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HomeMy WebLinkAbout11142-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...g.'l.'l.~.'] 5 ......... Date ........... .~..~..e..7. .............. l~.. THIS CERTIFIES that the building .~-.d.d.~.~.~9.~. ..................................... Location of Property ...~9(~. ~9~c.o~r..~.~.¥~ ............. .Q~.~9~.o.g~. ~ ................ House No. Street Hamlet County Tax Map No. lOO0 Section . ~.O. Zf ....... Block ..... ~ ......... Lot ..... ']. ........... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore Fried in this office dated ........ _~;Lj..27 .... ,198.'1. pursuant to which Building Permit No..'l.q'J¢~.~ ............. dated ..... FI~. 8 ................. 198~., 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 ......... ..... f. or. enclosed, ca-rigorS:..&, ev-Zarge.d .at.~ache~ .deck .................... The certificate is issued to .. 1~.. &. 2vl]~...ST~¢'~ .GlOOmS .............................. (owner, levee or tenant/ of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE NO. lXI/g' Building Inspector Rev. 1/81 FOl~I WO, ~ TOWN ,or' ~u~r,~.i~ TOWN 'HALL SOUTHOLD, N~ Y. BUILDING P,ERt~iT (THIS PERMIT MUST BE KEPT ON 'T,H,E PREMIses COMPLETION OF THE WORK AUTHORIZED) N©. 111 4 2 'Z ~ote . ...~ UNTIL ULL Permission is hereby grorffed to: .......... Z .......... , .................. ~.Z~..~.~z:.. .... '"7: ' .............................. ........... ,.. 7..,...~,. · ....? ......... ~ .................................. ....................................... z ........ ~ ............... ~::"~~ ....................................... at premises ,ocoted o, ..~.~.~ ....... ~.~.,.-~'~ ...................................... ................................................................................. ........... ...... co~ ,~ ~,~ ~o. ~°00 s,~,o~ ....~.~.:.:. ~o~k ~q.~ ........ ~, ~o..~.z ........... ~ ~/~. ~..~ ......... [.-, 19.~., ond opproved bv tho pursuont to opplicotion datod... ~ ............. · ~.. gufldlno Inspoctor. / Fee $..,... .................. ~ 'Building In~ector Rev. 6/30/80 ~ FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hell $outho~d, N.Y. 11@71 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in tyoewritar OR ink, and subr~itted in duplicate to the Building Inspec- tor ~wth the following; for new buildings or new usa: 1. Final survey of property with accurate location of all buildings, property hnes, streets, and unusual natural or togograohic features 2.Final approval of Health DepT. of water supply and sewerage dispose -(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildlngs, industrial buiJd~inas, Multip e Resi.clence~s and similar buildi[?s and n,sta o- rions, a cerdf cate of Code complianc~ fr~om the Arch tec~ or ~-ngineer responsibie'Jor the bui,dmg. 5. Submit Planning Board approval of completed s~te plan requirements where applicable. B. For ex;sting Ldild,ngs (prior to April 1957], Non-conforming uses, or buildings and "pre-exis~:ng'' land uses: 1. Accurate survey of peoperty showing all property lines, streets, bulidings 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 $5,00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Rev. 10-10 78 New B~i~:~+,~ .~ .... Old or Pre-existing Bulidlng(,'~) ........ .=/Vacant [.and -. .......... Owner or Owners of Property . . ~, ~% County Tax Map No. 1000 Section ............ Block ............... Lot .............. Subdivision ............................... Fded Map No ........... Lot No .............. HeaJt~ Dept. Approval ........................ Labor Dept. Approval ...................... Unde~r~ters Approval ........................ Planmng Board Approval .................. Request for Temporary Certificate ..................... Final Certificate ................. Fee Submitted S ............................. Cunstruction'on above described 5udding and perm¢~ mee~s afl a~p~cabl~odas and regulations. FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION FERN. STATE ENERGY C~DE FINAL ADDITIONAL COMMENTS: Addendum to Building Permit Application filed April 27, 1981, for Stephen & Carole Gross Hickory Drive East Cutehouge~ N.Y. Designer FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 kpproved .,'!d.~...~.. ...... Z" , 19 .Cr~2/. rermit No ............ Application No. t' [' / ~7~ ~'~ )isapproved a/c ..................................... ~--~------~- 0 //' ' ......................................... : ./.?... ~ . (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 description of layout of property must be drawn on the diagram which is part of this appli- :ation. c. The work covered by this application may not be commenced before issuance of Building Pe.rmit. d. Upon approval of this application, the Building Inspector will 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 ]uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or '~egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ['he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to ~dmit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) .fi..'/.:.. (Mailing address of applicant) ~ ~tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. qame of owner of premises . ]~.., .4/...~..~......~....~....~....~... ........................................ (as on the tax roll or latest deed) f 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. "-- Other Trade's License No. I. Location of land on which proposed work will be done....'~J~.~.....t:3~.....'~D~..l~.. ~,~ .................. ...... .c?. ............... ........ c.4rr .u. ............. House Number Street Hamlet County Tax Map No. 1000 Section ........ IO~. ..... Block ...... /~5. ......... 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 ....".-.~.l..1'~...L~.......~....'Ti . ...~...~ ............................... b. Intended use and occupancy ,~--,-,~M~5 A'~ ~ 3. Nature of work (check which applicable): New Building .......... Addition .......... Repair .............. Removal .............. Demolition .............. Other Work ............... ~' ~n( ~ ~' ~ (D e scription ) ! (to be paid on filing this application) ~. If dwelling, number of dwelling units...q~. ...... Number of dwelling units on each floor.. · .'~. ........... If garage, number of cars ..... ' ..... ~. ....................................................... 5. If business, commercial or mixed occupancy, specify nature and extent of each type of use . ~. 7. D~menmons of existing structures, if any Front .... (aC) ........ Rear ........... e ....... Height .............. um er o ones ............. ~ .......................... · ' " It ' dd'' s:F t ~~Re Dnnenslons of same structure wl!h a eratlons or a ltlon ton . ar ................. Depth .................. ... Height ...................... Number of StOries ................. L D~a. ensions of entire new construction: Front ............... Rear ............... Depth .............. ~e~ght ............... Nu_m~er of Stories ................................... ~'~ ............ ). Date of Purchase /~k. it' 1~/1~ ............... Name of Former Owner I':~q't~ I. Zone or use district in which premises are situated..~g~.~,tl;:~ ..................................... 2. Does proposed construction viol ate any zoning law, ordinance or regulation: .1710 ............................ 3. Will lot be regraded ..... 1~ ................... Will ex.cess fill be removed from premise~; -x Yes .(~ PLOT DIAGRAM Locate clearly and distinctly all, buildings, whether existing or proposed, and. indicate all set-back dimensions from t'operty lines. Give street and block Dumber or description according to deed, and show street names and indicate whether terior or corner lot. ~ TATE OFNEWj~ORK, . .... .... ~~:..~J.~.. ;~. .......... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) )eve named· els the .................. .............................................................. (Contractor, agent, corporate officer, etc.) f said owner or ownem, ~d is duly authorized to perform or have perfo~ed the said work and to m~e and file this 9plication; that all statements contained ~ this application are true to the best of his knowledge and belief; ~d that the 'ork will be perfo~ed in the manner set'forth ~ the application filed therewith. worn,before me this ...... .. ...... [,,~,~. ~,,,,~ a,,,, a0, ~ (Signature of appHc~t) I