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HomeMy WebLinkAbout13447-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building . .I).e.q k. .......................................... LoCation of Property .5 15..C.p. 9~p..l~qo.d..L.a..n.e .................... C.u.b.c.h.o. ~.u.e .......... House Ho. Street Hamlet County Tax Map No. 1000 Section . .. ] g9 ...... Block ...... .2 ........ Lot ..... .~ .2...3. ....... Subdivision...~..~ .o.~.n...Iv .ap. cl...L .a.n.e. .......... Filed Map No. 6.2.8..9 .... Lot No...3 ........... conforms substantially to the Application for Building Permit heretofore f'ded in this office dated ..... S e P.~.e.rat~ e r..~. 9.., 198,~.. pursuant to which Building Permit No. 1.3 ~ ,~.7.~ .............. dated .. ~ e.g [ e mb.e.g.. ~ S ............ 19 ~3A, 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 ......... ..... Deck..ad ¢£.~.~,9a..~.q. aB..~¥ ~.~,~g..qn, e,, f?.m..~ .]_y..d.~.e.J_.l.~ n. g., ................. The certificate is issued to .... g~n.~p. ],.e~..~. ~..L.~..ri.d.a..K..u.e.b.l.e..~ ......................... (owner, I~ t~t~t)~ X X X of the aforesaid building. Suffolk County Department of Health Approval ......... ~J ~'g .............................. UNDERWRITERS CERTIFICATE NO ................. N.../.A .............................. Rev. 1/81 Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PEPu~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13447 Z Permission is hereby granted to: /) , ~ ~ ...... ~~ ....... ~~ ...... ...~.:.~.....~.!.~..~..~.. .... .C.~.~~....~....~..u...~...~..~.-.. . ...... ................................ at premises located at ....~.~...~......~.~...~.z;~. ....... ~.~~ ........... pursuant ,0 application doted .... -- -~-~~.....L.~. ......... , 19.~.(~..,---- and approved by the Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A, This application must be filled in Wpewriter OR ink, and submitte~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 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 Enqineer responsible for the building, 5, Submit Planning Board approval of completed site plan requiremer~ts where applicable, B, 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 features. o 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 informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling / land use 3. Copy of certificate of occupancy $1.00 / --Pre-Existing C.O. $15.00 Vacant~ land C.O. $ 5.00 Date..~,/~/,~,, ,'~, .............. New Building .... ~. ........ Old or Pre-existing Building ............ Vacant Land ............ Location of Property . ...~./..~.. o~/~.c~. L~/ ....... /_ .~ r4.~. . ~ - C---Y'(<2 ~c4 ......... . House Ho. Street Ham/et Owner or Owners of Property .............. - ........................... .. . . . . . . .. County Tax Map .o. 1000 Section .... /, ,0.~, ....... Block ... ~ .... Lot Subdivision .~o....~j.'J...L.~ .~.~..../7./t..~.~;~. ........ Filed Map No..(-¢~.~. ~....Lot No...~-~ ......... itN /~.~.,~.~...Z~. fp .~//~/..~.~. /~ .~.~.~..~.~.~. Perm o. . Dated ermit ..Applicant ...; .................. .. . . . 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 p~er,mit meets all applicable codes and regulations Applicant .. ~,'0~ ~ ' FIELD INSPECTION COMMENTS FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & FLUMBING INSULATION FERN. Y. STATE ENERGY ODE FINAL ADDITIONAL COMMENTS: Rg: BP #13447Z-C0 Z-12819 LoHBARDI 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved ..... , 195.t . Permit No ............ Disapproved a/c ..................................... Received ........... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by Wpewriter 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 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 ail applicable laws, ordinances, building code, housing code, and regulations, and to for necessary in e,ctions. admit authorized inspectors on premises and in building . . .~. e_,c~..