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HomeMy WebLinkAbout11023-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y~ CERTIFICATE OF OCCUPANCY No Z-17673 Date JANUARY 12, 1989 THIS CERTIFIES that the buildin~ Location of Property 38705 MAIN ROAD House No. County Tax Map No. 1000 Section 085 Subdivision SECOND FLOOR ADDITION Street Block 02 Lot 018 Filed Map No. Lot No. PECONIC, N.Y. Hamlet conforms substantially to the Application for Building Permit heretofore filed in this office dated JAUARY 30, 1981 pursuant to which Building Permit No. 11023-Z dated FEBRUARY 2, 1981 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 SECOND FLOOR ADDITION TO EXISTING OFFICE SECTION OF AGR.BLD. The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED FRANK CICHANOWICZ, JR. N-849106 - 1/7/1988 tot Rev. 1/81 FOI~ NO. Tow. OF S~"~L~ TOWN ~LL SOUTH'OLD, BUILDIN~ P.E~IT (THIS PERMIT MUST BE KEPT ON THE PRE~IS~s UNTIL FULL COMPLETION OF THE WORK ^UTt;IORIZED) ~? 1102:t 2[ r~at~ ..:~.~.~.,...~., ............ ; ~..~/ Permissio~ is hereby granted to: .... ~X .... x.~~ ~.~.~.. ............................ ,..~ ............ ....~. ~5....~z~.~.....~. c..... ~.c ~.~.... ~... ¢ ~/o~ ............. ~ p~o~o, ~o,~$ ~...~.~.g~.~ ......... ~ ......,..,...? ....................................... : ........... :...: .......... ........ ..................... ..... ....... ~ ....................................................................... ~ ....~ . .~ ~'*',, r ........t ........ Coufi~ *ox ~op ~o. moo s,ction ............ ~o*k i~. ,,~ ......... [*t ~o..D.~. ......... purs~ont fo applicotion d~t*d ~.~....~......~....~....., 1~. , ~nd opprov~ by the Building Inspector. ) : F~e ............... FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted .- ~ to the Building Inspec- tor with the fo{~owing; 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 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 in~alla- tlons, 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 property showing ail 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. C. Fees: 1. Certificate of occupancy $25.00 -- BUSINESS $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $I0.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date .......................... NewCons truction...~... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ..................... ,,..; .................... House NO. Street Ham/er Owner or Owners of Property ....... ~. ~e....~..~ .................... County/ax Map No. 1000 Section ............... Block ..... Lot Subdivision ................................. Filed Map No ........... Lot No .............. Permit No.J~.. Date of Permit ..... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ...... Underwriters Approval ........................ Planning Board Approval ,,, Request for Temporary Certificate ..................... Final Certificate ..... Fee Submitted $ ............................. Construction on above described building and permit meets all applicable codes and regulations. Applicant .................. TOWN OF SOUTIIOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTtlOLD, N.Y. 11971 TEL. 765-1802 To Whom This May Concern, We are unable to complete your Certificate of Occupancy because ~o~ the following reasons. An application for Certificate of Occupancy is not on file. No Underwriters Certificate on file. Tile check is(outdated/not qn fi!~.)~l©.C~3 No Health Dept. Approval on file. No final inspection has been made° Please contact our office on this matter. Thank you for your cooperation. Building Permit ~I _~ _~_ ~_ _~ ~ Z Building Dept. ***/5/ No Plumber Solder Certificate on file. ( all permits involving plumbing being issued after April 1,1984 ) FIELD INSPECTION COMMENTS FOUNDATION ( ~ st ) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE E ~N~GY CO.DE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1803 Examined~..e~....'~2. ...... , 19c.~/. Approvcdj-~..: ........ 19.~. Pemfit No. Disapproved a/c .................................... ./~ (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No..//.~. ?..~.~7 ....... . 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. 77~ ........................... State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. Name of owner of premises ..... ~-~Z,4q-... ~;~.~.: .-~.~. 6~. 4 ~ .'?. .... .~..~ ......................... (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. d .~/. Z'q ./9...0. .......... Other Trade's License No ...................... Location of land on which proposed work will he don~ ...................... ~7 ....................... ...... ........... . .................. z .o.. .u. .. . ........ House Number -- Street Hamlet -- County Tax Map No. 1000 Section . .Q'.~..~.. .......... Block ...O..'~. ........... Lot...O..F..~. ........... 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 ..... ~.C/~.f,~..//~..~.../.Ag. 7-~..~G../.~..d~C .7.~.... O~.. ! ~ ~.. .......... .. . z...-..,d ................. b. Intended use and occupancy 3. Nature of work (check which applicable): New Building .......... Addition........../ Alteration Repair ........... Removal .............. Demolition .............. Other Work ............... ~f / 5~ ~ (Description) 4. Estimated Cost ........................ 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 ........................................................................ 6. If business, commercial or mixedi occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structure~, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ' Height Number of Stories 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...........; .......... Rear ...................... Depth ...................... 10. Date of Purchase ........... i ................. N)xme. of Former Owner ............................. 1 1. Zone or use district in which premises are situated ..... ~.~ .............................................. 1 2. Does p~oposed construction violate any zoning law, ordinance or regulation: ............................ 13. Will lotbe regraded ...... /~}.¢/. '. .............. Will excess fill be removed from premises: Yes 14. Name of Owner of premises .... ............... Address ................... Phone No ................ Name of Architect .......... ............... Address ................... Phone No ................ Name of Contractor ........................ Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all i~buildings, whether existing or proposed, and, indicate all set-back dimensions from 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/IrJORK. COU T ¥jO · .~~'" '~.-.~ .... being duly sworn, deposes and says that he is the applicant ' (Name of individual signing co{lffact) above named. He is the ..................... (Co{~t~'ractor , agent, corporate officer, etc.) of said owner or. owners, ~d is duly autho~zed to perform or have perfomed the said work and to m~e ~d file thi~ application; that all statements cont~ned ~ this application are tree to the best of his ~owledge and belief; and that ~. work w~l be perfomed in the m~n~r set forth ~ the application filed therewith. Sworn to before me this Nota~.Ppblic, . .... ~ ~~ .. County [t0, 5~,81~5850, u 01k ~' ............................ i 1~ Expires ~arch 30, 19,~ ~ (Signature of applicant)