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Home My WebLink About13043-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No Z 15372 Date March 18., 1987 THIS CERTIFIES that the building ...A.d.d.i..t .i.o.n. · 570 Bayview Ave. G'reenpor t Location of Property ............................................................... House No. Street Ham/et County Tax Map No. 1000 Section . .0.5. 2. ....... Block ...5 ............ Lot ...4. ! ............ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Pemit heretofore filed in this office dated .... .Ap.r.i. 1...I.6. x..1.9.8.4. · ,, pursuant to which Building Permit No.. I. 3. 9.4.3.Z. ............. dated .... . ................. ,.....AP r i 1 16, 19 84 ,. 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 ......... Construct deck addition to an existing one family dwelling. The certificate is issued to FRED & HELEN HANSEN (owner, ~.,~tlq. YOX of the aforesaid building. Suffolk County Department of Health Approval .......... N./~ ............................. UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED: N/A · ' '~' '~ ~l~qlding Inspector ............. Rev. 1/81 l~OmW NO. Jl 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? 130~3 Z Date ~ ........ , .... Permission is hereby granted to: .... ....~.~t.~)..~.....~ ................................ ......~....~.~~L.....~.:..~.,....LI...cI.~..I ........ , ,o ...~~..~.....&.~.....~~....~...~...~~ .... at premi!s located a~t .. .~. :.7....~. ...~...~.~..~~ .~ County Tax Map No. ZOO0 Section {) ~' ~-~ Block ~-~ Lot No. ~- [ (P 19..~.!t., and approved by the pumuant to application dated ....... ....~.~ ..................................... , Building Inspector. B Rev. 6/30/80 FORM NO. $ TOWN OF SOUTItOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A, This application must be filled in typewriter OR ink, and submitted ~a ~ ...... ~ 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 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. B. 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 inspectior~ of buildings or premises, or other pertinent info:ma- tion required to prepare a certificate. C, Fees: 1. Certificate qJ occupancy Now Dwell:Lng. S25.00, Acce~.3ory ,.$10.00 Bualne~:J $50.00 2. Certificate of occupancy on pro-existing dwelling $ 5 0.0 0 3, Copy of certificate of occupancy $ 5.'00, over 5 years $10.00 o.oo 5.Uodated ~.O. $ 50.00 Date ......... 6. Alteratzon $25.00 '' New Cona~c ~lon ...... Old or Pre-existing 8,uildJng ............ Vacant Land ............. Owner or Owners of e ~'C ~ ' ~~~ ~ Pro rt .~..~ ........ ~ ...... County Tax Map No. ~000 Section ............... Block ............... Lot ............ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No, J:.(~ ¢-~. ~ Date of Perml~. zJ=/.~.: .z~', ,z~,,,.Applicant/~. ,~.0/~,,, WK~, :,/~. ~,(~. ~ ......... Health Dept, Approval ........................ Labor Dopt, 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. ¢?. ..................... FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall 8outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitte~l;]icat= 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 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. C. Fees: I. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling land use --?re-E×±s t±ng C.O. $15.00 3. Copy of certificate of occupancy $1.00 Vacant land/C.Ol $ 5.00 Date ........ 6..L.~ .~.L..~.~../~. .... New Building . .~C~ .~.... Old or Pre-existing Building ............ Vacant Land ............. Location of Property .... ~[ .~. ~). .~.-~(-/f ~ ~ .ou o. ' ............ ........ ' ........... Owner or Owners of Property .......... . .~..~.'~_(~ ....'~.~ ...................... CountyTax Map No. 1000 Section .... Q .?-.:.~'.... Block ...... Q.~..U .... Lot .... .O..~../... Subdivision ...... ~ ......................... Filed Map .No. /~ ..... Lot No. . ./~.. Permit No..t..~..0..~..~Date of Permit .~. ~(0..~.Applican, ....~..~....~ .... .~/.~..~-~... ~ ...... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval .... ...~...f". ............ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. ~ ~0-~ ~ Construction on above described building and permit meets all applicable codes and regulations. f'IEL~ INSPECTION FOUNDATION (1st) FOUNDATION 2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE FINAL COMMENTS ADDITIONAL COMMENTS: TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR 1'.O. BOX 728 TOWN ItALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 This is to advise you that the job under building permit no. 13043Z issued to Fred Hansen on ~/~6/84 _ for Addition is completed and a final inspection bas ( ) has not ( x ) been done. fn order to complete this file, it is necessary that a Certificate of Occupancy be issued. Please fill out the enclosed form, return same to the above office with a check for $25.00 payable to the Town of Southold. Please indicate to Whom the Certificate of Occupancy is to be mailed, and arrange wit}] this office for an inspection date Occupancy or use is unlawful without a Certificate of Occupsncy. Please help ~s to clear up this matter so that legal action does not have to be taken. Thank yurt for yonr prompt attention. Very truly y~, Victor Lessard Executive Administrator VL:gnr oriel. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL.: 765-1803 ^pproved ...... eermit No, 55 Disapproved a/¢ .......................... ' ........... Application No .................. (Building Inspector) APPLICATION FOR BUI LDING PERM IT Date ................... 19... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate 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. - & Upon approval of this application, the Building Inspector will issue 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 Occupaixcy 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, housing code, and regulations, ~.nd to admit authorized inspectors on premises and in buildings for necessaw inspections. (Signature of aOplican~r name, if ~x~o~poration) v (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .......................................... ................................ (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 ..... ~l.~..: .. ........... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposedr~.) [ )w°rk will be ,done .................................................. ~'~L~· '~' ' ' .¢:? ........... . ,, ........ .............. .......... [ Street Hamlet U House Number ' C~hnty Tax Map No. 1000 Section ' .C~.~.~'.~?.~ ..... Block ....... .~.~ ........ Lot......c//~l ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and ~ccupanc~premises and intended use and ~ccupancy ~f pr~p~sed c~nstructi~n: a. Existing use and occupancy . .~l~ · .r~T. · · ~ ......... .~ ~ ........ ?~. ...................... b. Intended use and occupancy .... i¢.-~....~..~>..~. ?.~ .... ~....)..)~.-C~.~.. ..................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. RemoVal ............ Demolition .............. Other___W°rk ............... 4. Estimated Cost .... ~ ............. Fee ............ (to be paid on filing this application) $. If dwelling, number of dwelling units ............... Number o f 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. Dimensions of existing structure~, if any: Front ............... Rear .............. Depth .............. Height . .............. Number of Stories '. .................................................... Dimensions of same structure with alterations or additions: Front ................. Rear ................ Height Number of Stories Depth .................... i ........................................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............ Number of Stories Height .................................................................... 9 Size of lot: Front ~ Rear Depth Name of Former Owner 10. Date of Purchase ........... ............................................ 11. Zone or use district in which pr6mises are situated ................................................... ' ' ' ordinance or regulation: 12. Does proposed construction Vlotate any zomng law, .............................. 13. Will lot be regraded ......... ' ................... Will excess fill be removed from premises: Yes No ' Address Phone No 14. Name of Owner of premises ............................................. Name of Architect ..... i Address Phone No ' Address Phone No Name of Contractor .......... . ................................................... PLOT DIAGRAM Locate clearly and distinctly allI buildings, whether existing or proposed, and, indicate ail set-back dimensions from property lines. Give street and blockinumber or description according to deed, and show street names and indicate whether interior or corner lot. : STATE OF NEW YORK, S.S COUNTY OF ................. ............................ ..................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract above named. He is the ..................... i .......... (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 ~e this application; that all statements 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 NOT/}RY ['[J[~[!~, 5t0~e of N~-w Y0d~ (Signature of applicant)