HomeMy WebLinkAbout11179-zFORM NO, 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No..Z1.1.~7.7 ....... Date Decamber 21 19 82
THIS CERTIFIES that the~maftd'/ng'-. .... d.e..c.k .......................................
Location of Property 450 Huntington Boulevard Peconic
h3usb bio; .................... 's't/e3i .......................
County Tax Map No. 1000 Section ...0. 6. .7 ...... Block ...Off. .......... Lot .... 0..0.7 ..........
Subdivision...?e.c. 9.n.:[.q..s.h.o. re..~ .......... Filed Map No..6.5.4. .... Lot No. 8..37.8.~ ~..~.n.c. 1.,
conforms substantially to the Application for Building Permit heretofore filed in this office dated
........ .lC.ay. 21 ..... 19 .8.1. pursuant to wbJch Building Permit No... 1. J .1.7.9..Z ...........
dated .... ~q. a7 2.9. .............. 19 ~.~., 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 .........
....... .a..~.ec..k. ~. ~. i.~.~.o.r:..~.o., e..x3.s.~..~.n~..a....e.~).~..n.~.. ............................
The certificate is issued to . .~.a.r.b.a?.a...~.m.m.e.r.~.h' .~...Jp.a.n...l,.e.a.v..~.~.~. .....................
(owner,
of the aforesmd building.
Suffolk County Department of Health Approval .... n../.a ...................................
UNDERWRITERS CERTIFICATE NO ............ n. ,/.a ...................................
.........
Building Inspector
Rev. 1/81
TOWN ~ ~UT.O~p
BUlLD NG D~p,~RYM~NT~
TOWN HALL
SOUTHOLD, N~ ~.
,N°. 1~117 9 Z
BUILDING P,ERMIT ·
(THIS PERM;IT MUST BE KEPT ON ~H,E PI~EMIS~SUNTIL I~ULL
COMPLETION OF THE WORK ^UTH(~RIZED~
,Dote ' , ............ ,
Permission is hereby gror~ted to:
parsuant to application!dated ............................................. ~
Bu[(ding Inspector.
Fee $../(.~. ~ ...~...~.:...
...... 19,..J.,., ,and approved by the
/ Buir'ding InSpector
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hail
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This apphcation must be hlled 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 Iocatlon 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 instaIla-
t~ons, 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 peoperty 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-
t~on required to prepare a certificate.
Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or land use
3. Copy of certificate of occupancy $1.00
$5.00
Date .......
New Building . .1.~.E..(L./~ ..... Old or Pre-existing BuildJng(:~) ....... ~ ZVacant Land . ...........
Locat,on of Property LU:~- .~.-
,.. ~ ..... ~ ...... ~. ....... : .~?:~¢.~.,d~_.~ ...................
House No.
.~ . . ., Street.s.? ,~ Ham/et
Owner or Owners of Property .%~ .....
County Tax Map No. lOOOSeotion .... ~'~ 7' Block
Subdivision ..... i;~.......J·~ ~.....:.~..~: ',' .Filed Map No. "t ·· ~,:,, ..LotNo. ~ ~ ~t.,," ...~ ,' (
Perm,tDate ofPerm,t.. 7 ...........
Health Dept. Approval ........................ Labor Dept. Approval .........................
Underwriters Approval ........................ Planning Board Approval .................. ~ , .~
Request for Temporary Certificate ..................... Fina[ Certificate .... >.'..- ......... *
Fee ~ubmitted $ .... : ..... ~, ~ . ~ ...........
Construction on above described building am
Rev 10-10-78
all
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL. 765-1802
17 June 1982
Wilbur Vermty
420 Cedar Drive
Southold? NY 11971
- Applicant
Dear __ ~..Emmerth S ,T. L~avitt
This is to advise you that the job under Building
Permlt No. 11t79 issued to Wilbur Verity
on 5_29_81 for deck ~s completed and
a final znspectlon has/-~ has not~ been done.
In order to complete this file, it ~s necessary that
a Certificate of Occupancy be ~ssued. Please fill out the
enclosed form(s), return same to the above office with a
check for $5.00 payable to the Town of Southold. Please
indzcate to whom the Certifmcate of Occupancy is to be
and arrange w~th this office for an inspection date.
Thank you for your prompt attention.
Very truly yours,
Victor Lessard
Administrator
VL:ec
Enclosures
mailed,
FOUNDATION
FOUNDATION
24
ROUGH FRAME &
(1
FLUMBING
INSULATION PER N.
STATE ENERGY
~DE
FINAL
NOTE= I~~- MONUMENT FOUND
SUBDIVISION )'JAP FILED IN THE
OFFICE OF TH~ CLEF'tK OF SUFFOI.K
ON SEPT, {5~ I9~O kS MAP NO. 654.
