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HomeMy WebLinkAbout11246-zFORt'vl NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ....Z. 1..1 3.4.0. ....... Date ......... p.e.q e..m.b.e.v.. $..3 ........... 198.~. THIS CERTIFIES that the building ................................................ Location of Property ... 1.65. ,l?arkNay..&..1~ 0.0..Cri.t. tens..Lane.,..Sou.t, hold .......... House No. Street Ham/et County Tax Map No. 1000 Section ,0.7.0 ........ Block 0.L2 ........... Lot O.O, 6 ............. Subdivision .... S. o..u .q.h.E o. 9 .d ................. Filed Map No. 2 J ).1 ..... Lot No, . 3. .2 .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... J. uno. 2.2.., ....... , 19 B.2_ pursuant to which Building Pe~it No..3.1~.6.6, Z ............. dated .... d.u. 17.6 ................. 19 82., 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 ......... .......... ac.c.e s s o.r'.~r, s.t.~r, agm..buil.ding ................................... 'The certificate is issued to .... War,non. /3.nic ch.i .&. b*.i~ .............................. (owner, les~.e~.te,'~,'~ t~ of the aforesaid building. Suffolk Cmmty Department of Itealth Approval ...g/. A .................................... UNDERWRITERS CERTIEICATE NO... Iq././t ........................................... Building Inspector Rev. 1/81 ~'OE~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AuTHoRIZED) 11246 Z Permission is hereby granted to: /2 ..... ..... ~.,~,~t~....~..~..: ........... ..... ~ ~~-~ ............................................ , ......................................................... : ...................................... ~.: ...... co,,~ Wx M~p No. ~000 Se~t~o..~...q.g~ ...... S,o~g ....~/~ ...... ~ot No...~.~g, ......... pursuant to ~ppficotion d~t .... ~ ....... : ............... , 19.~., ~nd ~pproved by tho ~uildln0 ~nsp~ctor. 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 ail 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 3. Copy of certificate of occupancy $1.00 $5.00 Date New Building ............. Old or Pre-existing Bu~ilding(Z) ......... = ZVacant Land -i ............ Location of Property...l -~, ................ .~ ...... ~.- .... ~.... .... .~.... House No. . .~. . . Street ~. ~.~.~. ~ Ham/et Owner or Owners of Property .... .~. i~, ~".~. ~..- = ,. ~ ~ ~ ...... .............. .~. ~' . .~...~[.~-~ t C°unty Tax Map N°' 1000~°n,' 't'~'n~'~'~'~ 'r~ ~ ......... Block' ..... .~. ~..~.. .... Lot....~ ',~ .~. Subdivision ..... ~..'~..'-'.'~ .'.. T.~.. ~%J.'.'.'.'.'.'.'.~?. ........ Filed Map No ........ Lot No .............. Permit No ........ Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Appro~/al ...; .................. ,.. Underwriters Approval ........................ Planning Board Approval .................. ~ · .., Request for Temporary Certificate ..................... Final Certificate ........ - ......... - Fee ~ubmitted ~ ~ ~ ~ Construction on above described building and permit~meets all app~cable_.co.de~ and regulations. ~ ~-O Applicant ...... ,, ....... _,..... ...... ~./. ............ . .................... TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O, BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 This is to advise you that the job under Building Permit No. ]l~ issued to'-P.'~$z. &~ [ ....... on Q/{o~l ........ for'~=~.O~e~-,-~7~T~P~,~i~'s~- dtom~-~l~'ted an~ a fi~n~l inspectio~ has ~' has no~ ~een done. In order to complete this file, it is necessary that a Certificate of Occupancy be issued. Please fill out the enclosed form(s), return same to the above office with a check for $5.00 payable to the Town of Southold. Please indicate to whom the Certificate of Occupancy is to be mailed, and arrange with this office for an inspection date. Thank you for your prompt sttention. Very truly yours~ Victor Lessard Administrator VL:ec Enclosures FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF O~CUPANCY 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 all property lines, streets, buildings and unusual natural or topographic featu res. 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 $5,00 Date...V~..O. ~..~-~....~..~.~ . . F..~... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ..v' .... % ( .~. ,~i'. .~.'~. ...... .~. ..~. House No. ! Hamlet .: County Tax Map No. lO00Section '¢i~ii~70 Block ..... /.'.~.-. ,. ,: .... ¢~ ...... .... Lot ................ Subdivision .................... ~ ............ Filed Map No .......... Lot No .......... Permit No. ~Z~ ~. Date of Permit ~/¢ J ~. Health Dept. ~pproval ...... ~ ............. kabor Dopt. Approval Underwriters Approval ......... ~-~ .............. Planning Board Approval ...................... Request for Temporarv Certificate ..................... Final CeFtificate ....................... FeeSubmitted$...5 ~O?~'''~ -- ~.~L~ ~ , ~ Construction on above described building and permit meets all applicable codes and regulations. Applicant./]~. ((~..~..~.~..