HomeMy WebLinkAbout10834-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N,Y.
Certificate Of Occupancy
Date ~Ugust 26 .,19.~?
THIS CERTIFIES that the building ...............................................
655 Cedar' Drive, Southold
Location of Property ..............................................................
House No. Street Hem/et
County Tax Map No. 1000 Section ....O'f.~. ..... Block ..... 97. ....... Lot .... .0~.9. .........
Subdivision .............................. Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
..... /~.~. ge..~.~...~ 3., .... , 19 .~.0. pursuant to winch Building Permit No .... .1.0. ~. 5. /) . ?.. .........
dated . . .~.ugt.l~ .~..'(9. ............... 19..~.0, 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 .........
...... .~. ??.?..o..¢.y..~.t.or~.~. ?' . .~.z..z¢~,. ...........................................
The certificate is issued to ~l exander Peck
................... [o¥,'&. Ydd. e.d..:t~M,'o'-: ....................
of the aforesaid building.
Suffolk County Department of Health Approval N/R
UNDERWRITERS CERTIFICATE NO. I~'/R
/
<'? /. /
Building Inspector
Rev 4/79
BUILDING F,ERMIT
(THIS PERMIT MUST BE KEPT ON THE PP~EMi~ES UNTIL ~ULL
COMPLETION OF THE WORK AUTHORIZED)
N? 10834 Z D~te ..,,~.:~.~..~E .~ .............. , ~..
Permission is hereby grahted to:
..~~~/~ ..... ~ . ..............
...d~....&&~...~.~ ................
~. ~......~,
"'
~t premises Ioceted et ........................
~ ~' ~ Lot o
...................................... , ......................................... ; .............. V..~,; ................ ~ ............
pursuant to application dated~. ...... .Z~ ............... ~....J}....., 19~.., and approved by the
Bulldin Ins ector ' /
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 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 buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of peoperty showing a{~ property lines, streets, buildings and unusua~ 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.
C. 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 ............ Vacant Land .............
Location of Property ...................................................................
p Street ~cl~ Hamlet
House No.
Owner or Owners of Propertv ...~J~ .~ ........................................
County Tax Map No. JO00 Section ...~.7.~. ..... Block ..... ~7 ...... Lot ..... ~. ~ .~...
Subdivision ................................ Filed Map No ........... Lot No ..............
Permit No./~.~ Z
...... Date of Permit . .Applicant .............
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $.,, ~-,~', ~' .....................
Construction on above described building an~l.p~rmit meets all applicable~o~es and regulations.
Rev. 10d0-78
FIELD INSPECTION
1.
FOUNDATION
COMMENTS
FOUNDATION
2.
ROUGH FRAME &
PLUMBING
INSULATION PER N.Y.
STATE ENERGY
CO~E
FINAL
ADDITIONAL COMMENTS:
th Greenbriar
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our new dynam,c s~mulated 3-D doors ~n a contemporary patio furniture, tools and recreational vehicles
forest green design wdh attractive colon~ai-okve panehng ~t's a
beautiful soluhon 1o storage problems
, year-round, Perma~Plate~;
protection.
Overlapping panels, and mid-wall brace for
extra support.
e roof beams at ridge for extra strength.
galvanized frame remsts corrosion.
here's why ROW
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Easy to Assemble~ Constructed of complelely prefabncated and
pre-fln~shed parts, there's no cutting, sn~pp~ng, hammenng, special
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Improved Operation
]ea,/y duty slide, molded in Dupont
has step adjustment for easy
ahgnment
stop interlocks with
door lambs ~n closed poslhon
More Strength
provides more
reinforcement at the handle (Not on
buddings w~th 6 or 8 ft front)
gth vertical door braces
-- for extra strength and protection
against wind damage (Not on budd-
ings with 6 ft front)
ng door that rides deeper in
lower track -- always stays in place
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FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
Examined .~. ~./.~ ..../. ~. ....,19.0~.0.
Approved/~..~?..(?...., 19.~.~. Permit No.//.~. ~..~.~.-¢..~-
(Building Inspector)
APPLICATION FOR BUILDING PERMIT ~JJ.~J/~
Date ..... /.~. ........
