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HomeMy WebLinkAbout12849-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...~ 12.:!67 ..... Date ....... ,F.e.b..r.u.a. ry..1.6. ............19 .8.4. THIS CERTIFIES that the building .-:-rl'p.o.~ ove~7 ipuildi.n~s, entrance. .. Location of Property 1455 Main Road Laurel House No. Street Ham/et County Tax Map No. 1000 Section ...1.2.5. ...... Block ....0.2. ......... Lot ...0.0.1....3 ......... Subdivision .... .X. ......................... Filed Map No....X. .... Lot No. X conforms substantially to the Application for Building Permit heretofore filed in this office dated Janu. ary 13 19.8.4 ursuant to which Building Permit No 12849 Z -dated ...... .J.a.~u. 9.fy' . 3. .0 .......... 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 ......... a roof addition over buildin~j's e.n. tran.c.e.. The certificate isissued to RICHARD & DONNALEE E AND GILBERT ...- ..... (owner,~r~'orz~'~ttrt') JUNE WERNER of the aforesaid building. Suffolk County Department of Health Approval ..... N./..A .................................. UNDERWRITERS CERTIFICATE NO ............. N../.A .............. : ................... Budding Inspector Rev. 1/81 ~0~ NO. ~ 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) 12549 Z Permission is hereby granted to: .... ........ .... .... ~....o...:......:~.~c .......... ./..~..~.... ................. ...... ~.~.~.~..,...~..:..~. ......................... ro ....~.~~....~...........:~..~...~..~.....~.~.~.~......~c.~.~ ~i..&--..~...~..~...C.~. ot pre~is. ,o~ated at..../...¢...~.:~ ~..~. ~ ...................... ........................ Z~c~.~....~ ....... ~... County Tax Map No. 1000 Section ..... ./~..~... ...... Block ....~..¢~,. ....... Lot No. pursuant to application dated ..... ~../~.~..,~..~...C~....~.~. .......... , 19..~,~.., and approved by the Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF $0UTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in tvPewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of propertv w th.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 complia'nce 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 peopert~y 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 dr premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling / 3. Copy of certificate of occupancy $1,00 New Buimding ,~0(~ .~..~Y~!(~.'. Old or Pre-existing Building landuse--Fre-Existing C,O. $15.00 Vacant land C.O. $ 5.00 Date .... ~.--1/.(~. (,~, .g'; ......... ............ Vacant Land ............. Location of Property ....................................... Namlet Hous~ No. Street Owner or Owners of Property . .[~..-.~. ~.-.~.~..~.d. w ~ o.'-.,~v~z,~_. ~ ~ ~.~. ~. [~T. ~..T. '~ ~ ....... , County Tax Map No. ]000 Section .............. Block .. C) ~ Lot t ~ .... Subdivision ..... ~ .......................... Filed Map No... ~ ...... Lot No..~ ........... Health ~e~t. Approval ........................ ka~or Dopt ......................... ~nd~riters A~roval ........................ Plannin~ Board ~pproval ...................... / ~oquost for Tom~orarg ~ertificato ..................... Final Co~ifieate .. ~. ................. Feo Submitted $.. ~..~. ~ ............... Gonstruetion on above described bu[Idin~ and permit me,ts all ap~l~cabl~ cod~ and reflulations. Rev, 10-10-78 F~LD~NSFECTION DATE COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ___ ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY ~?DE ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL.: 765-1803 Examined ~/2z'j-:Z'-~:....//~, ~ ..... , 19 .%'. J;2 -- ^pprov ..o. ..... Disapprolfed a/c ........ 7.7 .................. .. 2, __ (Building Inspector) APPLICATION FOR BUILDING PERMIT Received .......... ,19... INSTRUCTIONS a. Tins application must be corhpletely 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 tkis 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 throu~aout 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, !3pusing code, and regulations, and to admit autkc, Hzed inspcctors on premises and in building for necessary inspections. (Signature of applicant, , ' p ' ..... P...~. Ji&~_.~. ~&5..LaP£d.,. bl....Y: .... (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 roTf 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 Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. u..r ,. Z... .................. House Number Street Hamlet County Tax Map No. 1000 Section .... I.~..~ .......... Block .... C~ ............ Lot...~. :3 ............ 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 . .~.~.O. P~.~'...~-: &~ .................... :~. , . . b. Intended use and occupancy .......... ~z~G~.,~....<.~: .~. ?..~, ....... '.. & ~,,,:~..~~ o 10. 11. 12. 13. 14. property lines. Give street and block number or description according to deed, and .show street names Nature of work (check which applicable): New Building . Addition ................... Alteration .......... Repair .............. Rem'oval .............. Demolition ............ Other Work ............... i~'2. Od) ~..~)....o~. (Description) Estimated Cost , o ~ ~ (to be paid on filing this application) If dwelling, number of dwelling units ...I ............ Number of dweliing units on each floor ................ If garage number of cars If business, commercial or mix{d occupancy, specify nature and extent of each type of use ..................... nsofe i ti gstructures if y Font ~$'-~ Re r ¢~.zO./.'. ..... Depth 6,~.:-~.° Dimensio xs n , an : r .. a Height ............... Nmpber of Stories . ~. ....................... Dimensions of same structure With alterations or additions: Front 2.~-.' .o~' .... .' ...... ................ Rear .~..~,.~; ............ 't; .......... D pth ................... ... Height ....... ) .......... Number of Stories ................ , [- - t¢ ~ . -~ ~ ...... Dimensions of entire new cons(ruction: Front .. J.--. 7 ......... Rear .//7.7. .......... Depth ~. i~ .......... Height /2-r'O.". ........ ~Number of Stories ....................................................... Size of lot: Front . .~27..~..'-.<~}'! ............ Rear . .~..~..~.7'0. t., ........... Depth ./.[.~. 0 .-~.' ........ Date of Purchase ...1~/~.1/~.~ ............. ~..NameofFormerOwner ...~.~.O.~[ ~J'.~...~.~[z?,~ .... Zone or use district in which p~emises are situated. C~>.t.~ B.~12¢~.h-... ! .i~5.1... Does proposed construction violate any zoning law, ordinance or regulation: [l]~. ......................... Will lot be regraded ./~, .... i .................... Will excess fig be removed from premises: . Yes Name of Owner of premises . Address .Q..~. ~(~.~ .&.~.?> ..... Phone.No..c~.q?~.~.O...~.[ Name of Architect .......................... Address ~. .... .L.~...o.C.~.[,.~l.~... Phone No ................ Name of Contractor Address . Phone No PLOT DIAGRAM Locate~ clearly and distinctly al buildings, whether existing or proposed, and. indicate all set-back dimensions from and indicate whether interior or corner lot. STATE O F NE_W.~O g, KX COUNTY OF~.. ...... ~~.//.o~ ................ being duly sworn, deposes and says that he is the applicant (Name of individual ~oing contract) . above named. .' He is the ..................... J ................................................................... ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have perfo~ed the said work and to m~e and file ~is application; that all statements cont¢ined ~ this application are true to the best of his ~owledge and belief; and that the work will be perfomed in the m~n~r set forth in the application filed~therewith. Sworn to before me this Notaw PuNic~.~. ~~County , ~tary Public, Sta~ ~ NMy~ / ..............