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HomeMy WebLinkAbout11116-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Date June 18, 1987 THIS CERTIFIES that the bmlding ........ .n?.w...f.o.u.n.d..a.t.i.o..n..t.o..?.x3.s.t..i.n.g..d..w?.l.k.i. n9~. Location of Property .... .4.2.0, Lakeview Terrace East Marion House NO. ' ..................... County Tax Map No. 1000 Section ...... .3.1....Block ........... 9....Lot 1 1 Subdivision ............. .X. ................ Filed Map No .... X. ....Lot No... X conforms substantially to the Application for Building Permit heretofore filed in this office dated April 11, 1981 lll16Z ..................... pursuant to which Building Permit No ...................... April 21, 1986 dated ............................. was issued, and conforms to all of the requirements of the applicable provisions of the law. Tile occupancy for which this certificate is issued is ......... New foundation to existing dwelling. The certificate is issued to ................. [vI~R.K.. &. SHARON MIDDLETON ..................... of the aforesaid building. Suffolk County Department of Health Approval ................ N. [.A. ...................... UNDERWRITERS CERTIFICATE NO ........................ N. [.A. ...................... PLUMBERS CERTIFICATION DATED: Rev. 1/81 TOW. Or ~OUTU~ BUILDING DE~[PARTA~tli.1 TOWN {HALl;, SOUTHOLD, N. Y. BUILDING eEI~IT: (THIS PER~ T MUST BE KEPT ONi IHE PP, E/~IS~S UNTIL ULL COMPLETION OF THE WORK AUTHORIZED N©. 111 1~ ~ot~ ... Permission is hereby granted to:~ . ~ · , ..... ~,..~:....~l~.~.~,t~. ....... ......:....&.q.~. .......... L.;.... ................ ...... Z~ ~~~ ~o ..................... ] ................ ~.. ~: ..... ...... ~ ................ ~ . * ~ ........................... ...~.~X.t~G~.~ ......................... ¢~ ............. ~ ........ ,..,,?...~: ................ ? ............. ~ p~o~o~ ~o~to~ ~t .~..~ ........ ~.5~.~.,~ .... · ............................... ....................................... ......................................... ........ CounW Tax Map No. lO00 Section ,,,~,~,~ .......... ~t No. ,~,~./ ............ ..... ond opproved by the B~ldln~ In~poctor. FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall Southotd, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted m ~ 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 instalta- 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 p~operty 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. C. Fees: 1. Certificate of occupancy $25.00 -- BUSINESS $50.00 ACCESSORY $10.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Cop¥ of certificate of occupancy $ 5.00, over 5 years $10.00 4.vacant and o.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/et or Ownerso Pro,erty ... ................... County Tax Map No. 1000 Section ..... .5.~ ...... Block ....... ¢.? ..... Lot...// .......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. /./././~.... Date of Permit '~'/~' il ~?'/' .Applicant...~b~, t'~ .~f.../~¢.~/~ ....... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ...... ~ ............. Fee Submitted$...~.~..~.....~.~...~.~.9.~... Construction on above descmbed building and permit meets all applicable codes and regulations. Rev, 30-10-78 gUll I 8 1987 Ltow~ OF SOUTHO~ TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 To Whom This May Concern, We are unable to complete your Certificate of Occupancy because,of the following reasons. /_~/ An application for Certificate of Occupancy is not on file.~C~S~d) /--/ No Underwrikers Certificate on file. /~/ The check is(outdated/not on file,) ~oo /5/ No Health Dept. Approval on file. /5/ No final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. Building Dept. ***/5/ No Plumber Solder Certificate on file. ( all permits involving plumbing being issued after April 1,1984 FIEbD INSFhCTION FOUNDATION (1 FOUNDATION ( 2. ROUGH FRAME & FLUMBING INSULATION PER N STATE ENERGY CODE 7GS-1802 BUILDING DEPT. [ ] FOUNDATION 1ST [ ] ROUGH [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING ' DATE INSPEGTOE Memorandum fro~ .[,~... BueLl)mO I~?,EcroRs OmC~ TOWN OF SOUTItOLD Town HALL, SOUTHOLD, l~q. Y. 11971 765-1802 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ix amin ed/~/~/.~...~n ( ..... lP ~..~. ., )isapproved a/c .................................... ~ (B~llding Inspector) APPLICATION FOR BUILDING PERMIT Application No.././//. ~ .......... