HomeMy WebLinkAbout13250-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. Z ]5566 Date April 1 , 1987
THIS CERTIFIES that tile building ., .A,c. c. e..s .s?. r..y ...................................
37800 MAIN ROAD ORIENT
Location of Property ~/~t~s~ ~o: ....... Street Hamlet
County Tax Map No. 1000 Section 020 .Block 03 .Lot 009. 1
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
June 25, 1984 , gp 13250. Z
....................... .. pursuant to which Buildin ermit No .....................
dated J u n e 2 5, 1 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 .........
Accessory sro'rage barn.
The certificate is issued to s c o t t L. tt a r r 5_ s
..................... ?o¥.'o;, .....................
of the aforesaid building.
Suffolk County Department of Health Approval ...... .N./.A. ................................
UNDERWRITERS CERTIFICATE NO. .N./,~ .....
PLUMBERS CERTIFICATION DATED: N/A
Building Inspector
Rev. 1/81
FOIB,~ NO. Il
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. ¥.
BUILDING PERMIT
(THIS PEPu~IT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 13250 Z
Date ...................... 19
Permission is hereby granted to:
......... ..~T..¢~../.7:. ....... .~., ...... ~.....,~ .......
........ .............
...... .G2.~z,....~..,..~ ......
,o ....... ~'~.,~...,,x../=~.~...~.~......~...~.~.,~;~z~.~....~ ...... ~z~.~:....~,,~x~
premises located at ................. : ........... .~ ...........
~ ~'~,.~.. .... 19 ~' and o roved b the
pursuant to application doted ........ ~...,~,~Z'~ ......................... , ..... i:,~ pp y
Building Inspector.
Fee $ ........................
Building Inspector
Rev. 6/30/80
FORM NO, 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
This application must be filled in typewriter OR ink, and submitted i~ 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 featu res.
2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal).
3. Approva~ of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and sYmilar 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 p~"operty 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 condition of buildings.
3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa-
tion requ ired to prepare a certificate.
C. Fees:
1. Certificate of occupancy $5.00
2. Certificate of bccupancy on pre-existing dwelling $15.00
3. Copy of certificate of occupancy $1.00
4.Vacant Land C.O. $5.00 ,~...(~.~, j..~. i ~
5. Updated C.O. $15.00 Date ...............
New Building .., ,)~ ....... Old or Pre-existing Building ............ Vacant Land .............
Location of Property . .~. 7K~t~ .~....~ .~. ~.~. ! .l~t....~..O.~-~. ............... . .O. I~.~t ~.~..% ~. ~..~.,
House No. Street Hamlet
Owner or Owners of Property ....... ?.~ .O. ~'~...~.~,...L-*J~,t.~'~-,~.f2i .........................
Cea nty Tax Map No, 1000 Section ,, ,O, ~ ..... Block ...~. ~ ........ Lot...~..O...~ .,..~...
Subdivision ........................ , ........ Filed Map No ........... Lot No ..............
Permit No. [~.~-,~..(~). Date of Permit~l~..~/8.~c'.Applicant ,~T~..~..~.~/.~...~-='~.[.~. .......
Health Dept. Approval ....... ~.~ .......... Labor Dept. Approval ... ~.~ ............
Unde~riters Approval ...... ~ .[~ ........... Planning Board Approval .. ~.~.~ ...........
Request for Temporary Certificate .................. ... Final Certificate . . ...~............ .....
Fee Submitted $..
described build~n~ and~rmit meets al pp~icabl co e~ and regulations.
A~plican ..................
~EL~ INSPECTION COMMENTS
FOUNDATION (1st)
FOUNDATION (2nd)
2.
