HomeMy WebLinkAbout11201-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N,Y.
Certificate Of Occupancy
No. Z10673 Date Sep%ember 10
.................................................. l~...
THIS CERTIFIES that tile bLdlding ................................................
Location of Property ..... ?8.0..qO.l.d, ,,S.p. g?..R.O..a.d.~ ..... ~.14 ~ .O.h.O.~g .e,~' .~e. i..¢..~.o.~..k ........
House Ho. Street Ham/et
County Tax Map No. 1000 Section .. ,0.9.5. ...... Block ....0.4 .......... Lot ,. 9J.8 ............
Subdivision. 9r.e. gc~r~. ,~.J, 9 .w..~.~.~ .a.g.ep. ....... Filed Map No. 6..2,4.1 .... Lot No...1.4. .........
conforms substantially to the Application for Building Permit heretofore filed in this office dated
l~.a. 7. ¢.9 ............... , 198..1. pursuant to which Bnilding Permit No .... ~.~.2. 9J. iz...' ........
dated .... .J.u.n.e...2.3 ................ 198. 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 .........
............... .&c.e.e.s..~ .o ?.y.. c., .a.e.a.~ e. ..............................................
The certificate is issued to .... P..a,t~ r';l..c.k. [~.ela.~hCrs ......................................
(owner, xtelsiloxo, ixt,X.t,R.~&
of the aforesaid building.
Suffolk County Department of Health Approval ...... N/.~t .................................
UNDERWRITERS CERTIFICATE NO ...... /~/.I~ ........................................
Rev. 1/al
Building Inspector
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N~ Y.
BUILDING PERMIT
(THIS pERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
No. 112O1 Z
Permission is hereby granted to:
......... ~~....~,.~ ...... ~..~..,, ~.,,~,
........... ./:~ ...... ~.~ ........
I'O ~' " "" *~ ...............
~';::~;i';:';;'~;=';~'iiii~iL~..,:4z....~,~....~,,~ ......................................
.... ~.....~~_,,x_~......~z'~. ................... ~....,..~...
~" ~ N.o
~un~Tox Mo, No. ,000 ~c,ion ...~.~.. ......... B,~k o. ................ ~, o~.~ ...........
~u.uon, ,o o~.,,~o,,on ~o,~ ::~...~.~ .......................... ,
Building Inspector.
Rev. 6/30/80
FOUNDATION
(1st)
FOUNDATION (2nd)
2.
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
GODE
FINAL
ADDITIONAL COMMENTS:
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:
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 Res dences and similar buildings and installa-
tions, a certificate of Code compliance from the Architect or Engineer responsible for the building.
5. Submit Plann r g Board approval of cornpleted 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 featu res.
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.
1. Certificate of occupancy $5.09
2. Certificate of occupancy on pre-existing dwelling or land use
3. Copy of certificate of occupancy $1.00
$5.00
New Building ............. Old or Pre~existing Building ............ Vacant La~ ............
Ho.s No. * s;,;;t ' :'
Owner or Owners of Property . .. ~ ..............................
County Tax Map No. 1000 Section ............... Block ............... Lot..~../.~ .....
z?
Subdivision.
Permit No ........... Date of Permit .......... Applicant .~. ..~~ .......
Health Dept. Approval .... ~.'. ~t .............. Labor Dept. Approval ~ ~.{ ................
Unde~riters Approval .... ~ 2. ~., .............. Planning Board Approval . ~.'.~.'.... ~.
Request for Temporary Certificate ..................... Final Certificate ...'~..~
Fee Subm tted $ ~ t ~ .............
Construction on above described building and p,e~rmLt meets all applicable,codes and regulatiom
Rev. 10-I0-78
APPROVED AS NOTED
/C) ~' BY: ~
FEE:
Notify BUILDING D¢PAR~-M~NT AT
765-1802 9 AM TO 4 PM FOR THE
FOLLOWING INS2ECTIONS:
]. FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING
3. INSULATION
4. FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C. O.
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N.Y.
STATE CONSTRUCTION & ENERGY
CODES. NOT RESPONSIBLE FOR
DE-SIGN OR CONSTRUCTION ERRORS.
NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT i
TOWN CLERK'S OFFICE
/~ SOUTHOLD, N. Y.
Examined ../~4¢~rcZ~,~¢~.....°~.....~... ........ , 19~/;.. ~ ~ Application No...~.~ ..............
~prove~/ ................................. , .... , .................................
Disapprov~-- a/c ..................... ~.~.........~ ........................................................
z (B~ding Inspector)
APPLICATION FOR BUILDING: pERMIT
Date
............. ...7.. ........................... , .....
