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HomeMy WebLinkAbout10848-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.. Z.q.q.66~ ......... Date ................. Nay..~.q ......... 19 .~3 Additiom THIS CERTIFIES that the budding ................................................ Location of Pro err 995 Cove circle off 6th street Greenport House No. Street Ham/et County Ta× Map No. lO00 Seotio,, .. ?.? ...... Blook ...0.! .......... ~t...0.!? ........... Subdivision ........... ~x .................. Filed Map No .... .~....Lot No.../~. ........ conforms substantially to the Apphcation for Building Permit heretofore filed in this office dated .... ,A.~.~.~. 8..~..2.6. ....... 19 5.©. pursuant to wh/ch Building Permit No. q OS/beg dated .fi:.~..~.~.~...2.6 ................ 19, $.O,.. was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... R~ised deck addition (2nd floor ) to existing dwelling The certificate is issued to . . G.e.o..r~.e . .B?.O?. ........................................... (owner, ~) of the aforesaid building. Suffolk County Department of Health Approval .. ~/.~. .................................... UNDERWRITERS CERTIFICATE NO .......... .~/.~ .................................... Building Inspector Rev. 1/81 FORM NO, 2 TOWN OF S~OUTHOt D ~ TOWN HALL SOUTH'OLD, N, ¥. BUILDING PERMITi ~ ' (THIS PERMIT MUST BE KEPT ON THE P~E~IS S UNTIL PULL COMPLETION OF THE WORK AUTHORIZED) ? Date ... ........... il .......................... ' ¢ IN'? 10848 Z Permission is hereby granted to:--,- ....... ~ ............ c/ re"~.~ ~ . ~.,.. . . , ' .......... ~.., ~ ~ ...... ........ ........... ~ ......... ..... .. ~ .~ ~~":~"~"'~' / ~,~ ~"'~~ , ........................................................... :.¢~ ~ ~/ ': .. ::..~ ....... Goun~ T~x ~*p ~o. 1000 Seclion ..>.~. ........ Q....;. Block ~ ...... : ............ ~ot mo ............... / ........ _ -.. purs~ont to opphcohon d~ted ... ~........., 19.. , ond ~pprovo the Building Inspector. ~.e *..../...~--,...5... Rev. 6/30/80 RICilTER ttOME IMPROVEMENT CO., INC. 5]5 Sever,th%tree! GREENPOR~, NEW YORK ]]944 (516) 477-0998 JOB NAME JOB PHONE ~1¢ ~'~p¢~i~ hereby to furnish material and labor -- complete ~n accordance with above spec,ftcations, for the sum of - Payment to be made as follows __ dolla rs ($ ............... ) Ar~eptaure o~ ~Iroposa! --The a~o~ prices, spec,f,cat,ons end cond~hons ere seOsfactor¥ and ~re hereby accepted You are authouzed to do the work es specdmd Payment wdl be made as outhned above Date of Acceptance S~gnature ___ , S*gnature RICHTER HOME IMPROVEMENT CO., INC. ;ubmffted by .......... Date Job Name Accepted by ........ Dale Accepted by .............. Date 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. F~nal survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Fma{ approva~ of Health Oept. of water supply and sewerag~dispose~-(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 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 Data .......................... New Bud ng ............. Old or Pre-existir~g~Building ............ Vacant Land ............. Location of Property /~/z-'.p'/-2~ ;v;.' ......................... 'S'tle. t ....... Owner or Owners of Property ...~-, .~-G~. ,'~.~'...~....~.~d..,~-. ................................... County Tax Map No. 1000 Section . . .~.~. ~. ...... Block . . .~i./ ......... Lot... 4:?~. ~. ....... Subdivision ................................ Filed Map No ........... Lot No .............. Permit No./.~..~, .~.~,' .~.. Date of Permit~.~.~.~?. ..... .~. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate .../~ .................. Fee Submitted $ '-~-~ ~ Construction on above described building and permit meets all applicable codes and regulations. Applicant..~.~,../~?. ,~,'.~... ,~,,..~,./~/.~,Z~?-, ,/~ ................... Rev. 10-10-78 FIELD INSPECTION ~ ~COMMENTS ~ ~ FOUNDATION (~st) FOUNOATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY CO~E FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 , // (Building Inspector) ~ (./t&C~.