REVIf~IONS
YOUNG & YOUNG
400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK
SURVEY FOR:
VICTOR
"MAP No, 2
PECONIC
SOU'fHOLD
E. L'EPLATTEN/ER '
OF PECONIC SHORES"
SOUTHOL. D SAVINGS BANK
HOME TITLE DIVISION OF CHICAGO
INSURANCE CO.
"': I", ,',~¢ ~ ' f',:;[ 2,t972 I
FORM NO, 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL,: 765-1802
Disapproved a/c ..................................... /
(Building tnsnector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
Application No...4././. .~.?..~.. · . ·
a. This application must be completely filledqn by typewriter or in ink and submitted in triplicate to the Buitdi
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 stre~
or areas, and giving a detailed 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 approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such pern
shall be kept ou the premises available for inspection throughout the work.
e. No building shall be occnpied or used in whole or in part for any purpose whatever until a Certificate of Occupan
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 t
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describ~
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulati ~ns, and
admit authorized inspectors on premises and in buildings for necessary inspections.
(Signature of applicant, o~,lame, if a corporation)
:, . ....... ....c
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build,
... :'/, ............................................................
Name of owner of premises ~.a.C~.~,.. ~7.--tv:t..r~. ?..'? ~.~...~....~.~,.. ~ff~ ~.,.'~.4.z. ..................... (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.. ~/t.e .................
Electrician's License No..ff.~..qr& ...............
Other Trade s License No ................
1. Location of land on which proposed work will be done ................................................
V.5: ./g, ., / . .4:
House Number Sffeet ' ltamlet
County Tax Map No. 1000 Section ..... g7 Block ..... ~ ....... Lot.. ff. .........
Subdivision. / "g~ ' (Nmne)
2. State existing use and occupancy of premises and intended use and occupaney of proposed construction:
a. Existing use and occupancy .... ~. ~e~ ................................................... ..
b. Intended use and occupancy ..................................................................
).
1.
!.
{.
{.
Nature of work (check which applicable): New Building .......... Addition .......... Alteration ,~¢,~' ....
Repair · Removal Demolition Other Work
t~,.~ ~. ~ .-~/~__ ~, (Description).
Estimated Cost ............................... Fee ......................... ¢ ...........
(to be paid on Fding this application)
If dwelling, number of dwelling units ...............~ Number of dwelling units on each floor.. ~ .......... .
· number of cars
If garage, ......................................................................
If business, commercial or mixed occupancy, specify nature and extent of each type of use ....o ................
..... . ~ Y' ~.
Dm~enslons of ex~stmg structures, if any. Front..~.. '. .......... Rear . .~.~ ......... Depth...-? .u~', .......
Height .... /~f'..ff"f. ..... Number of Stories ....Z. ..................................................
Dimensions of sagae structure wilth alterations or additions: Front .../~.~.." ........... Rear ...~. P'...~. ........
.......... Number of Stories .............
Depth .... .~.Z ............ i..Height ..... ":':">'' .... Rear...~. .......... Depth
Dimensions of. entire new constrqction: Front...~.-~'. ..... ~ Y'* ....
Hight ~e-~'~. N 'b fSt ' ~ '..
e .... um er o ones ......... . ...............................
t~.-.~.4.-'. :': .' ......... R /-i'X* pth
Size of lot: Front .... ear .................... De .............
Date of Purchase ..---7..~'~. Name of Former Owner
Zone or use district m which premises are situated ....................................................
,
Does proposed construction violhte any zoning law, ordinance or regulation: ........... .............
:o? ·
Will lot be regr ..... ~ .' .................. Will excess filI be rem ed from prenl~ses: Yes
Name of Owner of premises . ~-F'.~. ~'~.. .......... Address . ./,'4~.d..,~.q~...~t {;j/-,m. Phone No...- .............
Name of Architect .... ~q., .! ................. Address ................... Phone No ................
Nmne of Contractor . .TM~ ~*i¢. · ~.~- ..... Address ...~. ~.. ~.~ttq'~.. 117/~. Phone No. ,~..~'4~.';..f.~.d~..~...
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from
:opexty lines. Give street and block ~umber or description according to deed, and show street names and indicate whether
,te. rior or corner lot.
...........~). ~./,~.tl,rd ........ ~ ~ffe~].~: .............. .... being duly sworn, deposes and says that he is the applicant
(Name of individual sighing contract)
hove named.
is the ..................... ~ ...................................................................
{ (Contractor, agent, corporate officer, etc.)
said owner or owners, ~d is duly authorized to perform or have performed th'e sgid work and to m~e and file
9plication; that all statements conthined ~ this application are true to the best of his B{owledge and belief; ~d that the
,ork will be performed in the manner set forth in the application filed therewith.
worn to be~ fore me th~ ,
.......... ..... ........
·
' L~NDA F. KO~A~S;fl ~
NOT^Ey PUSI. IC, ~t,l~ , .,~w ¥Otll ' · · ~ .....