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HomeMy WebLinkAbout10703-zFORNI NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No. Z13723 Date August 7 ., 198.5. THIS CERTIFIES that the building access .o.r.y... ......................... 7085 Horton Lane Southold Location of Property/:/t~us~ ~/o: ' ' ............................................... Street County Tax Map No. 1000 Section ..... .5.4. .... Block .......... 7, .... Lot ...... .1...4. ....... Subdivision x ...Filed Map No...x. ..... Lot No. x conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... .M.a.y. ?9. ........ 19.8.0. pursuant to wlfich Budding Permit No. 10703Z dated ........ ....... June... ......... 5 19 .8.0., 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 ......... Accessory structure. The certificate is issued to .......... .M.r.....&..M.r.s. :..J. qs..ep.h..H..a.w.k.i.n..s .................. (owner, of the aforesaid building. Suffolk County Department of Health Approval .................... .N./.A. .................. UNDERWRITERS CERTIFICATE NO ............................ .N./..A .................. Building Inspector Rev 4/79 FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTJv~ENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION (DF THE WORK AUTHORIZED) No. 10703 Z Permission is hereby granted to: / at premises located at ~..~..~ pursuant ,o application dated /~.~. ....... ~..~. ................, 19~.(~, Qnd opproved by the Building Inspector. ~.!.: ............... FORM NO. 6 TOWN OF SOUTHOLD Building Departme,n.~ Town Hall $outhold, N.Y. 11@71 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This aoplication must be idled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor ,,v~tn the following; for new buddings or new use: 1. Fmat sur~zey of property with accurate location of all buildings, property lines, streets, and unusual na[ural or tooograohic features. 2.Fm3l a2~)roval of Health Dept. of water supply and sewerage d sposa -(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- tions, a cerUflcate of Code compliance from the Architect or Engineer responsible for the building. 5.Suom~t Planning Board approval of completed site plan requirements where applicable. B. For ex~sting buildings (prior to April 1957}, Non-conforming uses, or bu;Idings 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. Dar0 of any housing code or safety inspection of buddings or premises, or other pertinent informa- tion required to prepare a cerbflcate. / C. Fees: 1. Cartdicate of occupancy $5.00 2. Cartd~cate of occupancy on pre-existing dwelling or land use $5.00 3. Cop,/of certificate of occupancy $1.00 Date .... , . · New Building ~ Old or Pre-existing Building(:<:) ......... ~/Vacant Land ' Hou~ No, Sfroe~ Hamlet County Tax Mae No. 1000 Section .............. Block ............... Lot ................ Subdlwslon ................................. Filed Map No ........... Lot No .............. Health Deot Approval Labor Dep~ Approval Undo~vr~ters Approval ................ p~ i B d App I Request for Temporary Certificate ..................... Final Certificate ........ - ......... Fee Submitted S ........................... Construction on above described bud ng and p, er~it'me_.ets all app'.cab e_co. des and re ul ' s .<_ __ g etlon . ....... ..... ... :: ...................... COMMENTS FIE~_IN~PECTION FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY COpE FINAL ADDITIONAL COMMENTS: TO!FN OF SOU~OLD OFFICE OF BUILDING INSPECTOR ' P.O. BOX 728 TOWN HALL $OUTHOLD, N.Y. 1 ~71 TEL. 765-I 802 1~-~ ~ 0__~ Applicant Dear .. ~ , : ~ ~h!s is to advise you ~hat the job under to a fxnal ~nsnect~o~ ~ ~- ' ~ ~ ~ .i~ u an~ In orser to complete ~ oh_s file, it is necessary that a Certificate of Occupancy be issued. Please f~ll out the enclosed form(s) , rezurn same to t~he above r ~ o~f_c~ with a check for $5.00 payable to the Town of Southold. Please · ndxcate to whom the Certifacate of Occupancy is to be ma,!ed, and arrange w~h thls off,ce for an inspecfflon date. Thank you for your prompt attention. Very truly yours, Victor Lessard Adm!nis~rg tor VL:ec EnClosures FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 ...... Disapproved a/c ................................. ¢ APPLICATION FOR BUILDING PERMIT Application No. (.~. 7.~. .~. ........ 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 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. (Signatd}e of apph;a'n~; ~a:e, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · © ...................................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ...... ..~.-=.~. f~a: ............. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... I. Location of land on which proposed work will be done .................................................. · 30. ................. :.er. .q ......... ........... House Number Street Hamlet County Tax Map No. 1000 Section . O,-~--.~ ........... Block ..... .~ ........... Lot.. ~.: .~.~ ............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . ~.'~.-(~D. Y20.~2. ............................................... ~ ....... .c .... b. Intended use and occupancy ..... ~,~.~1C2 .C. (_~.O'\~ . .~ ~.. .. 3. Nature of work (check which aplplicable~: New Building .....~..... Addition ......... Alteration .......... Repair .............. Removal .............. Demolition ............. Other Work ............... (Description) 4. Estimated Cost ...... .~.q..~' C).O ..... Fee .O.~,,, ............................ · ' ................. ~ (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 t¥¢e of use ..................... 7. Dimensions of existing structures, if any: Front ..... ff. ........ Rear .............. Depth ..... ~( ......... Height ...... ~./. ...... Nuhber of Stories ........... /. ........................................... Dimensions of same structure with alterations or additions: Front ................. Rear .................. ' be of Stories Depth'. , Height Num r ................ en's ' · pth 8. Dim ions of entire new construction: Front ............... Rear ............... De ............... Number of Stories Height. ....................................................................... 9. Size of lot: Front .... ~Xqh~.'6~;) ......... Rear ..... .h,.~ ~.~ .......... Depth . .'5._~:Ql~.q. ............ 10. Date of Purchase ............................. Name of Former Owner .... .~-..~.~...~P?..~-~sx. ............ 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction vie!ate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ......... i .............. ,~ .... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ~r~.... ............. Address"~..~ ................ Name of Architect ......... ; ................. Address ................... Phone No ................ N~ne of Contractor ........ ~ ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly ail buildings, whether existing or proposed, and~ indicate all set-back dimensions from property lines. Give street and blockinumber or description according to deed, and show street names and indicate whether interior or corner lot. ,i STATE O'F NEW..~Q~K .... COUNTY OF. 4 .t'~-'.~.~/5' a'a ~. ~ ....................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) abow~ named· He is the .. O (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is d~ly authorized to perform or have peffomed the said work and to m~e ~d file this application; that ail statements contained ~ this application are true to the best of his ~owledge and belief; and that the work w~l be perfomed in the m~ffer set forth in the application filed therewith· Sworn to before me this ............ ' ' ' ~OI~RY ~8[lC,State ol ~ew ~o~ [~gna~ure o~ applicant)