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HomeMy WebLinkAbout11453-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Z12643 Date July 27 8..4 No. THIS CERTIFIES that the building Deck Addition Location of Property 820 East Road Cutchogue County Tax Map No. 1000 Section ...1.1.0 ....... Block .... 9.7 ......... Lot ....2.2 ............ X X X Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated Oct. 18 ...................... 19... pursuant to which Building Permit No. 11453Z dated November 13 19 81 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which ttfis certificate is issued is ......... Deck Addition The certificate is issued to DAVID W. ALLISON of the aforesaid building. Suffolk County Department of Health Approval ...N. ~'.A. ................................... UNDERWRITERS CERTIFICATE NO ........... .N/.A. ................................... Rev. 1/81 FORM NO. 2 TOWN OF $O~?HOLD BUILDING Ds:PARTMt:NT TOWN HALL SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 11153 Z Permission is hereby granted to: ,o ...... C~..X~-a~...,~.~.c-/~........~.~./..~...,..4~.~.~.~.~ ........................................ ................................. ~.~ ........ .~.~.e.,.~...~;...'. ZZ../,~.~.......~_..~ ........................................ County Tax Map No. 1000 Section ..././.. C) Block ..... ..~....7.. ........ Lot No. pursuant to application doted ..,~,~../..~.~........./.....~.. ..................... , 19....~../., and approved by the Building Inspector. Inspector Rev. 6/30/80 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 submitted 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: 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 SB.00 / 2, Certificate of occupancy on pre-existing dwelling/ land use 3. Copy of certificate of occupancy $1.00 --?r~-Existing C.O. $15.00 V~gant land C.O. $ 5.00 Date .......................... New Building .... ..~. ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ... ~ .~.C) ~_,~L~/ .'~...O..~.~'. .~.~.~....C~..~.~ Hou~ No. Steer ~ Hamlet Owner or Ownersof Property ...... ...... ,.. } , ............. O i. c ................. County Tax Map No. 1000 Section ~) ~ Block 0 ~ Lot Subdivision ................................. Filed Map No ........... Lot No .............. PermJtNo. J(........~ .... Date of Permit i~-~'....~.(..AppJicant~g~f~O.~..~,.~,. Health Dept. Approval ~ ......... al ~ . . .Labor Dept, Approv .......... f. ........... Unde~riters Approval ...... ~ ............ Planning Board Approval . ..,. ,~/~ .... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ . .~' .0 ~. ~ ~ ~ ~ ~' ~ .... . Construction on above described buildlng~~ and regulations. R~, 10-10-78 .IY/,4 P O,t;:' IP~P£ R TY FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved /(Y/crZ</ /2 19.~t/. Permit No //~z~,~-,~ Disapproved a/c ...... ... .......... ................ ::-':::"" ........... '"' " r APPLicATIoN FOR BUILDING PERMIT Application NofZ¢.~.~.~. ..... ' ..... Date .... INSTRUCTIONS a. This application must be completely filled in by typewriter or 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 buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- 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 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 part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department 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, ~de, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necess~W-~nspecnon~s. (Signature of applicant, or name, if a corporation) ~ ~... ~:~ .~ .o~~. .~. :;~.~ .......... (Mailing address of applicant) State whether applicant .is owner, lessee, agent, architect, engineer, e~er~ electrician, plumber or builder. .................. : ......... ....... :"'i .......... ii" .. Name of owner of prem,se, . ..~,t .~-..~ .................... ..~[~//.,r/7~./,///////~ (as on the tax roll or latest deed) ........... if applyn~~'o~thorized of~:er. .... ~..% .... ./~.~... . (Name.~title of corporate 5fficer)~ Builder's License No ...... .~. ~57~.'~. ~.. ......... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ..~..z..z..o. ......... ~ ..... ~..~_~. .......................................... House Number Street Hamlet County Tax Map No. 1000 Section ...... .//?. ~. ....... Block ...... ~.. ......... Lot ...... '.~..~. ........ Subdivision .................... ~. ............... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and/intended use and occupancy of proposed construction: a. Existing use and occupancy .......~./(..~.~/~ .... ~,,~. · .~. ~.~ ......... ~, ................... .... .... .............. 3. Nature of work (check which a ,plicable): New Building .......... Addition .......... Alteration,~.,,. ~ .... Repair .............. Rem )val .............. Demolition .............. Other Work...,~-~?..'.~. ~... ' (Description) 4 Estimated Cost /../~ .(~3.~5...~. Fee (to be paid on filing this application) 5 If dwelling number of dwelling units Number of dwelling units on each floor ' - If garage, number of cars . 7. 10. 11. 12. 13. 14. If business, commercial or mixed occupancy, specify nature a~20d ~xtent of each type of. use ........ ._.~..~., ....... Dimensions of exisIing structures, if any: Front ....~...~.3': ..... Rear .... : (o. :.. D~p. th...~:/.. :.:.. Height .... ~..~. ...... Number of Stories . .. · .'~,-: ..................................... Dimensions of same,,~t,j;ucture with alterations or additjops: Front ...... ~..J~.. ...... Rear .... ~..Q~. ......... Depth. .... ~. ~..~ ....... i-.. Height .... ~. ~.. ............ Number of Stories ..... ~ ....~.. ! ........ Dimensions of entitle new construction: Front .... ~o..~. I:~ ......Rear .... X/. ~.. ...... Depth . .4~'.0 ......... Height ..... /.~ ....... NUmber of Stories ......... / ............................................. Size of lot: Front ........ ~. ~ ........... Rear ........ ~/. .......... Dep,~h .. q~..q~, .q~.. ~ ......... Date qf Purchase ...... ~t?.. i..~. o~. .............. Name of Former Owner . . .~)Q..6t.r. ,~:..~..5...~ ............ Zone or use district in which plemises are situated... F..~$.ff .~J-o~-~..'~.; .......... r ............. Does proposed construction violate any zoning law, ordinance or regulation: ............................ Will lot be regraded ......... i. · · "- ................ Will exces3 fill be removed from premises: Name of Owner of premises ~..~./-,<,&~. ....... Address . ~.:?. .... Phone No. Z .~.. 7~'.~. (.~... Name of Architect ......... .'. ............ , .... Address . .,~.~..G~ ..... Phone No ................ Name of Contractor .~.'.~. ~..~..,..~. · ~. Address . ..~. ~ ....... Phone No..'2 ~. Y7.2. ~7'~.... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions frown property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW,~YQ.I]~,~ e S COUNT~'OF....~4.. ~..1~. ~.~Y~)~-/-~.., abovenam~d./'~ D~/~ ~. / ................................................ ' ~C~tract~nt, corporate officer, etc.) of said ow~erg~nd is duly autho~rform or have performed the said work and to m~e and file this application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the work will be perfo~ed in the man~er set forth in the application filed therewith. Sworn to before me this ~ IIOT~RY PUBLIC, St~0 o , .Y -. , ~ ~ - ~m ' ~ No. 4725080, Suffolk County ' ........ ,~ }~ ....... ~ay o~ ..... ~.~S~ ...... , 19 .~3 Term [x0ires March 30, 19~~ Notm~ Public, ........ County ', ~ ...... /~- ~gnatureofapphcant) J ~,~LL~,r~ ~1' !~, ~OUr~m' ~ ....... "~' -.. :%'~ ~LL COx~L~CT~ON S~ALL M~ THE RF~:"~:~Eh~S OF THE N, STATE CC~:~RUCT~ON & CODES. NOT RESPONSIBLE ~ESI~N OR CON~RU~ION ERROR~.