~._.k~-<~ ~..044~.,4~. :-:,~ ~' ~/~ ~'/) (Signature of ai~pliCant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, enl~neer, general contractor, electrician, plumber or builder. ............. ............................................................ Name of owner of premises .. ~..~P ~P..~. ] ~-'./'('. ~ff~.~- ~-~. · · '~.. ~'/?'~'~'~'' .~r. ~ ¢~/¢F .................. (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 ......... .~./6~ ............ Plumber's License No ........ ./~/./( -~- ........... Electrician's License No ...... .~..//~. · .......... Other Trade's License No ...... ~.~./~. .......... I. Location of land on which proposed work will be done .......................... House Number Street Hamlet County Tax Map No. 1000 Section ..... .~..~..~. ....... Block .... ~-.. · . · Lot.../~..~.~. ......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed constructi°n: a. Existing use and occupancy ..... O~./.~'. '.,,,,... ............................... 3. Nature of work (check which a )plicable): New Building .... ' Addition .......... Alteration .......... Repair .............. RemOval .., ............ Demolition .............. Othe,Woxk .... ~,~ ......... (Description) 4. Estimated Cost ..... .~. ~..~. i .......................... Fee...~.~.. ..... ~';t'~ '~ .~.fr..~.~.~.. '. ~ ................. i ~' (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 ' ' ' specify natur0 and extent of each type of uso ~' . , commercial or m~xe~d occupancy, ............ 7. Dimensions of existing structures,, if any: Front ..... ~e/~ ...... Rear .............. Depth. ~ ........... Height ............... NuOber of Stories ....................................................... D~ensions of same structure with alterations or additions: Front .. ~ .......... Rear ................. Dep~ ................... .... HeiSt ..................... Number of Stoges ..................... 8. Dimensions of entire new construction:. Front ...... ~.~-... Rear ...... . ........ Depth ......... .... . Height ............... Number of Stories ...................................................... 9. Size of lot: Front .. ~..~ ............ Rear... ~ ......... ~ ..... Depth ~/~v2.~{ ............ I 0. ~ate of Purchase .~g/~ [~ ~ .................. Nam~of Fomer Owner . ~a ~ .~.~t~t~ ~ ......... I 1.Zone or use district in which pr~emises are situated 7...~': ~ ........................................... 12. Does proposed construction vio.late any zoning law, ordinance or regulation: .~ ........................ 13. Will lot be regraded ........ ~.~.. % .............. Will excess fill be removed from prqmises: Yes 14. N~e of Owner of premises ~'~. ~. Address . .~/~.~.~.~O. ~No. ~.~ Name of Architect ......... ' .................. Address ................... Phone No ................ Nme of Contractor ' Address Phone No PLOT DIAG~ Locate cle~ly ~d dis~ctly Mi bufld~gs, whether existing or proposed, ~d, indicate ~1 set-back d~ensions from property ~nes. Give street ~d blocE number or description accordMg to deed, ~d show street nines ~d indicate whether interior or comer lot. NOTIFY BUILDING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR T[4F FOLLOWING INSPECTIONS: 1. FOUNDATION -TWO REQUIRED ,o,cI' FOR POURED CONCRETE 2. ROUGH - FRAMING &PLUMBING 3. INSULATION 4. FINAL .. CON'STRUCTION i MUST /~,~ BE CqMPI.FTE FOR C.O. ~ ~ ~¢ ~ ALL CONSTRUCTION SHALL~ MEET THE REel IRrMENTS OF THE N,Y STATE CONSTRUCTION & ENF CODES. NOT RESPONS1BL~ DESIGN OR CONSTRUCTION ERRO] STATE OFNEW YORK~ .... cou v OF .... s.s ...... ZX:~O~...~.. ~/¢~ ................ being July sworn, deposes ~d says tha~he is the (Name of i~Jivid~al sigr tng contract) , . above named. (Contractor, agent, corporate officer, e~c.) ~~, ~d is duly authorized ~o perform or have perfo~ed ~he said work and to m~e ~d file ~is application; that all statements conthined ~ ~his application are true to the best ofhis ~owledge and belief; and that tho work w~l be perfo~ed in ~he m~n~r so~ forth ~ the application filed therewRh. Swo~ to before me this .......... ....