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HomeMy WebLinkAbout11350-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.. ,~113.7.7. ........ Date ..... ~ecCmb~.r. !6. .............. 19 .8.2. THIS CERTIFIES that the building ................................................ Location of Property .. 11).850. ~air~. Road~..~la$t. MarioJ1 ........................... House No. Street Ham/et County Tax Map No. 1000 Section Q3J- ......... Block . .],$ ........... Lot ...OJ..2 ........... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... Au~rz~,~t;. 26 ....... , 1981. pursuant to which Building Permit No. ~3.5.Qg. .............. dated ... J~uqus.t: .27 .............. 19 .SJ,, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occnpancy for which this certificate is issued is ......... .... cons.true.t- .accassor.y..qaraqe ............................................. The certificate is issued to ..... ~lohn..H o. B£J, lmar~.. ' *~Z .:Z- %.'. '. 2 Z -'-;., ...................... of the aforesaid building. Suffolk County Department of Health Approval . .BI/A ..................................... UNDERWRITERS CERTIFICATE NO .... N/A ........................................... Rev. 1/81 Building Inspector FO~ ~0~ ~ , TOWN o, BUILDINi~ TOWN;HALi; SOUTH'OLD,~ N~ BUILDING: P,ER~IT (THIS PERMIT MUST BE KEPT ON TH,~ P'RE/~IS~S UNTIL ~ULL COMPLETION OF THE WORK AUT~OR ZED) ii - No., ~1350 Z ~o~e ...!~'!~.~/..~'~.~!i ~.~7 ..... ~..~/ Per~issio~ is hereby granted to: CO, U~ To~, Map No. 1000 Sect on ............ BI~E; ....~. ................ , ~Lot No....L ..... ~ ...... , a~ I~ing I~Spector. Rev FORM NO. 6 TOWN OF SOUTHOLD Bulk~ing Department Town Hall Southold, N.Y. 11371 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and subr~it;ed in duplicate to the Building Inspec- tor wt~h the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusua[ natural or tooograohic feBtures. 2.Fina~ approve of Health DepT. of water supply and sewerage disposa -(S-g form or equal). 3.Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildine~ and installa- tions, a certificate of Code compliance from the Architect or Engineer reeponsible"f~)r the building. 5.Submit Planning Board approval of compieted site plan requirements where applicable. B. For existing buildings (prior to ,~pril 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate sunzey of peoperty showing all property lines, streets, buildings and unusual natural or topo§raphic features. 2.Sworn statement of owner or previous owner as to use, occupancy end condition of buildings. 3. Date of any housing code or safety inspection of buildings or prer~ises, 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 $1.00 Date New Building . . &- ...... Old or Pre-existing Building(:Z) ........ =/Vacant Land ............. Location of Property . ../.O.~..¢-.~. ....... .~..~/.~-7-..../~../).].~.4 . .~D ............ House No. ,$rree~ ' ' ' Ham/et Owner ar Owners of Property I~ £ 'r T/l/ J~. / 4,...~. iv'ti.l-Ill .................. County Tax Map No..lOOO Section ,..~.! ........ Block .../.f. .......... Lot.. Subdivision ' ..... - ............... Filed Map No...; ....... Lot No .............. Health Dept. Approval ... , .~1~, .¢~_..../~/..~ ....... Labor Dept. Approval .... ~//~. ................ Underwriters Approval . '.,'~.... ·........·..A/~. ...... Planning Board Approval .. /Y/.'~. ......,,.. Request for Temporary Certificate ..................... Final Certificate ........ Fee Submitted S ~ ' Construction on above described buiiding a~d p~rmit'~ee'ts all appLipable~codas and regulations. Rev. 10-10.78 FOUNDATION (~st} FOUNDATION ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C,ODE FINAL h ADDITIONAL COMMENTS: I':Loo,~ .~Y?"C';-n l6 R. ? FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1302 ..... Disapproved ~/c ..... ~ ..................... ....~ ' . ,. (Bui[diff~nspector) ~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No. / ! ~.. ~' '~I~ Date .%...~.¢ ........ 19F-/ 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 te schedule. b. Plot plan showing location of lot and of buildings on premises, rdationship to adjoining premises or public stre¢ or areas, and giving a detailed description of layout of property must be drawn on the dia~am which is part of this apr cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon apprcval of this application, the Building Inspector will issue a Building Permit to the applicant. Such peril shall be kept on the premises available for inspection throughout the work. e. No building sbalI 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 IIEREBY 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 iuspections. ((~dgnature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is raw, er, lessee, agent, architect, engineer, general contractor, electrician, plumber or build, Nmne of owner of premises . ..(~:¢..,~. V', (as on the tax roll or latest deed) If applicant is a corporation, signature of duly attthorized officer. (Name and title of corporate officer) License No .... .~...~.....-¢~-~. w, ........ Builder's Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No. (4/)~vp./'/. Location of land on which proposed work will be done ................................................ ...... ................... ........ ,- House Number Street Hamlet County Tax Map No. I000 Section 3~ Block ~z Lot Subdivision ..................................... Filed Map NO ............... Lot .............. (Name) State existing use and occupancy of premises and intended use and occnpancy of proposed construction: a. Existing use and occupancy ...................................................................