INSTRUCTIONS
o. This application must be completely filled in by typewriter or, in ink and submitted in triplicate to the Building
Inspector, with 3 sere of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing lecation, of lot and of buildings on premises, relo~io~iship to adjoining premises or public streets or
areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application.
c. The wore 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 Deportment for the issuance of o 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, et for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in buildings for necessary inspections.
(Signature of applicant, or nome, if a corporation)
.......................... ...............................
State whether applicant is owner, ~see, agent, architect, engineer, general contractor, electrician, plumber or builder.
Nome of owner of premises ...... .~....~.'~.>.?.~..~......~...~..~.~ .................................................................................
If applicant is a corporate, signature of duly authorized officer.
(Nome and title of corporate officer)
Builder's License No ........ ~.......~..~.......~.....~..:....--. .........
Plumber's License No .................................................
Electrician's License No .............................................
Other Trade's License No ...............................................
/
Location of land on whic~ ~pro,qos~d ~.ork will be do~e.
Street and~t/Number7 ~C) ""~' "~'"'¢'~""~'
State existing use and occupancy of premises and intended use and ~)ccupancy of proposed construction:
.....
3. Nature of work (check which applicable): New Building,. ........... Addition .................. Alteration .................
Repair .................. Removal'. ................. Demolitior ..................... Other Work ................................................ . ....
(Description)
4. Estimated Cost ..... ~...~..i ........................................ Fee ..........................................................................................
I (to be paid on filing this application)
5. If dwelling, number of dwel!ing units ............... ..."~.. ....... Numbcr of dwelling units on each floor ............................
if garage, number of cars i ..... ~ ...........................................................................................................
6. If business, commercial or [ mixed occupancy, specify nature and extent of each type of use ............................
7. Dimensions of existing structures, if any: Front ............ ~ ............ Rear ................................ Depth ....................
e ........................ u er o aries .................................................................................................................
Dimensions of same structure with alterations or additions: Front ................... ~ ................ Rear ............................
Depth ................................ e t ............................ Number of Stories ................................
8. Dimensions of entire new colnstruction: Front ..../....~.. ........................ Rear .. /. ..~. ../, ................ Depth ~ 2.,, ,
Height ...... J..~ ........ Number of Storms ....................................................................................................... ~ ...........
11. Zone or use district in which, premises are situated ...~,,~4,*....~....~.~,~',;:~.~-~,.....'~.. .............................
12. Does proposed construction violate any zoning law, ordinance or regulation: ......... ~,.,~. ................................
13. Will'lot be regraded ......~ ............. WiL[excess fill be removed fr~ premises: ( ) Yes (~Ck, No
14. Name of Owner of premmses ...~.,..-'~....%-~./r;N~m~l,~-:~... ........Address ~~.....i/Phone No .......................
Name of Architect .... ~....~ ......................................................
Name of Contractor .......... Address
PLOT DIAGRAM
Locate clearly and distinctly a 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. I ~,*'~'~ !
STATE OF NEW'Rjr,/./7/ ISS
................ ~ ....~¢~..~:...:...,..being duly sworn, deposes and says that he is the applicam
i (Name of individua]-~ignlng contmcf)
above named.
He is the~ ................................ ~ ..............................................................................................................
~ (Contractor, a~ent, corporate officer, etc.)
of said owner or owners, and'is duly"'~LL~oriz~perforrn or hove performed the said work and to make and file,
this application; that oil statements contam~R~in ~this application are true to the best of his knowledge and belief; and
ti,or the work will be performed in the manner set forth in the application filed therewith.
Sworn to b.e~ore me this i ^ ~
P6blic,
~'~ ELI~ETH ANN NEVILLE '
NOTARY I~UBLIC, State of New York
No. 52-8125850, Suffolk
!Tern] Exp res March 30, 19~..
OOI~T~' EEAL~It D~PA~TM~2/!
1~ 1~7I
, '~. ~. ~. ~ $~9-/.
~ilposal ~ ~ater su~pl~
for this location have been
~Y this department ~d found
NOTE:
m --- MONUMENT.
SUBDIWSION MAP F/£ED IN THE OFFICE
OF TH£ CtER~ OF SUPFOL~ COUNTY ON
~I~ 4~ 1975 ~S M~PNO.~2WI,
NE~EST W~TE~ MAIN= 4 MITES t
A
R=25.1
YOUNG & YOUNG
400 OSTRANDER AVENUE. RIVERHEAD, NEW YORK
ALDEN W YOUNG HOWARD W. YOUNG
SURVEY FOR:
FRANK ~ORN
£ 0 T I~0. I~, "OREGON
VIE W ES TA TES "