HomeMy WebLinkAbout13389-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate O[ Occupancy
No. Z-15665 Date .A.p.r. il 21, 1.9~?.
THIS CERTIFIES that the building ...A..1 .t.e.r.a..t .i.o.n...t.o..A.c..c.e.s.s..o .ry..G..a .r.a.~ q .........
Location of Property 32305 Main Road Orient, New York
House No. Street Hamlet
County Tax Map No. 1000 Section 019 .... Block I .Lot 13
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
August: 27, 1984 pursuant to which Building Permit No. 13389z
dated . .~.u.g.u..s.~.. 2. .7, ..... 198....4 .... ... was issued, and conforms to all of the requirements
of the applicable provisions or' the law. The occupancy for which this certificate is issued is .........
ALTERATION TO ACCESSORY GARAGE AS APPLIED FOR
The certificate is issued to EUGENE & SUSAN MOISA
..................... gv t i ft .....................
of the aforesaid building.
Suffolk County Department of Health Approval .......... .~./.A. ............................
UNDERWRITERS CERTIFICATE NO .................. .~/.A. ............................
PLUMBERS CERTIFICATION DATED: N/A
Building Inspector
Rev. 1/81
FO~W NO. ~
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y,
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 13389 Z
Permission is hereby granted to:
· .~.....~,.~...~,~.~, .............................. .: ............. .. ............... ~ ......... , ........... : ....................
premises located at ..... ~.~.~.~......~.J~-~....~ ..................... ~ .....................
County Tax Map No. 1000 Sec~...(~....!.3 ......... Block .......... ]. .......... Lot No ......... J...~.. .........
pursuant to application dated ~L4~.~.....s~,..~ ................ , 19.~....~.., and approved by the
Building Inspector.
Fee $...~...,b./',,...~ ....
Building Inspector
Rev. 6/30/80
FORM NO. $
TOWN OF SOUTHOLD
E, uiIding Depertmont
Town Hnll
Southoldo N.Y. 11971
BLDG. DEPT.
765 1802 TOWN OF SOUTHOLD
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
This application must be filled in typewriter OR ink, and submitted ~= Immmmmm 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 Ilnes, streets, and unu~al
natural or topographic features.
2. Final approval of Health Dept. of water supply and sewerage dlsposel-{S-O form or equal).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and ins~aUa-
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 proporty 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. Data of any housing code or safety inspection of buildings or premises, or other pertinent informa-
tion required to prepare a certificate. I
C, Fees:
1. Certificate of occupancy New bwellln~,$25.00, 'Accea~ory :$10,00 Bue.{ne.~;~ $50.00
2. Certificate of occupancy on pre-existing dwelling $ .50.00
3. Copy of certiflcate of occupancy $ 5.'00, over 5 yeara $10o00
4.Vacant Land C.O. $ 20.00 ~
5.Uodatod C.Oo $ 50.00 Da,e.,...r.~.,.~....--~'./..,./.~.;/..../) :/ /'~ /~ 'Q
6. Alteration $25~00
New C on s t. ~' u c t~ I on ......Old or Pre-existing Building ............ Vacant Land .............
Location of Property -.-~..~.-.~.Q .'~. ........ ;.. · : ...................
HOUSO No. &freer Ham/et
Owner or Owners of Property ....... - ......................
County Tax Map No. 1000 Section ............... Block ............... Lot ................
Subdivision ................................. Flied Map No ........... Lot No ..............
Permit No. ~J,3..~.~ ~.. Date of Pe~'mi~ ~.T.~'.?L~.~.Applicant . ~;~. (q..~.;.../?J...0./.3'. ~ .........
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval Planning Board Approval
Request for Temporary Certificate ' Final Certificate
Fee Submitted $ ,~..'-~. ' 0 0
Construction on above described building and pe.~, it meets all applicable codes and regulations.
FIELD INSFECTION
FOUNDATION (1st)
FOUNDATION (2nd)
ROUGH FRAME &
PLUMBING
INSULATION FERN. Y.
STATE ENERGY
qODE
o
COMMENTS
ADDITIONAL COMMENTS:
TOWN OF SOUTIIOLD
OFFICE OF BUILDING INSPECTOR
1'.O. BOX 728
TOWN ItALL
SOUTHOLD, N.Y. i 1971
TEL. 765.1802
This is to advise you that the job under building
permi~ no. 13389Z issued to _,E,~,~ene Moisa
on _~Z2I/~L~___ for ,hddi~io~ is completed and
;] il. hal inspection has ( ) has not--( x---x~been done.
