Loading...
HomeMy WebLinkAbout11521-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buiidin§ Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.. Zq'l. 62~. ........ Date ........ AP~J-...:7 .............. 19 THIS CERTIFIES that the building Accessary L ..... ~q705 Main Rd. ?etonic ocatlon oI rroper[y ............................................................... House tVo, Street Hamlet County Tax Map No. 1000 Section 0~75 .Block 05 .Lot Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore flied in this office dated ~December 4/4 19 84 pursuant to which Building Permit No. 44 524 Z dated December 48 19 84 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 ......... Foundation under existing accessary building The certificate is issued to . . .i~..r.i.m.°. . .1~...r~.e..y.e?.s. ...................................... (owner, lessee or tenant} of the aforesaid building. Suffolk County Department of Health Approval .... N.../.A. .................................. UNDERWRITERS CERTIFICATE NO .................................................. Rev. 1/81 N? I1521 Z Permission is hereby granted to:----~ TOW~N ~01 BUILDING DE~ PARTIvlEN1 TOWN HALL sOuTHOLD, N'. Y. BUILDING' P, ERJ~iT (THIS PERMIT MUST BE KEPT ON' TH,E PRE! IS~S UNTIL~F JLL ' COMPLETION,OF THE WORK AUTHORIZED) at p~emise~/Jocated at ' ' · ....... ; ......... i' ................................................................... - -' ....... "'~"' ~' ....... r ........ 'r' ........... ........................... Cou~ty~TC~x Map No. 1000 Section .... '~-7"': .,., Bilk ..~ ....... ~kotNo. ,~Z/. ............ pursuant to application dated ~~.~../.~ ....:..-..,' ]~', and approv~ by the Building I~spector. ' ' : ~- Fee 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 sub~ tted in duplicate to the Building Inspec- tor with the following; for new buildings or new use: I. 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: I. 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. / 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 . New Building ............. Old or Pre-existing Building(X) ..._~ ..... =/Vacant Land i ........... Location of Property ~-) ) ~.,~, ~ ~Y.)..~-...~ .~.~. ,. - House No. Street Ham/et Owner or Owners of Property ? h-7. .............. County Tax Map No, 1000 Section .... ,,~..-7..~:~, .... Block ..... .~. ,~.~, ..... Lot .... .(~.~ ....... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. of Permit ".7.1~'~.J.~.L)..Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. Underwriters Approval .RI.. ("~.. ,¢'.~. ~..¢..,~,....Planning Board Approval .................. . Request for Temporary Certificate ..................... Final Certificate ................. Fee Submitted $...~'~ .4.4~..~ ........... Construction on above described building and per~rtit'meets all appEc, able_.codes and regulations. APplicant Rev. lO-10-7a FIEL~ %N~PECTION COMMENTS FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY G~ODE FINAL ~ADDITIONAL COMMENTS FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y, NOTICE OF DISAPPROVAL File No ................................ To ~""~..[.Q~t~..~....~_C"~.c--J.,~.O-~..~/. ....... j~c. ~.~E ~ ~ ...~.. ~ ................ . ~,~ ~, ... ..... House No. ' ..... ~treet Hamlet County Tax Map No. 1000 Section .. ~ ...... Block ..... Q~ ..... Lot . .~ .~ ..... Subdivision ................. Filed Ma o ................. Lot o .................. is returned herewith and disapproved on the following' grounds ~o/,w_~l.~-~ ~. ~.c~t.w.~ .o.¢~..· ..~ ...~..p.~ .X. ...... / -- ' Building Inspector RV 1/80 FOI~M NO. ! TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWn1 CLERK'S OFFICE SOUTHOLD, N. Y. Application No, .~.,/,,~,.~.~ ................. Disapproved a/c ............................... ~ ...................................... 7z ............. (Building Inspector) ^PPLmCATIO. FOR BUlL 'NG PERMIT Date ....... INSTRUCTIONS a. This application must be completely filled in by typewriter oX 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 buiidings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. 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 pa rt for any purpose whatever until o Certificate of Ocdupancy shoJl hove been granted by the Building inspector. APPLICATION IS HEREBY MADE to the Building Deportment 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, end regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. oture of opplicont, or nome, if a eorporofion) ...... (Addr~/ss of applicant)J J State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of prem.ses' ..... .~.....~..~...~....~.......~...~-~..~..~.:'f..l~.~.~.r.~> ...................................................................................... If applicant is a corporate, signature of duly authorized officer. (Nome 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. Map No.: J...D..°...M:r..~...I...~..T...~..S. ......... Lot No. C~ I I Street and ......................................... r .................. r' .................................... ~ ...... '~ ............... t .............................. 2. State ex~sTing use aha occupancy o~ premises and in~ended use and occupancy o~ proposed construction: o. Exisiting use and occupancy b. Intended use and occupancy .................... .~.'..~.~.~.~.~.....~.~.~.~,~.~ ...... ~~.~ ............. property lines. Give street and block whether interior or corner lot. 3. NatHre of work (check whichjapplicable): New Building .................. Addition .................. Alteration .................. Repair .....~ ..... Removal~ i .................. Demolition .................... Other Work ..................................................... ' ~.~'o! r~--a~C~ (Description) 4. Estimated Cost ...... .0.~.~.~.. ............................ Fee ...~..~......'~'. ..................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... ~ ......... Number of dwelling units on each floor ............................ If gdroge, number of cars ..... r .................................................................................................................................... -- 6. If bpmness, commercml or mixed occupancy, specify nlature and extent of each,type of use .....~.....O../.~.o... ....... 7. Dimensions of existing structures, if any: Front ..........~ ............Rear .......... ..~.. .................. Depth ....)..~'~...!. .... Height ....... J ................ Number of Stories .................. ! .............................................................................................. Dimensions of same structur~ with alterations or additions: Front 'Z ~ Rear Depth .... ................................ J ~'~ .... Height ~..J3t'.~ ............... Number of Stories .............I ................... 8. D~m~ns~ons of entire new construction: Front ............ J~.....j~. .......... Rear ............................ Depth ........................ Height .................... Number[ of Stories ..................................................................................................................... 10. Date of Purchase ................. ~ ...................................... Name of Former Owner ........................................................ 11. Zone or use district in which bremises are situated ......................~..) ........................................................................... 12. Does proposed construction vi.olate any zoning law, ordinance or regulation: T~I ~ 13. Will at be regraded ....... ..N.....~.. ............ Will excess fill be removed from premises: ( ) Yes (~) No 4, Name, of Owner of premises ..... ............................... ,~ .............. Address ................... [ ............Phone Na~e of Architect ......... ~ .................................................. Address ~ ................ ;..~ ........ Phone~ o PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from number or description according to deed, and show street names and indicate STATE OF 'NEW ~C]RK, .~.~ ................. ~ ...................................... ~.: ................................. :...oemg duly sworn, deposes ond seys thot he is the applicanl (Name of individual signing contract) above named. ~' ,/ (Contractor, ogen~.orporote~tc.) of sold owner or owners, and is dul'y authorized to perform or hove performed the sold work a,nd to make ond file this opplicotion; thor oll stotement~ contoined in this opplicotion ore true to the best of his knowledge ond belief; ond thor the wdrk will be performed in the monner set forth in the oppfication filed therewith. Sworn to be, fore me this Bo 52-8125850, Sun0l~ uoua~*~ Term Exoires March 30, 19 ........