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Home My WebLink About12990-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. z-I5564 Date April 1, 1987 DECK ADDITION THIS CERTIFIES that tile building ................................................ Location 465 Windjammer Drive Southold, New York of Property ~/~s~ h]o: ....................... '~'t/e~{ ....................... County Tax Map No. 1000 Section 0 79 .Block 4 .Lot 3 9 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated March 26, 1986 12990 Z ........................ pursuant to which Building Permit No ...................... April 9, 1984 dated ............................. was issued, and conforms to aH of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... DECK ADDITION TO EXISTING ONE FAMILY DWELLING ROBERT & MARGARET WILLIAMS The certificate is issued to ..................... [o~;n'o),'~'~st,~"i~aY~)x ..................... 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 1~0~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CT'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12999 Z Date ...................................... , 19 Permission is hereby granted to: .... ~.~.~....~.,.~.,....~.L~..'~...~ ..... ..~.~.~~...,...~.~......~..~..~:. .............................................................................. at premises located at ......L}...~...~ ......... ~.~... .~..dkO.,.....~.....~)..~.,.........~.~,,(~__ ...... Co p tion ...... .~.-J.....~. ...... Block ........ ..~. .......... Lot No.....~.~ ............. pursuant to application dated ....... .~.~....~..~ ................ , 19..~....~., and approved by the 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 submitted in duplicate to the Building Inspec- tor with the following; for new buildings or new use: 1. Fina~ survey of property with accurate location of a~l 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. 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 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 required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling/ land use 3. Copy of certificate of occupancy $I,00 --Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Date. x '/'. ........... · / New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ..~.~..~,~. .... ~;C~/-/~-.~.~.~.~Z.~.. ~.;. .~.~.~..~...~....~.''~'~-?r~/'~'''~¢) House No. Street Hem/et Owner or Ownersof Property ~'90~vO~..~, .~?.~..~.~.~;q~......~..~.~.~. t./~.~?. ...................... County Tax Map No. 1000 Section (-~-~ Block Y Lot ~.. ~. Subdivision ................................. Filed Map No ........... Lot No .............. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ...... ~..~/...~ .......... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $..: .~.. ? ?..j~ .~. Construction on above described building and~.eets al.l,a'~licable codes and regulations. Apphcant .................. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 76.5- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted ~a aat=aa~=m to the Building Inspec- tor with the following; for new buildings or new use; 1. Final suwey of property with accurate location of all buildings, property lines, streets, and unu~al 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 ~urvey of property showing all property lines, streets, bui[dings and unusua~ 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 informe- lion required to prepare a certificate. C. Fees: 1.CertH[cateofoccupanc¥ Neu DwellJ. ng,$25.00. Acce~.~ory ,,$10.00 ~ue].ne~:~ ~50.00 2. Certificate ~f occupancy on pre-existing dwcUing ~ 50.00 3. Copy of certificate of occupancy $ 5.'00~ ove~ 5 yea~s ~10.00 5.Uoda[ed c.g. ~ 50.00 Date .............. 6. Alteration ~2~00 Ne~Cons tructlon. ~.. O~d o~ ~e-ex~st~n9 8u~d~n~ ............ Vac~s~ [and ............. ...... ...... oubdw~s~on ............. q.,~ ........ t.~g.., t ed p No.~ .......... L t N ......... ~ z . 'A .... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ..... q~. ~.. ................ INSULATION ?ER N. STATE ENERGY C~ODE F'fELD I,ISFECTION iDATE !1 COMMENTS FOUNDATION (lst) FOUNDATION (2nd) 2. ROUGH FRAME & ?LUMBING ¥. FINAL ADDITIONAL COMMENTS: TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. ! 