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
QODE
ADDITIONAL COMMENTS:
TOWN OF SOUTHOLD
OFFICI~ OF BUILDING INSPECTOR
ILO. BOX 728
TOWN IIALL
SOUTHOLD, N.Y. 11971
TEL. 765-18O2
This in Co advise you chat the job under building
permiC no. t3250Z innued to Scott Harris
on 6J.~4/84 for Accessory ia completed
a final inspect[on hen ( ) has not ( X'")''been done.
and
fn order to complete this file, it ia necessary that
a Certlflcate of Occupaocy be issued. Please fill out the
enclosed form, return same to the above office with a check
for$10.O0 payable to the Town of S0uthold. Please'indlcate
to Whom the Certificate of Occnpaney is to be mailed, and
arrange with this office for an inapection date
Oceepancy or line in nnlawful without a Certificate of
Occupancy. l'lenne. I, eIp us to clear up th~. matter so that
legal action does not hav~ to be taken.
Thank you for yonr pro,pt attention.
Very truly _your~,
Victor Leseard
Executive Administrator
VL:gar
765-t802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION ZND [,] II~LATION~
FRAMING ["] FINAL
~'~ .......... /, ~ ,,
DATE
INSPECTOR
March 20, 1986
Please extend B.P. ~13250 for six months.
With this extension the permit is good
until June 25, 1986. Thank you.
'FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N.Y. 11971
TEL.: 765-1802
Examined ................. 19 Received..- .
Approved
Disapproved a/c ...~...~ ......... .~......~ -
//
. . , 19~.Q/Z~
INSTRUCTIONS
a. Tiffs 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 lnspector will issued a Building Permit to the applicant. Suchpermit
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·
APPLICXTION 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 applichble 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, ordinancestTl~uildiffg code, hgdsing code, and regulations, and to
admit authorized inspectors on premises and in building f°r nece~i'~-.~t....~.~ . ~'~'~ '" -
(Signature ¢t¢~pplicant, or i~ame, if a corporation)
·
(Mailing address of applio~nt)
State whether applicant is(~ lessee, agent, architect, engineer, general contractor, electri~i.an, plumber or builder.
Name of owner of premises .',~l=l~:~.t~,,, ~ ~..~l.P.r/..~.
(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 ~rade's License No ......................
!
1. Location of land on which proposed work will be done.. ~ ~1~.. ~_~..~. ~. g.~..~.~.~.. ~..~.~.2
House Number Street Hamlet
County Tax Map No. 1000 Section .... ~.~. ......... Block ..... ~ .......... Lot ..... ~./~ ..........
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../. .'~. ~..~. .... ~..t~..~. ....................................
b. Intended use and occupancy ~ ~... ~*~~ ~ '
3. Nature of work (check which applicable): New Building ..... Addition .......... Alteration ..........
Repair .............. Removal .............. Demolition .............. Other Work ...............
o'~ (Description)
4. Estimated Cost ............................ i Fee~,.~d~..[t ~, ................................ ~
· ~to be paid on filing this application)
5. If dwelling number of dwellingl units ............... 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 .....................
.... if any Front Rear Depth
7. Dtmenslons of existing structures, . ...........................................
Height ............... Number of Stones ........................................................
Dimensions of same structure With alterations or additions: Front ................. Rear ......
Depth ................. i... Height ...................... Number of Stories .....................
8. Dimensions of entire new construction Front ......... Rear .......... Depth .........
10. DateofPurchase ..,~.~.~! ................... Nam,e of Former Owner .~0~',~t ..............
11. Zone or use district in rwhich p(emises are situated...~.~'-~t~e~ ~...6..
12. Does proposed construction violate any zoning law, ordinance or regulation: .... ~..~. .......................
13. Will lot be regraded ... ~.0.~! .................... Will excess fill be removed from premises:,.,Yes
......... , ................. Address ................... Phone No ................
Name'of Contractor ................... Address .................. Phone No ...............
PLOT DIAGRAM
Locate clearly and distinctly ali buildings, whether existing or proposed, and. indicate all 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. ~
'
STAff OF' N :
copy__.. s.s
............
/ "(Name of individual sighing contract)
.I
.... being duly sworn, deposes and says that he is the applicant
above named.
He is th~ .....
(Contractor , agent , corporate officer , etc . )
of said Owner or owners, and is duiy authorized to perform or have performed the said work and to make and file this
application; that all statements cont!ained in this application are true to [he 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|'
' ......
Notary'Public,/ .. County
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