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HomeMy WebLinkAbout13292-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No....Z J.2.6.3. 9 ........ Date ...... .~.u.l.y...2.5 .................. ,198..4. THIS CERTIFIES that the building ... D..e.c.k.. a..d.d.i.t..i .o.n .............................. L,,c~tion of Pro,~ert,, I 1185 Soundview Ave Southold House No. Street Harnlot County Tax Map No. 1000 Section . 0..5.4 ........ Block .. 0..5 ........... Lot .. 0..3 .9 ............ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... .J .u.l.y...2.0 ........,198. 4.. pursuant to which Building Permit No.. ! .3.2.9. 2. .Z ............. dated . .J.u.t.y....2.3 ................... 198.4..., 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 ......... ..... .D.e.c~ ~dd~ion t9 existing dwelling lupp. er deck) The certificate is issued to ...... L. y..n p.e.. P..a .1 .m.e. v'' io'~.~;._ '/~q'~ ~r~) ................ of the aforesaid building. Suffolk County Department of Health Approval N / ^ UNDERWRITERS CERTIFICATE NO N/A Rev. 1/81 Building Inspector IPOB,~ NO. 0 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? 13292 Z Permission is hereby granted~t?/~ ~'/~_ /? .... ~.~.x.~..?~:?.~ ........ t....~:~.?...~... ............... .... u..~..~.~.....~.~.~....,A ....... ~. .......... ~..... ~..~~- ...... ~, ,...~/~'~..~ .. ..~ ...... ~.~. ~2.~ ...... ~;~ ............................................................................................................. ot p~mises I~oted ot ............................................................................................................................ County Tax Map No. 1000 Section ...... ..~.2~.~,, ....... Block ...... ..C.}.....~.. ....... Lot No .......~..~.?.~ ......... · ~ ~(~L~' ~ lg..~..~.t.,andopprovedbythe pursuant to application dated ........... ~.~, ..... ~..~ ............... , Building Inspector. 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 typewriter OR ink, and submitte~pNc=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 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 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 informa- tion required to prepare a certificate. Co Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling/ land 3. Copy of certificate of occupancy $1.00 use--Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Date, .~.~. ~./.~T.../¥. ...... New Building ....~'.....'.'~// ·.. Old or Pre-existing Building ...~ ~ Vacant Land Location of Property .. 1\1 .~.' .~: .............. ~.o.~.~.~..~..~...~,~-O.... ~ ....... ~...~...'~..~ .[.~.. House No, Steer Ham/et Owner or Owners of Property ............................................ County Tax Map No. 1000 Section ... ~..~..~ ...... Block ..... @.-~.'~. ...... Lot .... .~ ~.~ ....... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... 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 permit meets all applicable codes and regulations. Applicant....~~ .~ .?.~.. ....................... 4". O. FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL .. ~OUTHOLD, N.Y. 11971 TEL.: 765-1803 ~xaminedx,'~'' '~"~-'~ ':'~ "~ .... 19'~ ~J. ~,pproved . .~.-.:->,~.., 19g.'J. Pemdt No..1 .:~.~.t.~ '):. ;: 9isapproved a/c ..................................... .. ? ..-...~ ........... .~ ........ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date..~../..~7.(~. ...... ,19 ~.~.~/ a. This applicatio~ must be completely filled in by typewriter or in iuk and submitted to the Building Inspector, with 3 ;ets 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 )r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part. of this appli- :ation. ' 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 Buildh~g 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 constraction 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. CD_ ()_ (Signatu~of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, enCneer, general' contractor, electrician, plumber or builder. ............ © .~...~ .~. ~. ......................................................................... Nanie of owner of premises · ...L...'-/.t.Nt./?. [ ~ ....(3. ~ .k~O~.-I,~ ~ ................................. . ....... (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..~f~..~....~6~.~ .~ Plumber's License No ......................... ' Ele ician' Lic N ctr s ense o ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ...... ........ ..... x 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 constructi°n: a. Existing use and occu~pancy ......... ~.~'VXq Y'~3 .-fi~.,....Q. '~'~~.'~' ............... it ........ '~" b. Intended use and' occupancy ......... '~.¢...' · .-¢--~_~. · · ~' ~ ?~.~. · ~~-. k ( l~-w ppli ) ' .~.~,.C, ~. 3. Nature of wot chec hich a cable: New Building ...... Addition .. Alteration .......... Repair .............. Removal ............ Demolition .... 7 ......... Other Work ............... ~ (Description) 4. Estimated Cost....~.~-.~, ,~.~.-~. .................... Fee .~..~. ~.~.~ ............... .. .......... *:' (to be paid on filing this apphcation) 5. If dwelling, number of dwellingi units ........ \ ....... Number of dwelling units on each floor ................ If garage, number of cars .... , ................................................................. 6. If bus~ness, commercial or m~xed occupancy, specify nature and extent of each type of use ................... 7. Dimensions of existing structurgs, ifany: 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 ..... I~l ~t.~/ ..... [ .q.~? ........ Name of Former Owner . .~.o..~.c?.[.c~ .. 11. Zone or use district in which p~emises are situated ......... ~.qc?.~COp.[.d. ................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ........ f .x/.c). .................... 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises (~¥~.N..~'~. (~.~...ctS.. c:.-~...,. Address 37~.q ~: .~.~..~. ~,'. B.c[.. Phone No. ~. Name of Architect ........................ Address ................... Phone No ................ Name of Contractor [Zw-F,G.~:.t,~ ~&O..~.~..~0.~.. Address , .~..~ ]rF[oAq.o~. . Phone No ....... PLOT DIAGRAM Locate clearly and distinctly al1 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. STATE OF NEW YORK, COUNTY OF ......... ........ S.S being duly sworn, deposes and says that he is the applicant (Signature of applicam) (Name of md~vadual s~gmng contract) above named. He is the .......... ' .......... : ...................... · ............................................ ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dully authorized to perform or have performed the said work and io make and file this application; that all sfatements contained 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 ............. O~0. ~.~ .... day o;f ...... ~ ......... , 19. ~ Notew Public, ....... : .. ~e m ~x ~ res ~arc ~ 30, 19~ ~;~E IS ~,JLAWFUL WO'fD 'f CERTIFICATE OF OCCUPAN,C¥ r'-~'~ll DING NOTIFY ~u'~ FOR THE 765-1802 9 AM TO 4 PM ' FOLLOWING iNSPECTTONS: 1. FouNDATiON - ~0 REQUIRED coNCRETE FOR poURED & pLUMBiNG ~. ROUGH "FRAMING INSL LAT~ON 3. FINM pON.STRUCT~ON MuST 4. gE 'C'"'[v";;¥~ FOR C.O. MEET ALL ~,~:~ ~:~(~,~'t THE N, Y, THE R STATE coNR?RUCTION & ENERGY coveS. NOT Dg~IGN OR <ONsTRucTION