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HomeMy WebLinkAbout11395-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ...... g..19./.6. 1 ..... Date ....... I~ 9y.o.m.b.e..~..5. .............. 19..8 1 THIS CERTIFIES that the building ................................................ Location of Property ........ 2. 5. .29..B. 99.b.o' . pr~.v.e., ..... g .u.~.qt.~ 9g.u.o' ~. ~.e?...Yp!:k. ....... House No. Street Hamlet County Tax Map No. 1000 Section .... 1 0 3 ..... Block ..... 3 ......... Lot .... 1 ~ ........... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building permit heretofore filed in this office dated · .B..ep.~.e.m..b.e.t'.. ~..8 ..... , 19 . .g. lpursuant to which Building Permit No ....... 1.1.3. ~..g. ....... dated . .~.e.p.~.e.m.b..e F..2. 9 ............ 19 .8 J., 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 ......... ......... Afl~Lltioz~ .of..Deck..to. Or~e .Family. ~well£ng ........................ The certificate is issued to .... Chr&.at oph. e~.. G~dis ................................... [owner,/~S.~X O£ the aforesaid building. Suffolk County Department of Health Approval ... ?./..R .................. i ................ UNDERWRITERS CERTIFICATE NO ..... .N./..R ......................................... Rev, 1/81 Building Inspector FOl~ NO~ 2 TOW i. OF !our o! BUILDING Di~PART/~t~NY TOWN HALL sOUTH'OLD, bl~ Y. BuILOIHG I~,ERM!T~ (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL BULL COMPLETION OF THE WORK AUTHORIZED) ' Permission is hereby granted to: at premises located at ........................ .............. .. ........ ~ ....... ~ ....... ~ ................. ,t ........................................ Coun Tax Map No ..................... 1000 Secton Bock i L ~.....;...iLot. No ..... ~' ~ /~ 19 ..~.,~ and ~pproved by the pursuant lo application dated ............................................. ,.....:,,...., ........ Building I~spector, : : ;' Budding Inspector Rev: 6/30~80 ' TOWN OF $OUTHOLD , Building Department Town Clerks Office 5outhold, N. Y. 11071 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector 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 natura~ or topographic features. 2. Final approval of Health Dept. of water supply and sewerage dispose[--(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 installations, 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 ]957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey.of property 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 in- formation required to prepare a certificate. C. Fees: I. Certificate of occupancy $5.00 2, Certificate of occupancy on pre-existing dwelling or land use $5.00 Dote New Building ................ Addition............~ .... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ...~.._..~.,.....~ .................. ?,..~d ............... ,:~.'~..~,~ ............................................................. Owner Or Owners Of Property ..... ~i~,.. &,.~. ........ :~. ..... .":.'..~..~.~.. ........... '~. ...... '-;.,'~. ....................................... Subdivision ..................................................... , .......... Lot No..../.J ...... Block No..;~.. ......House No....~...~,J.'.?~. ¢~ Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fined Certificate ~ Fee Submitted $ ...~...~..q.,~'?. .................... Construction on above described building and I~ermit meets a~l applicable codes and regulations. Applicant ............. ~/.~ .~..~ ..... ' .............................................. Sworn to before me this ................ day of ............................................ (stomp or seal) Notary Public .................................... County FORM NO. 6 TOWN OF SOUTHOLD 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 features. 2. Final approval of Health Dept. of water supply and sewerage disposaI-(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 buiMings 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. 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 .. No.~gmber 5, 198~1 ,. New Building ............. Old or Pre-existing Building(Z) ~. ~x ...... =/Vacant Land ............. Location of Property . 2520 Beebe Drive, Cutchogue, New ~ork House No, Street Ham/et Chris~opher;~Gudis Owner or Owners of Property --- 103 3 11 County Tax Map No. 1000 Section ............... Block ............... LOt ................ Subdivision ................................. Filed Map No, . .'; ....... Lot No .............. PermitNo...113.9.5Z Date of Permit 9/18/81 Applicant Health Dept. Approval ........................ Labor Dept. Approval .................... Underwriters Approval ................. . .......Planning Board Approval ... i ....... ;,[~'.'~ , Request for Temporary Certificate ..................... Final Certific~ite ....... Fee Submitted $ .... 5..,GO .................... A;plicant .... ,..,~,~ .t~,j.. ~ .,~_ .~ ............ Rev, 10-10-78 FIELD INSPECTION FOUNDATION (~st) FOUNDATION (2nd) 2. ROUGH FRAME& PLUMBING INSULATION PER N.Y. STATE ENEBGY CODE FINAL COMMENTS ADDITIONAL COMMENT~: FEE> ~E STATE CONSTRUCTION '~ ~' ~ .... CODES, NOT ~' FORM NO. 1 '~ ' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 Examined ...... 19 ... ^pproved ..... . .,,.,,,, No. ./. /. ?.-5': ' --- Disapproved a c . .. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application mnst 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, relationship to adjoining premises or public stre¢ or areas, and giviug a detailed description of layout of property must be drawn on the dia~am which is part of this apF cation. 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 Build~ng Permit to the applicant· Such pern shall be kept on the premises available for inspection tt'~rougboot the work. e. No buildiag shaN be occnpied or used in whole or in part for any purpose whatever nntil a Certificate of Occupan shall have been granted bt>' the Building Inspector. APPLICATION 1S IIEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to t Building Zone Ordinance of tile Town of Southold, Soffolk 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 authorize6 inspectors on premises and in buildings for necessafp~spect~ns.ff/3/// -/,., . ~ L~ ,. , '(Signature of applicant, or name, if a corporation) .- .... ' (Mailing add[#(s4 of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bnild, · C.w.,.C.' ...... i ................ . .......................................... ~ne o~o,vner ofprom~s0s..C¢~,.~%.~t~o~... ~.&*~.'S ......................... . ............. (as on tile tax roll or latest deed) If applicant is a corporatiou, siguature of duly authorized officer· (Name and tide of forporate officer) Builder's License N ~'):.~./kJ. . ~C~l O ~ Plumber's License No ......................... Electrician's License No ....................... Other Trad'e's License No ...................... 1. LocatiOn of land on which proposed work will be done ................................................ House Number Street Hamlet County Tax Map No. 1000 Section .... ,~..~..~. ....... Block ...~.. ~. .......... Lot..d3..// .......... Subdivision..~.~"' .. ~ ............. Filed Map No...~...~...~../ ..... Lot ..... / ........ State existing use and occupancy of premises and intended u~e ahd occupancy of proposed construction: b Intended use and occupancy ' l. Nature of work (chcck which applicable): New Building .......... Addition ....... Alteration .'~.. :% .... Repair .............. Removal .............. Demolition .............. Other Work ............... ~, . ]..._.~. (Description) Estimated Cost... g-~ ~' r. "-'-- Fee . .~ .... (to be paid on filing this application) ;. If dwelling, number of dwelling units ............... Number of dwelling units' on'each floor ................ It' garage, number of cars ....................................................................... i. If business, commercial or mixed occupancy, specify n~ture and extent of each type of use .................... I. Dimensions of existing structures, if any: Front ............... Rear .............. Depth .............. Height ............... Number of Stories ...................................................... Dimensions of same structure with alterations or additions:- Front ................. Rear ............... Depth ...................... Height ...................... Number of Stories ................... J. Dimensions of entire new construction: Front ............... Rear ............... Depth ............ Height ............... Number of Stories ..................................................... ). Size oflot: Front ....................... Rear ............... - ....... Depth .................... ). Date 6f Purchase .......................... ;.. Name of Former Owner .......... ~ ............... I. Zone or use district in whicl~ premises are situated ................................... :'. ............... L D,oes proposed construction violate~any zoning law,. ordinance or regula:ion: ..... [~(~n~'-"' ' '--' ............. 1. V, ill lot be regraded ....... ........ .... -.. Will excess fill be removed premises: Yes No I. Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No. , .............. Name of Contractor .......................... Address .................. ~ Phone No...: .'.' .......... PLO~' DIAG R~M Locate clearly and distinctly ~ll building, whether existing or proposed, and,indicate all set-back dimensions from :operty lines, Give street and block number or deseripfion according to deed, and show street names and indicate whether :tefior or corner lot. - .- rATE OF N~-W~O~ t~.-,.. ~ ~ OUNTY ~ .~ll~. ~,.I.~'... o.o ~::. .......... v'~'l'~,-.~...~: ~O'~. being duly sworn, deposes and says that he is tile applicant . (~f individual signing contract) )ore named, f ~aid owner or owne~, and i~ duly auth~perform or have performed the said work and to ' ' ' ~plication; fl~at all statements contained ~ this application a~ true to the best of his knowledge and ~lief; and that the 'ork wil be perfonned in the intoner set for~ N the application filed therewith. ~om to before me tiffs "' / " !'" :" / : :(Signature0fapplicant) U,,~urhonzed alteration or addillon fo th~a survey Is a vlolaffml of section 7209 o~ lbo New York Store I~ducar Co~,es of this survey mop nc bo~-~ ,~ r~n Law. ,/ 'The Water sup'ply & sewage disposal sy,J~ toms for this residence will conform to the §teqdards of the Suffolk Coun~ DeP~' mont of Health Services. SUFFOLE COUNTY DEPARTNENT 0~' HEALTE SERVICES~ FOR APPROYAL OF CONSTEUCTION ONLY DATE , AT CUTCHOGUE TOWN OF counTY, , HIVEI~HEADo N.Y.