~../~,'<~..//~ .e:, .~..~/~/'?':'.~.~..~.~ ~ FIELD INSFE( 1. FOUNDATION ( ls t)~ COMMENTS FOUNDATION (2nd) ROUGH FRAME & PLUMBING 3. INSULATION PER N. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: FORM NO, 1 ~ TOWN OF SOUTHOLD ~ BUILDING DEPARTMENT TOWN HALL SOUTHOLD,, N,Y. 11971 ~. TEL.: 765-1802 ...... , , , .. , ,Otuilding Inspector) APPLICATION FOR BUILDING PERMIT Application No Date ~./.~. ....... ,19. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi 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 stre~ or areas, and giving a detailed description of layout of property must be drown on the diagram which is part of this ap~ cation. c. The work covered by this application may not be commenced before issuance of Building Pennit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such pern 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 Occupan 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 t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name,, if a corporation) . .4"/>:' 7..~'~..I../-'...~ :~.,,:~. ~.x~ ...... ,. (Mailing address of applicant~'~' ~' ~'~' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build, ...... ................................................... Name of owner of premises ...~...&X .v :~. y.! .... c. .I ...................................... (as on the tax roll or latest deed) · .............. (Name and title of corporate officer) Builder's License No ..... -'~ ./.~....~.~.'~.: ....... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1, Location of land on which proposed work will be done ................................................ ~ ~;~;i x~:~ ........... ~/& ~ ..... st~t $ county *~ ~p ~o. tO00 s~tio, .... ~. PI9. mo~ .................. ~ot ................. , Subdivision ..................... Filed Map No ..... ~ ....... Lot . ~ ........ (Nmne) 2. ~State existing use and occupancy of premises and intended use and occupancy of proposed construction: la Existing use and occupancy ~ ~ ~t ~ ~ ........... : ............................ ~. Intended use and occupancy .... ~.~.~(( ¢~.. ~. ~.~~..~*..~... 3. Nature of work (check which ap~licabl6): New Building ..../~ ..... Addition .......... Alteration ..... :, .... Repair .............. Removal ............. Demolition .............. Other Work .......... I, .... ' Estimated Cost .................................... Fee .................. ~' ........... "' I (to be paid on filing this application) ;. If dwelling, number of dwelling ~nits ............... Nmnber of dwelling units on each floor ................ If garage number of cars ~ ........... i. If business, commercial or mixe~ occupancy, specify ~0ture and extent of each type of use ..................... z. Dimensions of existing structureg, if any: Front ..... ~ ......... Rear .............. Depth ............... Hmght Nmnber of Stories Dimensions of same structure wilh alterations or additions: Front ................. Rear .................. Depth .................... I. · Height ...................... Number of Stories ...................... ' ' Front Rbar Depth ~. Dimensions of entire new constructton: ............................................. Height ............... Nm.&nher of Stones ............ ~:: ~ ..................... ;.~ 2 >-.-, ........... ). Size of lot: Front ...... /ff'¢' ' I ............ Rear ....... ('/). ........... Depth .... .t...¢ .............. )':Date 6fPurchase ........... I .................. l~ame of~Former,Owner~ ............................. bp,! :". .......... 1. Zone or use district in whic re nises are situated .... ~. ~ ................ ~2. Does proposed construction wol~t~efi, ny zoning law, ordinance or regnlation: . ./?.. · .~. ...................... 3. Will lot be regraded ........ .. I..A/..C~. ........ , ......Will ex~ess$ill be re..~ov.~fi frrgm premises: Yes~ ' [. Name of Owner of premises .~, ~Y.v.~. ?/..~'.~.f.~.~,~/.. AddressP)~ t.<.. Phone No .............. i ... Phone No ................ Name of Architect .......... I ................. Address ................ Nam e of Contractor ~.~ ,~./~ ~ ~...~.~. 76 .q :/.. ~. ,C'.°Address ..~. ~. ~T, ~. ,o~,~ .... Phone No. ~,,2, '1T. ,o.~,? ~.. PLOT DIAGRAM Locate clearly and distinctly all ibuildings, whether existing or proposed, and, indicate all set-back dimensions from roperty lines. Give street and block ~umber or description according to deed, and show street names and indicate whether ~terior or corner lot, ' ' TATE OF NEW_YtO~K,.,t/~ ff.b~ °n T xz (Name of individual sign ~ove named. e is the ................. ?plication; that all statements cont~ 'ork will be performed in the mannm worn to before me this ~~... being drily sworn, deposes and says that he is the applicant ~gent, corpOrate'officer, etc.) ..... ed tZ-l~rfform or have performed the said work and toanake and file this ned in this application are true to the best of his knowledge and belief; and that the set forth in the application filed therewith.