1971 TEL. 765-~02 This xs Co advx,,e you that the job under building permit no. 1299.0Z issued to Robert Williams sa __~/84 for Addition is completed a final inspection bas ( ) has not ( x ) been done. and In order to complete this file, it is necessary that a Certlflcate of Occupancy be issued. Please fill out the enclosed form, return same to the above office with a cheek for $25.00 payable to the Town of Southold. Please indicate to Whom cbc Certificate of Occupancy is to be mailed, and arrange with this office for an inspection date Occupancy or use is unlawful without a Certificate of Occupancy. l'lense help os to clear up this matter so that legal action does not have to be taken. Thank you for yn,r prompt attention. Very truly you~, Victor Lessard Executive Administrator VL: ga r 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y, 11971 TEL.: 765-1803 Examined .~ .... , 19 .~/. Approved .~. .... 193 ~. Permit No.J..~.~..~.O...~Zr.' Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tkis 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 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 all applicable laws, ordinances, building code.~t~using code, ajl.d regulations, and to admit authorized inspectors on premises and in building for necessary inspecti~ .zJ~"~-,d,, .,~ f/~ .......... .... (Signature of applict~_.~,, or name, if a co p ' ) ...... .... (Mailing address of applicant) State whether applicant is.~ owner, lessee, agent, architect, enCneer, general contractor, electrician, plumber or builder. .... ....................................................................... Name of owner of premises ...................................................................... (as on the tax roll or latest~eed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..... .~.D.~z~.. ............... Plumber s License No ......................... Electrician's License No ....................... Other ~rade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ..... ............ ...................... House Number Street Hamlet County Tax Map No. 1000 Section ....... ~ .......... Block ~ Lot ~,~;r ,, . Subdivision...~./..~.~.z~.~.,~....'~..~.~./~..~.. ~. :5.~.e&:../ .... Filed Map No. ~..~.~.'.'~ ....... Lot...~?o. ........ /~- (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy . .~.~.~..~. .... (d) ~':(c/, ~, ) .......................................... property lines. Give street and block~number or interior or corner lot. 3. Nature of work (check which applicable): New Building .......... i i n .......... Alteration . .;, ....... Repair .............. RemOval ........... Demolition ........ Other Work ~... g~.z:: .~.~... : (Description) **' (to be paid on filing this application) $ Ifd elli fd ' N b fd Iii hflo · w ng, number o welling units ............ um er o we ng units on eac or ............... If garage, number of cars .... ~ .................................................................. 6 If business commercial or mixe'd occupancy specify nature and extent of each type of use 7 Dim i f ' ' ~s 'fany: Front R Depth · ens ons o existing structur ,1 .............. , ear ............................. Height ............... Nutuber of Stories .... /. ................................................... D' ' f t "th alterations or add't' Front Rea lmenslons o same s ructure wi 1 ions: ................. r .................. Depth ' Height Number of Stories 8. Dimensions of entire new consthaction: Front ..... ~..o. ....... Rear ....2.~p ......... Depth .. g..~. ......... Height ............... Number of Stories ........................................................ 10 N fF · Date of Purchase .......... r .................. amc o ormerOwner ............................. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction vie!ate any zoning law, ordinance or regulation: ............................. ;.~. 13. Will lot be regraded ....... .~, ................... Will excess fill be removed from premises: Yes fNo~ Name of Architect ......... i ................. Address ................... Phone No ................ Name of Contractor .......... ~ · .'.?~ ......... Address .?,.o.,d .~.W. ?,,~q .~¢:, Phone No .............. PLOT DIAGRAM Locate clearly and distinctly al~ buildings, whether existing or proposed, and, indicate all set-back din~ensions from description according to deed, and show street names and indicate whether STATE OF NEW YORK, iS.S COUNTY OF ................. ' ' being duly sworn, deposes and says that he is the applicant ~'(Name of individual sign!ng contract) above named. He is the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements cont~ined in this application are true to the best of his knowledge and belief; and that the work will be performed in the manne~ set forth in the application filed therewith. Sworn to before me this ........................ day of ........... 19 Notary Public ...... ~ County (Signature of applicant) HFLEN K. DE VOE NOTARY PUBLIC, State, oi New York ~, 4Z07~!8, Sugolk County ~ T~rm Exp,res March 30, ]9~ i