HomeMy WebLinkAbout13073-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. Z15384 Date ....M.a.r.c..h..I.8.~ 1987 THIS CERTIFIES that th building Addition
Location of Property ..... .8.7.5. ..A.c.k.e..r.l.y. Pond Lane Southold
House No. Street Hamlet
County Tax Map No. 1000 Section 06 9 . .Block 05 .Lot 0 13
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
...... A.t~.~.i.1..!.3.,..1.9..8,4 .. pursuant to which Building Permit No. 1.3..07.3.Z. ..............
dated . .~.ay.. 1.,..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 .........
.................. 0e~k..~ <lcLi. c, ~, ~.n, .c,o...e.x.i.s..c.i.n.g..d.w.e.! ! .~.n.~: ....................
Thc certificate is issued to RANDY J. AND MARY YOUNG
..................... io¥,'o'r,'~d~do'&'tb~e;'O ......................
of the aforesaid building.
Suffolk County Department of Health Approval ........... .N./.A. ...........................
N/A
UNDERWRITERS CERTIFICATE NO ..................................................
PLUMBERS CERTIFICATION DATED: N/A
~ l~fiilding Inspector
Rev. 1/81
TOWN 0~ 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? ~3073 Z
Pen'nisslon is hereby granted to: ~ ~ ~
.......... .~.~.~...~....~.....~.~.~. ........
.... ~.7.~....~.~<~.~.~..:~.../~,
.... ~.~.~.~....~,...~ .......
..... ~~.~.~ ......................................................................................................................
~,,r,m.,,,~,ed ~, ......... .~.Z~'.~~...~.....~,~.....~ ................
.................................................................................................................... ~.~~...:: ......
pursuant to application doted. ...~./'/~:C~ ....... .~...................., 19.Z .~, and opproved by the
Building
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 Wpewritar OR ink, and submitted ~ m~ 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~at
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 property showing all property lines, streets, buildlngs 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:
1.Certificatagfoccupan¢¥ New DwellJ. n~.$25.00, Acce,.~o~y .~I0.00 ~u~ne~ 550.00
2. Certificate of occupancy on pre-existing dwelling ~ 50.00
3. Copy of certificate of occupancy $ 5.'00, over 5 yea~a ~10.00
4.Vacant Land C.O. $ 20.00 ~' 4': ~
NewCons t ~uc ~ion..~... Old or Pre-existing Building ............ Vacant Land ........
Owner or Owners of Property ...~DV ~ ~ ~ ..~. ~*~n~.
o0o .... ...... .......
Subdivision ................................. Filed Map No ........... Lot No ..............
Permi,,o. ........
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval Planning Board Approval
Request for Temporary Certificate Final Certificate .
Fee Submitted $ ...... ,~-...~.: ~(~ ...
Apphcant ................
FIELD INSPECTION ~ COMMENTS
FOUNDATION
FOUNDATION (2nd)
2.
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
~.ODE
FINAL
ADDITIONAL COMMENTS:
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN tIALL
$OUTHOLD, N.Y. 11971
TEL. 765-1802
This is to advise you that the job under building
permit no. 13073Z issued to tL~ndy g. Young
on 5/1/~4 for Addition is completed and
a final inspection has ( ) has not ( x ) been done.
tn order to complete thin 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 $25.00paynble to the Town of Southold. Please indicate
to Whom the Certificate of Occupancy in to be mailed, and
arrange with this office for an inspection date
Occupancy or use is unlawful without a Certificate of
Occupancy. t'lenae, help us to clear up this antler so that
legal action does not have to be taken. ..
Thank ynu for yo,r prompt attention.
Very truly y~,
Victor Lessard
Executive Administrator
VL:gar
cncl .
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N.Y.
NOTICE OF DISAPPROVAL
File No.. ~ ......... ~ ................. Date . r..5/,-e-'..~,. ~. · .~., .......
To ~,~,~&' .5~:..~ .' .... / ~e,.c/.C;. ....
.,~.w././~p.~ ..... ~...~ ........
PLEASE TAKE NOTICE ..... that your apphcatlon dated . .~.~c 6 .... /m.; ...... , 19
for pe~a to const~ct .... w; ..... .... ~ ....... ( .... : ......... ~ .................. at
co~.ty T~ mp So. ~o00 s~tio....~d~---- .... moo~ ... ~3. T~ ..... Lot . .~.~ ~'~ .....
