Loading...
HomeMy WebLinkAbout13576-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z14345 Date April 18 .................................................. 19.8.6. THIS CERTIFIES that the building Addition Location of Property 1295 Old Harbor Rd. New Suffolk ~3~ ~io: ........................................................ Street Hamlet County Tax Map No. 1000 Section . .. 3.1. 7 ..... Block ....0.3 .......... Lot .. 93.©. ........... Subdivision ........ .X ...................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... N..o.y?.m.b.o. ¥...1. .4..., 19..8.4pursuant to which Building Permit No ..... 1. .3 .5.7.6. g. .......... dated ...... .N.oy.e.m..b??....2.3 ........ 19.8..4, 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 ......... .... Construct an Addition--Second Floor ..... The certificate is issued to REED, JOHN D. & SUSAN POPE ..................... ...................... of the aforesaid building. Suffolk County Department of Health Approval ....... N. [ .R. ............................... UNDERWRITERS CERTIFICATE NO ............... ~'.e.n.d.~n, cj ........................... Rev. 1/81 Building Inspector l~o~g,~ NO,. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL PULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: . __ ~ ~ n/) ' . fi ' I r ~ . I J ~~ ....... .;~....~~~~.....;;..: ....... .:;.;...~--~;~ ........ .,,,em,,, ~.,.~.,...~.a~.~ ....... ~ ....... ~.~....~ ....... ~....~//~ ....... .tt ttt ...................... ................................................................................... --., t ~ ~ ~ /O Coun~ Tax Map No. 1000 Sec ion .... ~...~ ........... B ~k ...................... Lot No ......................... Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY /, ' ' OLD Instructions This application must be filled in typewriter OR ink, and submitted I ~ 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~toperty 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 $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5.Updated C.O. $15.00 New Building......,..,...V Old or Pre-existing Building $15.00 Date ......................... ............ Vacant Land ............. Location of Property .............. OLD House No, . Street Ham/et Owner or Owners of Property ..~[~ ~' ~~ County Tax Map No. 1000 Section .............. Block ............ Lot ................ Subdivision ................................. Filed Map No: .......... Eot No .............. Permit No /,.~S" 7~ .~. Date of Permit .Applicant ,~../CLx/ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ~o~ 0 Construction,on above described building and perF~it meets all applic~able codes and regulations. Ceb ~; I'~'~'-t'~ I/ /) ~ ~ ~ Applicant ..~:~...~..~~ ............... ~ ~' COMMENTS FIELD' INS~'ECTION FOUNDATION {1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION ?ER N. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL.: 765-1803 E×amined ~..~>~...~. ~ .~.., Approved .~.~q~...,~..~....~..~.., 19~.~. Pemit No. / g~?¢. % Disapproved a/c ..................................... ..... (Building Inspector) APPLICATION FOR BUILDING PE~IT Application No .................. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building 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 streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- 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 issued 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 Department for the issuance of a 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, or 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 building for necessary inspec,~io~.. ~ ~ ~ (Mailing address of applicant) State whether applicant is owner, les_.see~agent, architect, engineer, general contractor, electrician, plumber or builder. ............................ .................................................... Name of owner of premises .do:/7/q. .... -~ ~.'~,~: ~...~..~..'-~. ............................................. (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 ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be do~: .-. i'~ ?. ............ .. . ............ 1.a ........ ......... Fe ' .... ,?.: ......... ':.:/.'i... House Number Street Hamlet County Tax Map No. 1000 Section ! t.~. ~. 9.~ .......... Block . .~. }5.~.o. (D .......... Lot..,/..tJ..~.l.)(~.[fl.. .......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... /.'../.~.f.)~. ,..[~/... ~..~,.t.~ ./(t.~.: ~/.~ ................ ~. .................. b. lntended use and occupancy CJ.i//2f(c'O~' /?>.C.'p~ocmt~; .~.x.~....'qXfi~...~..~. 9. 10. 11. 12. 13. 14. Nature of work (check which a ,plicable): New Building .......... Addition . ...~. ..... Alteration ... Repair .............. Removal .............. Demolition .............. Other Work ............... "~' ~"~ ' ~.f~ ,' . (Description) Estimated Cost .... t.¥/.0.'?. ~i ......................... Fee...~.~. ............................. (to be paid on filing this application) If dwelling, number of dwelling [units ............... Number of dwelling units on each floor ................ If garage, number of cars .... J ................................................................... If business, commercial or mixea occupancy, spec/y nature and extent of each type of use ..................... I)~ensions of existing structures, if any: Front .... ~2...:: :. Rear ~ ......... Depth .~ .......... tteight. .*¢. ~. ......... Number of Stories .... ~ ................................. I)~ensions of same structure with alterations or additions: Front ~[[ ..... ~.. I)ep~ .... ~ ........... ~.. Height .. ~ 5 ................. Number of Stories .. ~ ................. Dimensions of entire new const~ction: Front ..... ~ ~ ....... Rear . ~ ........... Depth [.~.'f~ ........ tteig~t . ~. ~. ......... Number of Stories ...'~. ~ ................. ~ ..... ~ ....... Size of lot: Front ~.~ ~ ~ .... Rear .... ~k~ ~ ...... ' ..... Depth ~...~ f~ .... Date of Purchase :..~.~,~(q .~.~..ZF.XF ......... Name of ~o~r Owner ~ff~-45~f. Zone or use district in which pr~mises are situated .... ~~ .......... , ....................... Does proposed construction violate any zoning law, ordinance or remlation' . ~ Will lot be regraded ......... i ............ ~f' ..... Will exces~O~ll be =~ve~ Nme of Owner of premises . 4).~ 5 ......... Address .~ ~. [~-7 .~{. ~. ~[~. . Name of ~chitect .......... ~ ................. Address ................... Phone mo ................ ...... : .................................. ~ .............. ~ ....... No ................ PLOT DIAGRAM Locate clearly and distinctly allI 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. STATE OF NEW YORK, iS.S COUNTY OF .................. (Name of'l'ndiffdual signing contract) above named. Heisthe ......... ........................................ (Contractor, agent, corporate officer/etc.) of said owner or owners, and is duly. authorized to perform or have performed the said work and to make and file this application; that all statements contgined in this application are true to the best o(his knowledge and belief; and that the work will be performed in the manne? set forth in the application filed therewith· "Sworn to before me this ............... .... ........... Notary Public, ....... ~ .~.'...~.~..~/..¢~. County · 2 z Cutchogue, New 734-581 NOT~ '~DING '~~ AT 765d802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. IN,lB ATION 4. FINAl. - C?N'5-FR{~C'TION MUST BE C"~c~[ r:TF FC:R C. O. ALL CON'qTR~CFION SHALL ~EET THE RE~'"R~J,~.FNT5 OF THE N.Y. STATE CONfi'FRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DFq{¢N ~R CONSTRUCTION ERRORS. ,!