HomeMy WebLinkAbout10598-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
No ......... z.~. 9.a.oo.,. Date ...... .~.~.ff4~..~. 2.~. ................ 198.9.
THIS CERTIFIES that the building 'o'.]~&~7,' '] .................... eyre 7
' 10230 New o~.u~ Avenue ~ but~p~-~. ~.g.
Location of Property ~J~s~ ~o~ ....................... ~reet Hamlet
County x~x ~ap ~o. 1000 S~ct~o~ .. 33 f. ...... ~lock ...9~ .......... ~ot...99~ ..........
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
..... ~9~. ~ ~ ....... , 19 .O9pursuant to whch Building Permit No .... J.q~O~. ..........
dated .... ~g~h .~ .............. 19 .~, was issued, and conforms to a~ of the requirements
of the applicable provisions of the law. The occupancy for whch this certificate is issued is .........
................... ~$p~. ~9..~ ~.~g. ~g ..........................
The certificate is issued to Ad~i~ C. aaa ~a~2~~
..................... ?oT.b)~ .....................
of the aforesaid building.
Suffolk County Department of Health Approval .......... ~. ............................
UNDERWRITERS CERTIFICATE NO .............. ~[~. ........................
Building Inspector
Rev 4/79
FOK~I NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE P~EMIS~S UNTIL FULL
COMPLETION OF THE WORK AUTt'~ORIZED)
N? 10598 Z
Permission is hereby granted to~. .. > ,
.... m..~,:..~.~..~..~.,....~...~.....
~o .. ~f~.~.c.~.q...:~.~.~.~.~.....7:: ...... ~.~z~::jz~.~ .............................
.......... ~:~x~.~.~ ............................. : .......... '..:..: ........... ,:....<.:.,'.:'. ............ :....~,~ ............................
~t premises Io~ted
pursuant to application dated .Z~...~...,~../...~.f~ ./~.~. ...... .~.? ............... , 19~.., and approved by the
Building Inspector.
Fee SZ(.~. ....................
Building Inspector
FORM NO. 6
TOWN OF $OUTHOLD
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 featu res.
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. Su bm it P lan n in g Boa rd approval of completed site p lan 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 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.
C. Fees:
1. Certificate of occupancy $5,00
2. Certificate of occupancy on pre-existing dwelling or land use $5.00
3. Copy of certificate of occupancy $1.00
% Date .... ~./~./~) ............
New Building ............. Old or Pre-existing Building ............ Vacant Land .............
Location of Property ......................... /t[/~..' ~,~. ~ ....... ~;~. r~'
House No. Street H'amlet
Owner or Owners of Property .
County Tax Map No. 1000 Section ............... Block ...............Lot ................
Subdiwsion ................................. Filed Map No ........... Lot No ..............
' ~' .~.)'~,J0~..,Applicant .~.~Aj~.... ,~,..-~..P~..~[.
PermitUo.lO5 Pat of Permit....
Health Dept. Approval ....................... Labor Dept. Approval .....................
Unde~riters Approval ~.0. J ............ Planning Board Approval... ~J~ ...............
Request for Temporary Certificate,,. ' ......... Final Certificate ,, ~ .................
Fee Submitted $ .............................
Construction on above described building and I;¢ermtt meets all applicable codes and regulations.
Rev. 10-10-78
TOWN OF SOUTItOLD
OFFICE OF BUILDING INSPECTOR
TOWN HALL
SOUTHOLD, N. Y. 11971
TEL. 765-1802
August 11, 1980
John Bertani Builder Inc.
Colonial Road
Southold, New York
Dear Sir:
This is to advise you that the job under Building Permit
No. 10598Z issued to A. & M. McCall on
March 24, 19~0 for addition appears to be
completed as of Our la~ inspection. Before you can legally
use or occupy this structure a Certificate of Occupancy must
be issued.
Please fill out the enclosed form and return same to
the above office. There is a fee of $5.00 for a Certificate
of Occupancy
Thank you for your prompt attention.
Very truly yours,
GEORGE H. FISHIER
Sr. Building Inspector
encl.
FiRLD 'r?}SPEOTiON
FOUNDATION
FOUNDATION
2.
ROUGH FRAME &
PLUMBING
(2nd)
INSULATION PER N.Y.
STATE ENERGY
CODE
FINAL
ADDITIONAL COUNTS:
FORM NO, 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
.¢..,
Approved,' Permit
(]luil~ing Inspector)
APPLICATION FOR BUILDING PERMIT
Application No../'.~..~...~.. ......
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 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 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.
