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HomeMy WebLinkAbout11291-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y, Certificate Of Occupancy No.Z.1..2 .6.3.8. .......... Date .......... ~.u..1 7..2.5. .............. , ! 98. ~.. THIS CERTIFIES that the building ........ D. e. 9 .k..a.d..d .5 t i on 11185 Soundview Ave. Southold Location of Property ............................................................... House Ho. Street Ham/et County Tax Map No. 1000 Section . 0..5 ~ ........ Block . .0..5 ........... Lot ... 0..3 .9 ........... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Appllcat~on for Building Pem~it heretofore filed in this office dated ..... .d .u.l.y.. 2. 9 ........ , 198.1. . pursuant to which Building Permit No.. ] .1.2.9.1. g. ............. dated .... 5. u..3_ y..2. q ................ 193.1.., 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 ......... .... I~ e ¢K .~ c~ cl ~t.t. ~, or~..t.Q. 9 x.5, a ~; ;Ling. ql w.e.l.~ ~_ pg.. (. J, o w.e.p., ql e.c.!q ). .................... The certificate is issued to .. L. y.n.n.e...F.a.km, e. ? ........................................... (owner, I~t( ~tX't~r~t~ X X of the aforesaid building. Suffolk County Department of Health Approval ..... .N./.A ................................. UNDERWRITERS CERTIFICATE NO. N/g Building Inspector Rev. 1/81 ~o~ ~o. ~ TOWH OF SOUTHOL, BUlLDIH~ TOWN HALL SOUTHOLD, N~ ¥. N°. BUILDING' PERM!TI~ ~, (THIS PERMIT MUST BE KEPT ON THE PRE/~IS~S UNTIL F~ULL COMPLETION OF THE WORK AUTHORIZED) ~ 11291 Z Dote.,....~ ,' ~.......~C2 .................. , ~.~../ Permission is hereby granted to: ,r,) .... ..... ~r.~.~.;~- ....... ..... . ~o ..:~a ~-Z~...~.~ .....~c~.:::: ........ A~.~...~~[~ ......... ....~ ................ ;; ........................................ Coun~ Tox Mop No. 1000 Sectmn ....... , Bilk :. ......... ~Lot No ......~ ...... ., pursu=nt to opp coton dGted .............. ~....~....., Builaln~ Inspector. Re, v, 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall $]outhold, 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 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 ~rvey of peoperty showing al~ property lines, streets, buildings and unusum 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. C. Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling / 3. Copy of certificate of occupency $1.00 ~'J~IL-~.~ Id~°~'~ or Pre exlstln Bulldln New Building ............. 0 - ' ' g ' ' g landuse--Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Date ...july.5Y, b,..198~ ......... ............ Vacant Land ............. Location of Property .... .N/.S..S.op.n.d..V.~.e~/..A.v.e.n.u.e ............. .S.o.u.tjq.o.].d.,..N.Y...1.1.9.7.1 .......... House No. Street Hamlet Owner or Owners of Property...~.~. ~.~ ..................................... County Tax Map No. 1000 Section . · · .5.4 .......... Block ... ,5 ........... Lot.. ,3.9. ........... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. ~/.~,/.Z-... Date of Permit ?/~0/~.. /. .Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ... ~ ................ Fee Submitted $ ~5.00 ..... ....................... Construction on above described building and permit me / /'" ~e c~es and. regulations. ~Applicant ..... .~- .~ ~ . ....-' .'-~ ~' '' ' n.,. GARY.R::ANNER OLSEN, ESQ. -tf P.O. 60X 706 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INsuLATioN ]FRAMING [~ FINAL' REMARKS: FIELD INSPECTIO~ FOUNDATION ( ROUGH FRAME & INSULATION COMMENTS PLUMBING PER N STATE ENERGY C,ODE FINAL I nd) ©~. Y. ADDITIONAL COMMENTS: , FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 80UTHOLD, N.Y. 11971 TEL.: 765-1802 Application No. Ud~../. ........ DisapTroved ......... a/c .... ~... 7..... ~ ......... ./ , (Building Inspector) APPLICATION FOR BUILDING PERMIT INST RUCTIONS a. Tlus appl~cat[on must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi Inspector, w~th 3 sets of plans, accurate plot plan to scale. Fee accordiug te schedule. b. Plot plan qmwmg location of lot and of bmldings on premises, relationship to adjoining premises or public stre* or areas, and giving a detaded description of layout of property must be drawn on the diagram which is part of this apl: cation. c. The work covered by this ~application may not be commenced before issuance of Building Permit. d. Upon apprc.'al of tlus application, the Building Inspector will issue a Building Permit to the applicant. Such pern shall be kept on the prennses available for inspection throughout the work. e. No budding shall be occupmd or used m whole or in part for any purpose whatever until a Certificate of Occupan shall have been granted by the Building Inspector. APPLICATION IS IIEP, EBY MADE to the Building Department for the issuance ora Building Permit pursuant to t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulat~ous, 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, for necessary inspections. admit authorized respecters on premises and in buildings d/ (Signature of applicant, or na~e, if a corporation) (Mailing address of applicant) ! ! State whether applicant is o~ner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build Name of owner of premises . J~.