Application No./.~.0..~=).~/7 .......
INSTRUCTIONS
a. Th~s application must be completely filled in by typewriter or ~n ink and submitted in triplicate to the Building
Inspector, w~th 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
'~r areas, and giving a detailed description of layout of property must be drawn on the dia~am which is part of this appli-
cation.
I 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 ~n buildings for necessa,ry ~spections. -//:: _
................
(Signature of~pplicant,~r name, if a corporation)
(Mailing ad[tress of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
...................... 'lq,' '/L; .....................................................
Name of owner of premises .. )q~./~.~ ;¢ge.~._ //~-'e~ .... ('a; 'o'n' the' ;a'x' ;~li ;; i~t;;t' .........................
If apphcant is a corporation, signature of duly authorized officer.
(Name and t~tle of corporate officer)
Builder's License No ........................ .~. :g.~.~...
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 Street Hamlet
County Tax Map No. 1000 Section ....... O :7 ~'" Block ..... .~ ~ ....... Lot.. ~ .........
Subdivision ................................... Filed Map No ............... Lot ...............
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
'~. Existing use and occupancy..~-~x~. 7~:}5.' '~~' ' '; ........................
b Intended use and occupancy ~ ~~ ~~ ~ ~'
3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ..........
Repair .............. Removal .............. Demolition .............. Other Work ...............
.~..../. ,~..~ (Description)
4. Estimated Cost ...................................... Fee .............................
(to be paid on filing this application)
5. If dwelling, number of dwelling ~nits ............... Number of dwelling units on each floor ................
If garage, number of cars ..... 4 ..................................................................
6. If business, commercial or mixedloccupancy, specify nature and extent of each type of use .....................
7. Dimensions of existing structure~, if any: Front ............... Rear .............. Depth ...............
Height ............... Number of Stories ........................................................
Dimensions qf same structure with alterations or additions: Front ................. Rear ..................
Depth .................... ;. Height ............ ~ .......... Number of Stories ......................
8. Dimensions of entire new construction: Front .... /.0 ........ Rear ...... /. ~ f ..... Depth .... ~'. ~. ........
Height ...... t5. ~ ...... Number of Stories ..... t. ..................................................
9. Size of lot: Front ........... i .......... Rear .... ~ .................. Depth ......................
10. Date of Purchase ........... ~ ................. Name of Former Owner .............................
11. Zone or use district in which premises are situated ..... ~ ..............................................
12. Does proposed construction violate any zoning law, ordinanee or regulation: ...~..o ...........................
13. Will lot be regraded ........................... Will excess fill be removed,from premises: Yes No
14. Name of Owner of premises ...~. ~.../.~,.~.?P. ~.... Address ~.4~.~7.~ .~..a~-..'~2.~ .~.. Phone No. 7~-g?.z..~/. Y~. ....
Nancm.o~ch~teet 7 ........ /. ?.~0..a. ..... ~. Address .............. ~.~.... Phone No ................
Name-o f-Cmnt-raot or- ........................... Address ................... Phone No ................
PLOT DIAGRAM
Locate clearly and distinctly all ~:buildings, whether existing or proposed, and, indicate all set-back dimensions frown
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
~ y .
STATE OF NEW ORK ....
COUNTY OF...~... 'S'~
.......... ~ .~i~j..t~. ' ' .t~.~j~' ..... . .~. ...... being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is the .................... gP...~.~X, gl/~-~.~. · ........................................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is dul~ authorized to perform or have performed the said work and to make and file this
application; that all statements contoined in this application are true to the best of his knowledge and belief; and that the
work will be performed in the manney set forth in the application filed therewith.
Sworn to before me this
Not ubi'i~,~ .... day :liiiliB[lH~~?~it;9 .~.. ~. /~
I~OI~Y pUItt.lC State 0t New York
~10. 52.8125850, Sult0t[~ Cou3t~ ,,~ (Signature of applicant)
I larra Exi~l~e~ Uorcl~ 30, 19.~'"