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Home My WebLink About13400-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall 5outhold, N.Y. Certificate Of Occupancy No. Z12905 Date October 18 198..4 THIS CERTIFIES that the building .... A..c.c.e.s..s .o.ry. ................................. Location of Property ....4.3.0.0. ........... .B.e.r.g.e.n...Aye.: ....... Matt. House tVo. Street Hamlet County Tax Map No. 1000 Section . .1..1.3 ....... Block . .0..7 ........... Lot . ?../.O..1. ......... Subdivision ..... .X. ........................ Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·..A.u.q: ...... .3.0 ....... 19.8.4. pursuant to which Building Permit No....1.3.4.0..0.g ............ dated ............ % .ug.. .....3.0 ......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 ....... Accessory Farm Building The certificate is issued to WILLIJX2Vl CHUDIAK (owner,"lo~e~r ~r't~rarrO of the aforesaid building. Suffolk County Department of Health Approval I,I/3. UNDERWRITERS CERTIFICATE NO ......... N/A Building Inspector Rev. 1/81 TOWN OF SOUTHOLD 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? 13400 Z Permission is hereby granted to: ............... at premises located at ............................................................................................................................ County Tax Mop No. 1000 Section ..... ~.~...~,.~ ......... Block ...... ...(~....'] ....... Lot No .......~/~L.....l. ..... pursuant to application dated .... ~~R...~.......~..l~ .......... , 19.~..~., and approved by the Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall 5;~uthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in Wpewriter OR ink, and submitted,--i~=d~p~c=t= 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 disposel-(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 peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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 inform+ tion required to prepare a certificate. Fees: Certificate of occupancy $5.00 1. / Certificate of occupancy on pre-existing dwelling / land use 2. 3. Copy of certificate of occupancy $1.00 ~ --Pre-Exis%ing C.O. $15.00 Vacant land C.O. $ 5.00 Date ..(~..~.. .~"~...~ ........ Old or Pre-existing Buitding ............ Vacant Land ............. Location of Property . .~..~..o? ..... ~ ............. ~ ............ House No. Street Ham/et Owner or Owners of Property ..................................................... County Tax Map No. 1000Section .... !/.~i ...... Block ..... ~..? ....... Lot.. ~2.~. t Subdivision ................................. Filed Map No ........... Lot No .............. PermitNo~ ~Oo Date of Permit ~.1.5.?17~ .Applicant ~l~J,~,~,~ .~4~c....~..~... Health Dept. Approval ........................ Labor Dept, Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ' . .................. Construction on above described building and permit meets all applicable codes and regulations. App,ieant.. · .................. Rev. 10-10-78 FIELD INSPECTION FOUNDATION (1st) COMMENTS FOUNDATION {2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY FINAL ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. IHS IOH ~PECT FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSUU~TiON [] FRAMING [~/FINAL RE'MARKS: DATE INSPECTOR, 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ., SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined~...t~.~....~..0..., 19 .~.~. Disapproved a/c ..................................... Received ........... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 Inspect?r. 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 inspections. ' P ~ 2~ ~ ~', (Signature of FapRlicant, or,name, if a corporation) ..... .... ~ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. Name of owner of premises .......................................................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work v~ill be done .................................................. · ....... ............. ......................, House Number Hamlet County Tax Map No. 1000 Section ...... \~.~. ........ Block % .... .~..~ ......... Lot .... ~.1.~..-.~ .......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of preznj.~e~ and inte~4~e and occupancy of proposed construction: a. Existing use and occupancy ..... I.~.~ .~.~. ............... ; ................ b lntendeduseandocc~upancy ' Y~~.~ ~~ .r~!c[· 3. Nature,of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Rem6val ............. Demolition .............. Other Work ............... -~ ~1~ (Description) 4. Estimated Cost ......... , ....................... Fee . . .o ............................... ~ *" (to be paid on filing this application) 5. If dwelling, number of dwelling Units ............... Number of dwelling units on each floor ................ If garage, number of cars ......................................................................... 6. If business, commercial or mixed occupancy, specify nature a~O extent of each type of use ..................... 7 Dimensions of existing structures if any: Front ' Rear Depth Height ............. Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ' Height Number of Stories 8. Dimensions of entire new constrUction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ........... : ........... Rear ...................... Depth ...................... 10. Date of Purchase ........... ~ .................. Name of Former Owner ............................. 11. Zone or use district in which prgmises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ I .. Will excess fill be removed from premises: Yes No 13. Will lot be regraded ..: ...... , ................. 14 fp i Add N · Name of Owner o remises ..., ................. tess ................... Phone o ............ ' .... Name of Architect .......... . ................. Address ................... 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 property lines. Give street and blocklnumber or description according to deed, and show street names and indicate whether interior or coruer lot. STATE OF NEW YORK, COUNTY OF ........ ~ ......... S.S ............................ ' .................... being duly sworn, deposes and says that he is the applicant (Name of individual sigl dng 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; that all statements coniained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith· Sworu to before me this ........... .~.. ~....~. ..... day ......... , 19 .~..~ Notaiy Public ....... ~.. ::.. ; ...... County H[L~.N ii, OF, ¥0E NOTARY PU~JLtC, State Of New Ym'l~; ' Ntt. 470787~. Suffolk ~01mty ($ignatur~'o]' applicant)