~ ........................................ ~-/V./o{.~.~.~.- .~. ,~-..,~, ~·"'.~ , ............. · (as on the tax roll or latest deed) If applicant is a corporatmn, slguature of duly authorized officer· (Name aud title of corporate officer) Builder's License No ..... .~. -'/ [ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ............................ ~q///'/dY.5~'- ~ Location of land on which proposed work will be done. ~%D c;/t/~b/y/~-~ . /.,/~.. -~7-z'~.~.W~E,~,' ./z/ ltouse Nmnber ' - / Street ' ' Hamlet County Tax Mai, No. 1000 Section ...... 5 .¢'.'¢7 ....... Block ... '-~ Lot 3¢' Subd~vtsion ..................................... Filed Map No ............... Lot .............. (Name) State existing use and occupancy of premises and intended usc and occdpancy of proposed construction: a. Ex]sting use and occupancy ........ /~-.4Lr~.M. .............................. b. Intended use and occupancy ....... .~.,~/v.Z.~..~ ................................................. I. Nature of work (check wi, icl, applicable): New Building .......... Additiong.. ~..~r"5.. Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... Fee~/~~ o~d (Description) Estimated Cost ....... ~. ,~.(9.Q :.0.0. ........................................... ~- ........... (to be paid on filing tids application) ;. If dwelling, number of dwelling nmts ............... Nmnber of dwelling units on each floor ................ If garage, munber of cars ........................................................................ ~. If business, commercial or mixed occupancy, specify fiatnre and extent of eactLl;y, pe of us~ ..................... Dm~ensmns qf existing structures, ~f any: Front .... ~. P:-. ....... Rear . . .~.~.fl'... Depth . .~. ~.. ~. ....... Height ~.~ f..~.,~Pg-~... Number of Stories ...... ./ ........ ' ......................................... Dimensions of same structure with alterations or additions: Front .. ,;,O-..~. f .......... Rear .... .~. ,;?-../. ........ ]Depth .... .'~'././. fa l( Iteight ,..~',4-.-~. ~. ....... Number of Stories /. ~. Dnnensions or'entire new construction: Front ..... cC. Pr.z ..... Re.a.,r.. ~,., ~,/,9-1;b,./. ...... Depth ../.4~. ~ ........ Height ............... Number of Stories ......... ' ......... ~, Size of~ot: Front ...... 8'.0.~. ............ Rear .... .//,~.../. ........... ~. Depth ./,/,'?.~'..~."....~.4.~..~'../ .... ). Date of Purchase . . ./d/.7.25 .................... Nanle of Former Owner ,~0~,/!/. ,,q'~'?/~ I, Zone or use district in which premises are situated ................................... '../. r .............. 2, Does proposed construction violate any zoning law, ordinance or regulation: .. ,/t,Z'.t~ ......................... Lt.Wi[l lot be regraded ..... /I/P~Lv.,~t,,ff~_/.,, .................... Will excess fill be removed from premises: .Yes No Name of Owner of premises ,.,~S.,..,/,., ......~.._~.Z../'g..~.,,~. Address Phone No .............. Name of Arclut~ct'~ ........................... Address ............... ' ' .... Phone No ................ Name of Contractor ~O/kt,e/.~.~. ~.~.k~'l>./'{~N~./d'.'J~°,~ll~"a~iFT. 2f~.P. 5T'~4. ,,FF.,. .... Phone No...'[-TZ':: ?.7..c~... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from roperty hnes. Give street and block number or description according to deed, and show stieet names and indicate whether tenor or corner lot. I'ATE OF NEW T*0)RK. ' '~' S.S ~?/~ ,~ ~~ ',7/,-ff~(~ame of indMdual signing contract) being duly sworn, deposes aud says th,a.~e is the applicant >ow named. .~.~s the ............... ~ ..................................................... (Contract(~r, agent, corporate officer, etc.) f said owner or owners, and is duly author/zed to perform or have per,formed th~ said work and to make and file this ~plication; that all statements contaiued in this application are true to ~be best o~owledge and belief; and that the 'ork will be performed in the manner set forth in the application filed therewith. worn to before me this ..... '2 765-1802 9 AM TO ~ PM FOR THE FOLLOWING INSPECTIONS: ~]. FOUNDATION - TWO REQUIRED FOR POURFD CONCRETE 2, ROU~q _ FRAMING & PLUMBIN~ 3, INSULATION 4, FINAL - CONSTRUCTION MUST BE C,~/n~ EwE FOR C, O, ALL CONCTPUCT~ON SHALL MEET THE RFOU~PrMENTS OF THE N, Y, STATE CONSTRUCTION & ENERGy CODES NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION E~RORS,