~.~-~.I-~- C~'v~t~"-APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This apphcation 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 applicatmn 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 avmlable for lnspechon throughout the work. e. No bmlding 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 .~./. (.~ .~?~./.~. (?. / .~..~..7.~f .~. ,.~..~. ~. ~ buildings for necessar~nspecti9ns. · '"(Signatureof. ap~licant, orna e, lfa opo ' )'f" (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... ...... .... ............ Name of owner of premises ..... .~,...r~...~..(...~...~..~. ? ............................................ (as on the tax roll or latest deed) If applicant is a corporation_, s~gn[[ture qf d~uly._a_uthorized ofhcer. (Name and htle of corporate officer) Builder's L~cense No ..... ~./.¢..'~.r~.' .~ ..... Plumber's License No ..................... Electrician's L~cense No....~</.<:7..~y..'~--. ......... Other Trade's License No ................... 1. Location of land on which proposed work ,~ill be done ...... . .'~...../.~"/..~: .~. .................. ~ .... House Number Street County Tax Map No 1000 Section ....~...~. :/. ..... Block .... (./ ........... Lot... (7./. ~ ......... Subdivision ................................... Filed Map No ......... ~... Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of,proposed construction: · 3. Nature of work (check which applicable): New Building .......... Addition .......... Alterat~n Repair .............. Removal .............. Demolition .............. Other Work ..~.~t,l.l.o. (Description) 4. Estimated Cost ..... t .................... Fee ...................................... I (to be paid on filing this application) 5. If dwelling, number of dwelling pnits / 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 ~xisti~g structures, if any: Front... ~.~..~. ....... Rear .. ~...~. ....... Depth... ~.~. ....... Height .... ~..~..~. .... Number of Stories .. ~ ..................................... ._.,...~ ........ Dimensions of same ~macture with alterations or additJ, ons: Front ...... J..~. ....... Rear...._.~J. Depth ....... ,~ ~ ......... .. Height ..... ~.esl; ............. Number of Stories ...................... 7-.- 8. Dimensions of entire new construction: Front ... ,~...~....?~.. Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...~-~.... fl. tt;~ ....... Rear ...................... Depth ...................... 10. Date of Purchase ............................. majpe of Fo~mer Own._~r .. ~t... ~.t. [~.. ~..v. 11. Zone or use district in which premises are situated .... ,/5[7..~-..~. ! .qt...~--s..~,'/z./. ~ .~./ .......................... 12. Does proposed construction viota_te any zoning law, ordinance or regulation: ./.~. ~ .......................... 13. Will lot be regraded ...... ~/~.O. ......... t~' · ' x,t~. · Will excess fill be removed from premises: Yes No 14. Name of Owner of premises LS'...~--~A~'..~:~ 1~...~.vT.~..L. Address ................... Phone No ................ Nmne of Architect ...... · .................. Address ................... Phone No ................ /~t'~...~4Wafff..~Address . Phone No ................ Name of Contractor PLOT DIAGRAM Locate clearly and distinctly all. buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street mad block number or description according to deed, and show street names and indicate whether interior or corner lot. ~, STATE OF NEW iY'0RK~, .............. .... being duly sworn, deposes and says that he is the applicant (Name of individual signing co~tract) above named. He is the ..................... ~ .............................................. (Contractor, agent, corporate o~ficer, etc,) of saki 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 contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manne~ set forth in the application filed therewith. Sworn to before me this , , ~, ~a~e~0~v~te~we¥0r~ r (S g at appl ) ,/'