Subdivision ................. Filed Map No ................. Lot No.
is returned herewith and disapproved on the follow~g grounds . .~d'. ~.. ~At. ~7~ ....... /'.;~...
. / ....... ~..c-~ .....................
/
./~,.: ............................................. , ....................
Building Inspector
RV 1/80
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y, 11971
TEL.: 765-1802
Disapproved a/c.. ~','~, ~"d'~.7~ ........
. - -....
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Application No./.,~..O/X ......
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.
· d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit
shall bb 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 Occupahcy
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 hlterations, 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 buildings for necessary inspections.
%-''' iSign,~aturf,~f~, pli~, o~ne,---- ~ if a corporation)
.....
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engine¢r, .general contractor, electrician, plumber or builder.
......... .~.~. ~.e..< .........
iName OI owner OI p .................................... ; .......................
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
V~Builder's License No.. ,5'-e-..( .~. ...........
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No ......................
1. Location of land on which proposed work will be done ..................................................
K~:ve~-~' ........................................................
· .;5.7..-5 ...................... F. ........
House Number Street Hamlet
'C~hntyTaxMap'No. 1000 Section 'O~7~. 190 ' Block ... 0~', {90 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 occupancy .... "'-'/'~'~'/'~'q'~'~''': '~'' '~ff/~7'' 'I/: ......................................
b. Intended use and occupancy'. .... r-~../C.t t~ f~ff..X . . . ~. .,).e:.[/ [.tT .~ .... I:Z l)'b. . . . ~ ~. .C. g~ ......................
o
So
12.
13.
t4.
property lines. Give street and block
interior or corner lot.
Nature of work (check which applicable): New Building .......... Addition...~. ..... Alteration ..........
Repair .............. Remoyal .............. Demolition .............. Other Work ...............
Estimated Cost .......... : ~ .................. Fee ...........................
(to be paid on filing this application)
If dwelling, number of dwelling Chits ............... Number of dwelling units on each floor ...............
If garage, number of cars ..... I ..................................................................
If business, commercial or mixed occupancy, specify nptu/re and extent of each ty~pe of use .............. / .....
Dimensions of existing structure~, if any: Front .... ~.d. ........ Rear . .~1~. ......... Depth ... ~.~ .......
:her of Stories '
Height Num .................................
' ' .'~.Y. Rear ~.',
Dimensions of same structure with alterations or additions: Front .........................
Depth ...... ~.~ ........... .; Heigh ........... . .......... Number of Stories ....... /'. ....
Dimensmns of entire new construebon Front ...... ~ ....... Rear ...... ~f. .... Depth .... /.~. .......
~. ~' Number~ of Stones' ~. ~.~
Height.. ............................................................
Size of lot: Front i Rear Depth
Date of Purchase ........... i .................. Name of Former Owner .............................
Zone or use district in which pr~mises are situated ............... jf,7~' .....................
Does proposed construction vi~oS~te any zoning law, ordinance or regulation: ................................
Will lot be regraded ....... ~. ................... Will excess fill be remo~veql from premises: Yes
Name of Owner of premises . .,~..~.P.Y. ?.'~.~. ~'..~t~.. Address .~?~...~..~.'~.q~. ~r~.~.~. Phone No...~. ~..-~..~q..~. ·
Name of Architect..........~ ....... ;./.......Address ... ................ Phone No ................
Name of Contractor . .~.~.~g~'2:~K...O9~. . Address . ~t,/~g/~,~ .... Phone No ................
PLOT DIAGRAM
Locate clearly and distinctly all! buildings, whether existing or proposed, and, indicate all set-back dimensions from
number or description according to deed, and show street names and indicate whether
t
LoT"
STATE OF NEW YORK, ,
~S,S
COUNTY OF .................
· ~ b gd ly d d th tli th ppli
............................................... ein u sworn, eposesan says a ets e a cant
(Name of individual sig~ing 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 ~ill 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
.~. ................ day of. .... 9
Notary Public, ....... 5 .........
i - ' 'i ~ 4 ~