Loading...
HomeMy WebLinkAbout13379-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z-]5689 Date April 24, 2987 THIS CERTIFIES that the building ACCE S SORY SHED L ~. ¢~ , I900 Hiawatha Path Southold, New York ocatlorl o, ,roper,y ............................................................... House No. Street Hamlet County Tax Map No. 1000 Section 0 78 .Block 3 ,Lot 4 2 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated August 23, 1984 pursuant to which Building Permit No. 13379. Z dated .... A.u..g .u.s.t...2 .7.,.. ! .9 .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 ......... ACCESSORY SHED AS APPLIED FOR The certificate is issued to C.ARL P. & MARY C. BOERGESSON ..................... ?ol;.'o'r, '~&IC'f, grXt~t X .................... of the aforesaid building. Suffolk County Department of Health Approval N /A UNDERWRITERS CERTIFICATE NO. N / A N/A PLUMBERS CERTIFICATION DATED: Rev, 1/81 FOB, M BO. 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. N? BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 13379 Z ~to ~.z~..Y........~.~ ......... , / Permission is hereby gronte~t ................... ~......].~.~~ ....... ./....V.~.....~.~!...~ ...... ~.~&.......9..:.q~......!/...~. ...1...I. ......... ,o ...... at premises located at ............................................................................................................................ ?:22°2 ......................... pursuant to i o .............................. approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southoid, N,Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANC' Instructions This application must be filled in Wpewriter OR Ink, and submitted ta e~==mmea to the Building ln~pec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property Ilnes, streets, and unumal 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~operty showing all property lines, streets, buildings and unusua~ 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 Inspectlor~ of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancv 2. Certificate ~f occupancy on pro.existing dwelling ~ 50.00 3. Copy of cortiflcate of occupancy $ 5.'00, over 5 yeara $10.00 4.Vacant Land C.O. $ 20.00 5.U~dated ~O. $ 50.00 Date .......................... 6. Alteration $25.00 NewCOns t~uc ~ion ...... O~d or P?-exlstlng Building ............ ~acant Land ............. ..... ........... Location of Property House No.~ ............"- county Tax Map No. ~000 ~ectmn ............ BI c~ .............. Lot ................ ''' Filed Map No Subd~wsmn ........................................ Lot No .............. Permit No ........... Date of Permit ........ ~....Appllcant .................................. Health Dept. ~pproval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building a_nd permit mee~ all applicable codes and regulations. ..................... F1EL~ IN~FECTION FOUNDATION (1st) COMMENTS FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS: 'FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1803 ixamine~& ~??...~.')..., 19 ~.~. pp u,,.~-~= .-~ .................... )isapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT ,19... Date .................. ,19... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ets 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 inust be drawn on the diagram which is part of this appli- ation. c. The work covet. !d by this application may not be commenc?d .before issu..a~.? of Budding Permit;. d. Upon approval!of this application, the Building Inspector will issued a Building Permit to the appncant. Such permit hall be kept on the prsmises availahle for inspection throughout the work. e. No building shill be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy hall have been granted by the Buildhig Inspector. APPLICATION IS HEREBY MADE to the Building Depta'tment for the issuance of a Building Permit pursuant to the luilding 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. the applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to :dmit authorized inspectors on premises and in building for necessa inspec/~ons. .................. ?iCature of appliOnt, or name, if a corporation) ....... (Mailing addreis of applicant) Plumber's License No ......... .~/4 ........... Electrician's License No ..... / .............. Other Trade's License No.../. .................. 