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building .nspector, 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 )r areas, and giving a detailed descfiptmn of layout of property must be drawn on the diagram which is part of this appli- 'alien. c. The work cove~ed by this application may not be commenced before issuance of Building Pelxnit. d. Upon approval of this application, the Building Inspector wilt issue a Building Permit to the applicant. Such permit .hall 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 .hall 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 3uilding Zone Ordinance of the Town of Soutbold, 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. Fhe applicant agrees to comply with all applicable laws, ordinances, building code, housin~ code, and r,,egulations, and to ~dmit authorized inspectors on premises and in buildings for necessary insp~o~ //.f~ / / ..../<.. .............. ~ignatu~e of apphcant,- - 'or name., ~ a corporation) (Mailing address of applicant) / grate whether applicant is cwner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 'lane of owner of premises.....~/'~t~.~....~../ff~..¥.~.~.ff.//~]~'. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of co¢orate officer) Plumber's License No. Electrician's License No. /' /' ~' Other Trade's License No ...................... Location of land on which proposed work will be done..//~..~ .~..~.../.'~../ff.~.,4/. ~..~..~. ..... . . . ........... , . . . . . , . ............ House Number Street Himlet County Tax Map No. 1000 Section .~C ~T.ff. .... Block .................. Lot ................... Subdivision ..................................... Filed Map No ..... ~ . Lot ............... (Name) State existing use and occupancy of premises and intenfled u~e a~~ / ~ occupancy of proposed construction:c //, _ a. Existing use and occupancy ........ ~/*/~.. ~'.~.. ~z~'/~.~/ ..... .~. ..... ~ .......... b. Intended use and occupancy ...... ~.. ~ .f~ff~j~f~.... :~;;;~-~:'. .... 3. Nature of work (check which applicable): New Building .......... Additio teration .......... Repair ............. .a/Removal .............. Demolition .............. Other Work L Estimated Cost ..... : ................. Fee ................ -~ ........... " , ~ (to be paid on filing this apl~lication) i. If dwelling, number of dwelling dnits .... ~ ....... Number of dwelling units on each floor · ·/./.O,/b..~ .... If garage, number of cars ..... , ................................................................. i. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............ ) ....... ?. Dimensions of existing structures, if any: Front ........ Rear ......... Depth . .~',',~.'. ....... Height ............... Number of Stories ...... ,~' .... i ............. Dhnensions of same structure with alterations or additions: Front ... ,a'~Of. ·/ ......... Rear ... ~'~./. ........ Depth ....... ~---;~. ......... ;.. Height ...................... Number of Stories ..... Z ....... t. Dimensions of entire new construction: Front ..... ~ae( ..... Rear .... o/~..'. ...... Depth . .,~. :~. ....... Height .............. Number of Stories ......... ,, .................... ... · ;, ........... ~. S~zeoflot. Front ...... ,E'.~; .......... Rear .... ~.L~: .~. ......... Dept~, ~...~'~..e~. .... !'. Does proposed construction viol,at~e any zoning law, ordinance or regulation: ...... ~ ................... :t. Willlot be regraded ........ ;~,~ ............ t"' Will exces~llb,9 remo. v..9.d from premises: ./ Yes _ Name of Architect ....... ...,..e~/n~t'~.7~a~. ..... Address . ..~------~.~ . .. Phone No ................ Name of Contractor ......... i ................. Address ................... Phone No ............. ,.. PLOT DIAGRAM- Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from -operty lines. Give street and block terior or corner lot. lumber or description according to deed, and show street names and indicate whether ~"~TATE OF NE',E YORK, i S.S , O--ou rrY OF ...... .~.~..[C...~.: ~./tgDC~ Icj/0 being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) oove named. e is the ............................................................................... (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the ~ork will be performed in the manner set forth in the application filed therewith. worn to before~ this ...... ,ot,~ry Pul~hc, . ,...~.'x,,..--.., .............~x... ...... County (Signature of applicant) Commissio} Expires ~rclT 30, 19,J~'~''-'~