HomeMy WebLinkAbout11357-zFORM
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. g. 1. 1 ~ ~,8. ......... Date ..... S. q 9.[.~..b.e ?..1.~ .............. 19 .,.3.2
THIS CERTIFIES that the building ................................................
55 Ships Drive
Location of Property ..$ 9 f~.5 ................ ~.q~..gb. ?.o.u~..ko.. ~:%7. v.$py. ...... ~o..u.~.,h.q]:..d.
house Ale, Street Hamlet
County Tax Map No. ] 000 Section ... 9.7.9. ..... Block . . Q 3 ........... Lot .q 0. ~ .-:3.1. 0. ........
Subdivision ....... ~. ....................... Filed Map No..X. ...... Lot No...Z. ..........
conforms substantially to the Application for Building Permit heretofore filed in this office dated
· g.u.C~.~, .~..3. l ........., 19 .~ '! pursuant to which Building Permit No...1.1:3..5. 7...g ............
dated ... ?.u. g .u [~.g..3. J .............. 19.8.1., 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 .........
a solar collector ,~ree, ahouse ;-,.ddition to e×istin;~ d~,~elling.
The certificate is issued to Lenore kdamson
..................... .....................
of the aforesaid building.
Suffolk County Department of Health Approval .... r~/.~... ...............................
UNDERWRITERS CERTIFICATE NO ............ n/.~ ..................................
Rev. 1/81
Building Inspector
~TOWN
IuILDING
TOW~
souT,oLD, i'~ ~:.:
(THIS PERMIT ~MUST Bi KEPT ON ~H,E PP, E/~IS~S
COMPLETION OF THE WORK AUTHORIZEDi '
No. ~1357 Z
Date
Building: I~spector.
Permission ~s hereby granted to: /
~.~....~.../,~...~..~..~.~..~ ~,e~..
..~.e~..~,:~...~-..~r~:....~-~,.~..~x~~ __ ......... ~ ................ ~ ....
c~uh~ ,~ ~,p ~o. ~ooo s.~t,o~ .....~ ......
pursuant to application dated .
. pprov~ by the
, Rev.:6~30~80 . : :: ~i : ~ ~
FORM NO. 6
TOWN OF SOUTHOLO
Building Department
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
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. Submit Planning Board approval of completed site plan requirements where applicable.
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.
Co
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 Building(Z) .... ~N~ _ ~/Vacant Land ...........
Location of Property ........ r · ·,
House No.
/ Street
Owner or Owners of Property... ~'. ?. ~. ~' ~- TM
County Tax Map No. 1000 Section ............... Block ............... Lot ................
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No. II..~.T.7... Date of Permit ?.'.-~. ,/'~Z .Applicant...~'..~-..~-~?,/~..~,... ,~.-.~/..~. ,-~.~.~'...'~. ....
Health Dept. Approval ........................ Labor Dept. Approval .........................
Underwriters Approval ........................ Planning Board Approval .................. ~ ,. ~
Request for Temporary Certificate ..................... Final Certificat~ ........ - .........
Fee Submitted $ .....................
Construction on above described building and~m~ee~s all apph,'c~,de,~ and regulations.
Applicant.; .~~-~E._. ~. ,.~.'~. ~~~. ~- ..........
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/~nder Building
Permit No. //~g7 issued to ~ [/~J~g~_~
on ~/~J~ -- fo----~t~ ~~ is co'~plet~d and
f -
a inal inspection has/--~ has not~ been done.
In order to complete this file~ it is necessary that
a Certificate of Oceupancy be issued. Please fill out the
enelosed form(s)~ return same to the above office with a
cheek for $5.00 payable to the Town of Southold. Please
indicate to whom the Certificate of Occupancy is to be
and arrange with this office for an inspection date.
Thank you for your prompt attention.
Very truly yours,
Victor Lessard
Ad~ministrator
VL:ec
Enclosures
mailed,
Memorandum from.. , .
BUILDING INSPECTORS OFFICE
TOWN OF $OUTHOLD
Tow~ H^LL, SOUTHOLD, N. Y. 11971
765-1802
FIELD.%NSP~CTION
1.
FOUNDATION (]st)
FOUNDATION (2nd)
2.
COMMENTS
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
CgDE
FINAL
ADD'ITIONAL COMMENTS:
19
THIS PAGE aECOMES PART OF AND IN CONFORMANCE WITH PROPOSAl. NO,
Accepted by Date
Accepted by Date
19
19
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1802
APPLIC>,TION FOR BUILDING PERMIT
INSTRUCTIONS
Application No.. ~ ./,~, ,~..:,,,
a. This application must be completely filled iii '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 tc schedule.
b. Plot plan showing location of lot and of bnildings on premises, relationship 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
cation.
c. The work covered by this application may not be commenced before issuance of Building Pe~it.
d. Upon apprc':al of this application, the Building Inspector will issne 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 nsed in whole or in pa~ for any purpose whatever until a Certificate of Occupan
shall bare been granted by the Bu~ding Inspector.
~PLICATION IS HEREBY MADE to the Buitding Degartment for the issuance of a Building Pe~it pursuant to t
Building Zone Ordinance of the Town of Southold, Sufl~lk County, New York, and other applicable Laws, Ordinances
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descdbe
The applicant agrees to comply with all applicable laws, ordinances, building code, hou~ode, and regulations, ~d
a dmi, au,hoNzedi,,~pectorso, pren, isesan, inbuildin,sfm'nec~ctions.
/ (Signature of appHc~:t, or ~:me, J[a co~2omtJo:)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build,
Name of owner of prenlises ~. ~.4J ¢,5~. ~. ,~. ,.o~.5 r_) ,,t) ...
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(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.
f umber '
County Tax Map No. 1000 Section ..
/ZfZl .......................................
Hamlet
.. Block O~ Lot ~[.~ --
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 ~ ~/~e..w.0., ~
b. Intended use and occupancy .... .~..e ~,,~.v..va, ~..., . .,~..~. ~ ~~..~(~-.a' ..........