5tare' whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. x,,neorownerofpremisesCW.&..F.....'-F.)..e J °' .................. : .... : ............................ / (as on the.tax roll or retest deed) If applicant is a co¢oration, signature of duly autho~zed officer. ~O~.]~g ~ ~ 1. Location of land on which proposedt~9, .w°'rk w_ill~./Tn.e ........................ llouse Number Street . Hamlet ..'© .'X. County Tax Map No. 1000 Section Block 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 . . ....... b. IntenSe_ use and oc~panc .. ....................... ork (check which applicable): New Building ~ Addition Alteration 3. Nature ofw ........................... Repair .............. Removal .............. Demolition .............. Other Work ............... . (Description) 4 Estimated Cos Fee ........................ ~" (to be paid on filing this application) 5. If dwelling, number of dwelling Chits .............. Number of dwelling units on each floor ................ If garage number of cars ' ~ 6. If business, commercial or mixed occupancy, specffy nature and extent of each type of use ..................... 7 Dimensions of existing structure's if any: Front ~ ' Rear Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... i. · Height ....... O' r ............ Number of Stories .................... 8. Dimensions of entire new construction: Front .... Y. .......... Rear ............... Depth ./.~. t i ....... Height ............... Number of Stories ....................................................... 9 Size o£1ot: Front ' Rear Depth ~ Name of Former Owner O. Date of Purchase ........... . ............................................ 1. Zone Or use district in which pr4mises are situated .................................................. 2. Does proposed construction violate any zoning law, ordinance or regulation: ............................. 3. Will lot be regraded ..... r~ 'fi{.. :// ................ Will excess fill be removed from premises: ~Y,.es _, No 4. Name of Owner of .. Address ...... .............. Phone No. Name of Architect ............ /./ ......... Address ................... Phone No ................ Name of Contractor ................ v ........ Address ................... Phone No .............. PLOT DIAGRAM Locate clearly and distinctly alli buildings, whether existing or proposed, and, indicate all set-back dimensions from ,roperty lines. Give street and block number or description according to deed, and show street names and indicate whether aterior or corner lot. ,/ ;TATE OF NEW YORK, S.S 'OUNTY OF ................. i (Name of individual signing contract) bove named. APP=~*' 3 AS NOTED DATE: .?.p. ! F[E:_J..)_,_..=_'" .BY: NOTIFY BUILDING DEPART/,AFFY" 76§-1802 9 AM TO 4 PM FOR T'" FOLLOWING INSPECTIONS: '.. 1. FOUNDATION - TWO REO~,HRED FOR POURED CONCRETE 2. ROUGH - FRAMING & pLUMBING 3. INSULATION 4. FINAt. - CON~CFRU'-'~I''~N MUST BE C'~MPI.ETE FOR C.O. ALL CONSTR!JCTION SHAll THE REOIJIR~MENTS OF THE N,Y, STATE CONSTRUCTION & CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. being duly sworn, deposes and says that he is the applicant le is the ............ '~ ............................................. ; .............................. ,~ ,t. ~ (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 p plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the /ork will be perforu~ed in the mann{r set forth in the application filed therewith. woru to before me this : ...... 434I-A~ ...... dayoi .... ~ ............ , '~ ler~ Exp~)e~ Ua(ch 30, 1~ TOWN OF SOUTHOLD OF['~ICE OF BUILDING INSPECTOR I'.O. BOX 728 TOWN ItALL SOUTtIOLD. N.Y. 11971 TEL. 765-I 802 Thln in Co advlne you that the jq, b under building perraJ t no. 13379Z ,xs. ucd,;to Carl,,~oergesson' on 8/27/84 for A6ce~sory , is,~, tempi eted and In order to complete th~s file, it is necessary that a Cerelflcate of Occupaucy be issued. Please fill out thc enclosed fort,, return same to the above office with a check for $10.00 pay~ble to the Town of Southold. Please {ndlcate to Whom the Certificate of Occupancy is to be mailed, .and arrange with this office for an inspection date Oecupane. y or u:~e ia unlawful without n Certificate of Otc.panty. Please. he]p ..~ to clear tip thi~ matter so that legal action does not have to be taken. Thank you for yo,r prompt attention. Very truly Victor Lessard Executive Administrator VL:gar cuel.