In order to complete this file, it is necessary that
a Certificate of Occupancy be issued. Please fill out the
enclosed form, return same to the above office with a cheek
for $25.00 payable to the Town of Southold. Please indicate
to Whom the Certificate of Ocenpancy is to be mailed, and
arrange with this office for an inspection {late
Occnpancy or nat ia nnl, awfut without a Certificate of
Occupancy. Please. help Ils Lo clear tip tll~s matter no tiler
legal action does not have to be taken.
Thank yon for your prompt attention.
Very truly
Victor Lessard
Executive Admlnis~rator
VIe :gilt
encl .
'FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N.Y. 11971
Approve~.~....~.~..} 19~!. Permit No. '...~f .~.~. ~..~.
Disapproved a/c .....................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Rec
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 lo 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, arid to
admit authorized inspectors on premises and in building for necessary inspecti~, tz,_'~ ~, ~ ,
(Sighature of applic'a'O't, or name, if a corporation)
· · · g&
(Mailing address of applicant)v
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Nan~e of owner of premises..~ .exam · .~.... · .°A~ · · .~.°~r~ · · '~· '' · ~' ' '¢>m~q~- ................... (as on the tax roll_o~atest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No. 'i~i ii i i i
Plumber's License No. '
's License No ~
Electrician .......................
Other Trade's License No ......................
1. Location of land on which proposed work will be done ..................................................
................ .............. ..............
House Number Street Hamlet
County Tax Map No. 1000 Section ...... ~ .~.~. ...... Block ....... ~ .......... Lot... 1-~ ............
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. Intended use and occupancy .T.~->:D..%~k .~x54~--~x~ ~,~ ................................
3. Natureofwork(checkwhichapplicable): New Building .......... Addition .......... Alteration ..........
Repair .............. Removal .............. Demolition .............. Other Work ...............
: (Description)
Cost ,..
4. Estimated .. .i ......................... Fee ......................................
~ . , , i *'- (to be paid on filing this application)
!
5. H' dwelling ,rmm~.eL of dwelhng units ..... t ......... Number o f dwelling units on each floor ................
., tl~;gara~o~.am,,bo, .w, ca~s ~. ...................................................................
6tVll'i[usmess, commerclalJl~}ffi~xed occupancy, specify nature and extent of each type of use .....................
73 Dnnens~,nS g~F~t~,t,i~l~.strn0tnres, ff any: Front ..... Rear .......... Depth .......
i~ii~a~' ~*~.*~.~.~ ,,~-,~,~.kum,ber of Stones ........................................................
Dimensions of same structure with alterations or additions: Front ................. Rear
Depth ....................... Height ...................... Number of Stories ......................
new construction: Front ............... Rear Depth ...............
8. Dimensions of entire ' ' . ..............
Height ............... Num!ber of Stories ........................................................
Size of lot: Front ..........., ........... Rear ...................... Depth ......................
Date of Purchase ' Name of Former Owner
Zone or use district in which pr6mises are situated .....................................................
Does proposed constructmn wo[ate any zoning law, ordinance or regulation: .............................
Will lot be regraded ....... ~.~ ..................... Will e[,~ss fill lie removed from premises: Yes No
Name of Owner of premises ...~.[~Y~,t~,... Address{-.~ t.~'.~. .... Phone No.3 ~3. :.~..'-] (e. o.
Name of Architect .......... i ................. Address ............. .u .....Phone No .............. '...
Name of Contractor ' Address Phone No
PLOT DIAGRAM
Locate clearly and distinctly alli buildings, whether existing or proposed, and, indicate all set-back dimensions from
dumber or description according to deed, and show street names and indicate whether
10.
I1.
12.
13.
14.
property lines. Give street and block
interior or corner lot.
STATE OF NEW'~RK,
· .. ~...-~-O-~ · · .-El,-.' . .~..~.~ ................. being duly sworn, deposes and says that he is the applicant
(Name ot~individual signing contract)
above named.
//~He is the ................
I (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; tha~t all statements contained in this application are tr,ue to the best of his knowledge and belief; and that the
work will be perforlned in the manner set forth in the application filed therewith.
Sworn to before me this
. ......... ~.T~...day ~f .... ~/~,~....., 19
/
No.m.~ Public.,. .......... .,~...,' ..... ~aC~yjg¢~.. ~.x_County
No. 52 812586~, Suffolk
~' Term Expires Merch 30,
/
(Signature of applicant)