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HomeMy WebLinkAbout13418-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. ZI5409 Date March 24,. 1987 THIS CERTIFIES that the building .... .A .c.c. e. s. .s p.r.y. ................................. Location of Property 2765 Elijahs Lane, Mattituck House No. Street Hamlet County Tax Map No. 1000 Section . ! .0.8 ........ Block . 04 .Lot 7. l 6 ELIJAHS LANE EST. Subdivision... 8 e.e: · # .1 .................... Filed Map No. 6. .0.6.5 .... Lot No .... ! .3 ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated · .A.u.g. :..3.1. ,...I .9.8.4. ....... pursuant to which Building Permit No...1.3.4. ! .8? ............. dated ...S.e.p..t ....6. ,.................I 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 ......... Aqcessory shed in rear yard. STANTON AND EDITH SIMM The certificate is issued to ..................... ('oYn'of-,)~t~/~)' ..................... of the aforesaid building. Suffolk County Department of Health Approval N /A UNDERWRITERS CERTIFICATE NO... N/A PLUMBERS CERTIFICATION DATED: N/A 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? 13418 Z Permission is hereby granted to: ~ , , .... at premises located at ............................................................................................................................ Building Inspector. Building Insl:~ctor Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTItOLD Building Department Town Hall Southold. N.Y. 13971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A...,This application m.ust be filled in Wpewrlter OR Ink. and submitted r~ -- "to the Building Impec- '~or with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unumal natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage dlsposal-{S-9 form or equall. 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installs. tigris0 a certificate of Code compliance from the Architect or Engineer responsible ~or 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 property 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 cohdition of buildings. 3. Date of a. ny housing code or .safety inspection of buildings or premises, or other pertinent infarma- tion required to prepare a certificate. '. C. Fees: 1. Cerfificate of occupancy New DwellJ. ng.$25.00, 'Acce,sory ..$10.00 Bualnen~ ~50.00 2. Certificate of occupancy on pre-existing dwelling ~ 50. O0 3. Copy of certlflcate of occupancy $ 5.'00, over 5 years ~10.00 5.Undated C.O. $ 50.00 Oa~e .... '~ ~.~.~.~D.~. ..... 6. hlteration ~5.00 New C on s t r u c ~ i on.. ~. Old or Pre-existing Building ............ Vacant Land ............. Location of Property . ~ ~ ~ ~ ~ ~ ~ ~ ..... ~(~ ~ Owner or Owners of Property ............... ~ ............. ~ ................... County Tax Map No. 1000 Section . ~ ..... Bloc ............ Lot .......... · · ' Filed Map No Lot No Subd~msmn - · Permit No ........... Date of Perm[~ ........ Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... FIELD INSPECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING COMMENTS INSULATION PER N. Y. STATE ENERGY qODE FINAL ; ADDITIONAL COMMENTS TOWN OF SOUTHOLD oir:[:lCli OF BUILDING INSPECTOR P.O. BOX 728 TOWN ItALL SOUTHOLD, N.Y. ! 1971 TEL. 765.1802 Th~s is to adv{ae you ti, ac the job under building permit no. ~Z issued to StanCes Simm on 7/2/84 for Additioff is completed ;~ fi. hal inspection ha~ ( ) has not (x Y-been done. and in order to complete thi~ file, it is necessary that z~ Certificate of Occupancy be ~ssued. Please fill out the enclosed form, return same to the above office with a cheek for $10'00paynble to the Town of Southold. Please indicate to Whom the Certificate of Occupancy is to be mailed, and arrange with thls office for an inspection date Occupancy or ,lac is unlawful without a Certificate of Occupancy. l'lenne help os to clear t,p th~ mntter so that legal action doea not h~,ve to be taken. Thank you for yo,r prompt attention. Very truly Victor Lessard Executive Administrator VL:gar cncl. ~lOff:l.r::v E:' HI_'DING DEPART~AFNT AT 76.~.Tpn? g AM TO 4 PM FOR THE 1l. FO(IFm'',/~'TI'©N "TWO REQUIRED' ~:OR p~',J'~F) CONCRETE ~ ~ROUGH ~ FRAMI'NG ~ pL~U'MBIN~' ,~L I~N¢~I'! 4. Fl'hi^ '- CrqN%TP, UCTION' /v~UST' BE C~'¥p~ ](ZE FOR C.O. ~E REO!uPrME~TS' OF THE N.Y. ~A~E COnSTrUCTION & ENERGY' ~DES. NOT RESPONSIBLE FOR ~IGN OR CONS~uCTIO~ ERROR'S. 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL,: 765-1802 Approved ~ ...... .(0..i 19~.q.. Permit No. I .'~..~.\ ~.~.'.. Disapproved a/c ..................................... ................................ ........ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received ........... ,19... 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 appil- 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 shail 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 ~re of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............. .w. ........................................................................ Name of owner of premises . .~.~]~-~ £'2°. (ht· .r~. ~. ¢. t.T(~/... · ~ .~.~. ...................................... (as on the tax roi[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 LicenseNo ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. .............. £/..i ..... ........... House Number Street Hamlet County Tax Map No. 1000 Section .... /.~. ~. ........ Block ....... .Q. ¢ ..... Lot.. 2:../..~ .......... ,. · Subdivision~..~t.~.gJ/.~.. J,q.rv.j.?..~[ff.,. ¢..~.)Z.-~. f.... Filed Map No... ~.O..~. ~.~... Lot.../:.~ ......... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... ~.~'~.. I.~.~C~.~. · · · b. Intended use and occupancy ..... 3. Nature of work (check which applicable): New Building . .~{~.q~.... 'Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... ~ :~ (Description) 4. Estimated Cost .... ~,.... ......................... Fee ..................................... : ~" (to be paid on filing this application) 5. If dwelling, number of dwelling iunits ............... Number o f dwelling units on each floor ................ If garage, number of cars .... : ................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. r)imensions 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 n~ew construction Front ..... /.~.' ..... Rear ..... ./~r-- ..... Depth .../.®. ( ....... Height ~'.~. ;r..o./.¢ ..... Number of Stories ........ f. ........................ . .~...3f~. ~ .............. 9. Sizeoflot: Front ..... .,/.~¢*. ! ........... Rear ....... './~.~.' ?. ........ Depth .' ..... w- ............. 10. [)ate of Purchase .../.~...~....'~1.~.~.."~. ............ Name of Former Owner ............................. 11. Zone or use district in which pr~mises are situated ..... ~.~...~ ......................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ........ ! ................... Will excess fill._b~removed from premises: Yes No 14, Name of Owner of premises .~TT~.~P?. ~.. ~6,~. ,4'~. Address ~7.~('..~.(~.~. l.~.. ~.~.~Phone No...~. fi~'.c .S .~ (~. Name of Architect ......... ! ................. Address ................... Phone No ................ Name of Contractor ........ i ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and, indicate ail 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, COUNTY OF ................. iS'S (Name of individual sign'ing contract) above named. being duly sworn, deposes and says that he is the applicant He is the ..................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is du y authorized to perform or have performed the said work and to make and file this application; that all statements con~ ained 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. Sworn to before me this ......... · ~.../..~.. ........ day of .... ~ ............ Notary Public, ...... /.~'~-gr~ ~r. ~)~.../-/t~. County ,, ,,.;2;' ...... ...............