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 ........