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HomeMy WebLinkAbout13437-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ...... Z.~.Sq/3 ..... Date ......... ~q.e.D$~l~.~.~. 3 ........... 19.85 THIS CERTIFIES ilding addition. that the bu ................................................ 77. .o. x.¥? So thold Location of Property ................. ' ........................... House No. Street ~ Ham/et County Tax Map No. 1000 Section .... .5.9 ...... Block ....... .9. ......Lot..............fl 3 * fl ' Subdivision ...... X .Filed Map No. X .Lot No. X conforms substantially to the Application for Building Permit heretofore filed in this office dated September fl 3 19 8/4- pursuant to which Building Permit No. dated ....... S.e. ~o.t.e.m.b..e.r..~..3 ....... 19.8.~., 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 ......... A screened porch addition to exist.i.n~ one-£amily dwelling. The certificate is issued to ..... WILLIAM JAROSZ ................ id~,.'o~ ..................... of the aforesaid building. Suffolk County Department of Health Approval ............ .~/.~. .......................... UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 TOWN Of: SOU'I34OLD 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? 13437 Permission is hereby granted to: ........ ..................... ot premises Iocoted at ............................................................................................................................ County Tax Map No. 1000 Section ....~.....~..~ ....... Block ....... ..CJ. ........... Lot No....J...~..,....I ...... pursuant ,o application doted ....~.~~.....J...~'~ -- ............ , 19..~...~..,--~ and approved by the Building Inspector, Rev. 6/30/B0 FIELD INSPECTION FOUNDATION FOUNDATION 2. ROUGH FRAME & PLUMBING INSULATION FER No STATE ENERGY ~ODE (1st) FINAL COMMENTS ADDITIONAL COMMENTS: (2nd) ,], 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved . · .~.'.' ....................... 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 Inspect°r, 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 thc construction of buildings, additions or alterations, or for/f~'~ovai oy~ie~olition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, buildj~ co/de, hot,ins cgde, andtr~gulations, and to admit authorized inspectors on premises and in building for necessary...,~: .~._._~V5. _,..insp'~eln°n~ '~, / , ~ ...... ~Signa~re of applican((, ,~, ' ) ?~.~e d~ ~,,~ d~:.-c..~/...,~z~ ......... whether applicant is~owner,'~lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. State ................................................... . ~.ez.. .8... .................. · (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 ...................... 1. Location of land on which proposed work will be done .................................................. . .2 .7. .¢ . d.e. : '.,t. .,e. . . . d . . . ., ? .c.z. .o. / d ............................... House Num her Street Hamlet County Tax Map No. I000 Section .... .~.~...~. ...... Block ...... 2 .......... Lot .... 1.~, .] ......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use a,~ccupancy of propo, sed construction: , / ,,-%,~ ,'C,. .b ~e.//x ;~, ~ . ' . a. Existing use and occupancy ..... d. ............. yv ..... ' ............ :~,,.~ ........... .~ · . .... b. Intended use and occupancy : ................ ~ I~,~ ..... ~.. ./argOt ,~, ...... ~.: ..... 3. Nature of work (cheek which a~plicable): New Building ..... ' .... ~ ......... Alteration .......... Repair .............. .~n0val .............. Demolition' ".x~...~,-.-c. ..... Other Work ............... (Description) 4. Lstunated Cost ................... (to be paid on filing this application) 5 If dwelling number of dwelling iunits .... Number of 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:~...-7'~-. · ............ 7. Dunensmn_s o~f eJ4st;ing structures, if any: Front... f'f~...~. '... Rear ....~./~. ~...... Depth...~.O..~..~. .... l-te~ght ~ ............. Number of Stones .... ~.,.~-~. ............................................. Dimensions of same tructure with alterations or add~: Front ....~.~..~.'.7~... Rea*---~..~.~.'~. ?-..'.~.. Depth....~. ~...~.~.~.~. ~, ' ~' '- ........... ' ......... Height ...~__,..,.,/..~..~. ........ Number of Stones. [. ~)., ....... ~.~ ..... 8. Dimensions of entire new construction: Front ..... ,~..~./~'~.. Rear ....~...d~. . .~.'.~.-.. De-~....a~.~..~..'.~ .... Height.~9..~'.~.: ...... Number of Stories .. :: ..... ' ............................................. 9. Size or'lot: Front . ...i~.'-~.. 4 ~..~. ...... Rear ..... .~..t~...~. ~.~..: .... Depth .; .~...q.~ ..~. :~..: ..... 10. Date of Purchase ~ .~AL.~,....~. ~;. 2 ~. ........... Name of Former Owner .~--~...~,.,..~..~ ................ 1 I, Zone or use district in,ich prgmises are situated: .................................................... 12~ Does proposed construction violate any zoning law, ordinance or regulation: ...~2~.~. ...................... l& --'---- Will lot be regraded ........ i .................... Will excess fiil be~remove~l from premises: Yes No 14. Name of Owner of premise~.-~..h't ~ .~f~'~.<~0.~...~ Address ~.~O.x~/~<oZ~.~'~t~hone No,--m-~..,-.~ · ' · .. _ _ Name of Architect ........ i ................. Aaares~, ......... -. :... vnone mo ........... ' ..... Name of Contractor ....~.~.~..~... ~.~. ~/{~. .................. Phone No ................ PLOT DIAGRAM Locate clearly and distinctly al! buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines· Give street and blockinumber or description according to deed, and show street names and indicate whether interior or comer lot. NOTIFY BUILDING 765-1802 9 AM FOLLOWING 4. FINAL CON'STRI Jr~'~N ALL CONSTRUCTION ~lh} ~MEE THE REQUIREMENTS OF THE] STATE CONSTRUCTION & ENerGY CODES. NOT RESPONSIB-Ei~ DESIGN OR CONSTRUCTION E~RORS. STATE OF NE~Y~RI~, ~' '~ ~I ing don~~ being duly sworn, deposes ~d says that he is the applic~t above named. ~ ~ He is the ................... ~ ..................................................... (Contractor, agent, corporate officer, etc.) of said owner or ownem, ~d is duly authorized to perform or have perfomed the said work and to m~e ~d file ~is application; that all statements cont.'ained ~ this application are true to the best of his ~owledge and belief; ~d that work will be perfo~ed in the m~ner set forth in the application filed therewith. Sworn to b~fore me this ~