....~.~.0~.. ~B~7'.~. ~..~-.,.~',~. :z~¢ ......
(Signature of apphcant, or name, ff a corporation)
. h'7,.~...t. ~,~:.. 3. ~.~,. ~ ..... .-,~-: .~ .q..~.~.,¢b .......
(Maihng address of applicant)
State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
...~.'4,..t4¢~ .............................................................................
Name of owner of premises .. ~. D.g/./}.~. .~.'..l~r..~..C~.%~..(.(.(~.~...~..~.' .~..~. ~ ...............................
(as on the tax roll or latest deed)
If applica.nt is a corporation, s~gnature of duly authorized officer.
(Name and htle of corporate officer)
Builder's License No .... 1..SQ. .................
Plumber's License No...~.~.¥. ~.o~. g;.C/af~. .........
Electrician's L~cense No.. ~ 5(...°344.'.~.6.~ .....
Other Trade's License No ....................
Location of land on which proposed work will be done...Slre-4~ k'J&~ . ~.~ ta~, .... A~atw... ~45~-/~.~...~4~¥ ~ ......
· .G&...q.-c-...t-k-..,,:~ v.~: .......................................................... i ..............
House Number ~ .22~)~ g'..5-'O Street Hamlet
County Tax Map No. 1000 Sect, on., /./..~ .......... Block ....~.~. .......... Lot...O.(~. ~ .........
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 . . .O..~.'~...~ ~..~ . .~i~al~-~ ......... , ............................
b. Intended use and occupancy ~ ~ ~ ~ ~, ~ O ~
3. Nature of work (check which appiicable): New Building .......... Addition ... ~. .... Alteration ..........
Repair .............. Removal .............. Demolition .............. Other Work ...............
i ~ I~ (Description)
4. Estimated Cost~. .I.~.~ ~ ...... l; ........................ Fee ........ ~ ............................
(to be paid on filing this application)
5. If dwelling, number of dwelling urdts ............... Number of dwelling units on each floor ................
If garage, number of cars ...... ;,.. 1~ ..............................................................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .................
7. Dimensions of existing structuresi if any: Front .... ~ ........ Rear .... ~ ........ Depth ... ~ .....
Height .....:~1 ......... Number of Stories ....... ~ ........
Dimensions of same structure with alterations or additions: Front . ii i~i~itl i i i i i i i i 'l~;~r' i i
Depth ..... {~}.! ............. i' Height ..... .$,,.I.~ ............ Number of Stories ....~. .................
8. Dimensions of entire new construction: Front . . ~.~. . Rear 3 .'~.- Depth
Height .... [ ~ .;~ ...... NJamlSer of Stories .... tt/.a~. .......~ ........................ ~ ........ t ......
9. Size of lot: Front .... ~-ff~. · · .,i .......... Rear ...... ],t.~.. ........... Depth . ~..~....~.~.~. .......
10. Date of Purchase ............ , ................. Name of Former Owner .............................
11. Zone orluse district in which premises are situated .....................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: ...... .~.O. .......................
13. Will lot be regraded ...... /~.q .' ................... Will excess fill be removed from premises: Yes ,)~ No
14. Name of Owner of premises ~.. ]~.~.~,t~. Address .gl~t~l .~t~4~ .~¢~.. Phone No ................
N~ane of Architect ........... i ................ Address .,.. (-~r~.q-~/~. ~,... Phone No ...... .~ ........
Nmne of Contractor .~.~-...~44~'?~.. ~, Address 4U~..~q0.. Phone $o.~.~.~.. ~.¢
PLOT DIAGRAM
Locate clearly and distinetiy all buildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and block humber or description according to deed, and show street names and indicate whether
interior or corner lot.
STATE OF NE~W ~R~K~7-- / ~_/ "S S
... ~.~..'~~l~... .................... being duly sworn, deposes and says that he is the applicant
, (Name of individual signing contract)
above named.
He is the .................................................... ~ ...........
(Contractor, agent, corporate officer, etc.)
of said owner or owners, ~d is du~y author2ed to perform or have perfomed the said work ~d to m~e and file this
applicationl that all statements contorted ~ this application are true to the, best of his ~owledge and belief; and that the
work w~l be perfomed in the m~ndr set for~ in the application filed ~herewith.
Sworn to before me this
...... : ..... !~ ......... day o~..~. .......... , 19~
~ ~U~ State o~ N~w ~Of~ (Signature of applicant)
~ ~0 52,8125850, ~ffolk ~0~
= . Term E~p~r~s ~a~h 30~ ~
i'