..~...Z~C) ....... ~, .~.~,,....~"J~)~-'~Q,/(~ County Tax Mop No. 1000 Section ..... ~/.,~.0).. BI~I~-~.!I ~Lot No.' .../~J.~... ...... ur~uant to application dated ~ .../. ....... i"' ; 19~ and approved by the B~iildlng Inspector. Fee $ ............ : ' Rev, 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD BuiidinB Departme.n.~ Town Hall $outho~d, N,Y. 11@71 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. Th~s s~phcat~on must be filled in typewriter OR ink, and subr~itted in duplicate to the Building Inspec- tor,.vmh the following; for new buildings or new use: 1, Final uJrvey of property with accurate location of all buildings, property lines, streets, and unusual n,~ur31 e,r tooograohio features. 2. filnal ~'~roval of Heaith Dept. of water supply and sewerage disposal--(S-9 form or equal). 3. Acproval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buddings, Multiple Residences and similar buildings and installa- tlons, a certificate of Code compliance from the Architect or En§ineer responsible for the building. 5.Submit Planmng Board approval of completed site plan requirements where applicable. B. For ex~stmg buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate ~rvey of peoperty showing 8ii property Jlnes, streets, buildings and unusual natural or topogr~ohJe features. 2.Sworn st3Tement of owner or previous owner as to use, OCCUpancy and condition of buildings. 3. Da~a o( any housing code or safety inspection of buildings or premises, or other pertinent informa- tion re~u~red to prepare a certificate. / C. Fees: 1. Certd~cate of occupancy $5.00 2. Car~i~cate of occupancy on pre-existing dwelling or land use $5,00 3. Copy of certificate of occupancy $1.00 Data ., New e, uddmg ............. Old or Prmexlsting BuJldmg(:~) ........ =/Vacant Land -. ........... Location of Prcparty . .~,~,c~, / -- " ....... ; ...... 2£0.~,,,4a y.; Z~,~.~F. .... ,.. ~.~.,~,~ , Owner or Owners of Property . .~~z~' ~+~~. ........................ County Tax Mac No. 1000 Section . .~O ......... Block ,. ~ .......... Lot../~.~ .......... ....... No ........... ...................... Applicant ~ ~Z--ZZ¢, ¢84 ¢-~ '. ............. Health Dapt. Approval ........................ Labor Dapt. Approval ......................... Unden,vriters Approval ........................ Planning Board Approval .................. Request for Temporary Certificate ..................... Final Certificate ........ Construction on above described building and~t meets all app~cable~,godes and regulations. ................. FIELD INSPECTION COMMENTS FOm O ON FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1803 ., 19~..~. Permit No .......... Approve~.../f.. ~__~.j I.d. ~..~.¢ ~ Disapproved a/c ........... ; ........... ./~ ........ ./ (Buildtng Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled tn 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 avadable 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 ali applicable laws, ordinances, build.ing code, ho~usinj~6~de, and regulations, and to admit authorized inspectors on premtses and in buildings for necessary~ectigJ~s, fi// t/ ] ~ ignature of applicant, or name, if o r,~ol~poration) ..... ~ .&~.... ~.~... ~,~, .... (Mailing address of applicant) State whether applicant i~see, agent, architect, engineer, general contractor, electrician, plumber or builder. ............"' ~~'-'~ ~'"~""~' ................ ~ ........ i .......................................... Name of owner of premises. ~ ~.~..~. J'..../~?..~.a~.c~.n.~t~e.~a.X. ~o. li {~; i~t~t'{~) ......................... If apphcant is a corporation, stgnature of duly authorized officer. (Name and title of corporate officer) Builder's Ltcense No .... .LC..z~".(-..t-~.. ........... ? Plumber's License No ........ .~ ................ Electrician's License No .................... House Number ........ '~-m-~' ' ~' ........ Sir;;i .... '~' .......... l~l~n'l;~ ............... ~o~,~,~ ~o ,00~s~_,~o~ ¢.% ......... ~,o~ ...~...... ........ ~o, .... /..o..?.. ....... Subdivision . '.~. ~. ~9 ~../~.. ~.t~. ~. ~..'~-[~.~..~ ~ Filed Map No ............... Lot . .(~../. ......... (Name) 2. State existing use and occupancy of premtses and inte/tded use and occupancy of proposed construction: b. Intended use and occupancy vi~.~..4/..d~: ~Zi' ~d~<~[¢_ ,,~;?'.,~'Z //6'zC~/ ' 3. Nature of work (check which a~plicable): New Building .......... Addition .. 5.1~t~c~"V.'."... Alteration ...... ,r. ~ ... Repair .......... Removal .............. Demolition .............. Other Work ............... ~fi ~ ~J'~'O (Description) . . .......................... /5.-. 4. Lst~mated Cost ............ 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. D~mens~ons of ex~st~ng structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ~ Height .... Number of Stories 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of S{ories ........................................................ 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ........... i .................. Name of Former Owner ............................. 11, Zone (~r 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: Yes No 14. Name of Owner of premises .... ................. Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly allI buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block Inumber or description according to deed, and show street names and indicate whether interior or corner lot. COUNTY :S.S ............................. . .................... being duly sworn, deposes and says that he is the applicant (Name of individual siga'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. ................... : .... day o~ ......'/~'' ~ ~,c4~..~...'..., 19. ~ .~ Notary Public,/~L'~:.'~.-~.~.. County ..~/f~ c"~/f ~ (/l ~ Notary P~blic, State rtl New Yor~ . .~.~', .~,~ ,.~...v...~.~. ~. i , ,o. 2u; y/ .............................. ~mm~ss on Expires March $ ~ ~ / (Signature of applic~t)