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HomeMy WebLinkAbout12853-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hail Southold, N.Y. Certificate Of Occupancy No. Z12.263 Date .. February. 15 ........................................... 19 84 THIS CERTIFIES that the building .r.d.e,c,k,. ,a,d,d.i..t,ip, n,` ,&...a,q .cg.s.s.o. '.ry, .b.9 .i.l.d.%n. cJ.. 1250 Mount Beulah Avenue Southold Locatio n o f Proper ty House .............................................................. No. ' Street Hamlet County Tax Map No. 1000 Section 051 .Block 03 .... Lot ?.ar..t of 002 Subdivision... X .Filed Map No. X....Lot No. X conforms substantially to the Application for Building Permit heretofore fried in this office dated February l 19.84. 12853 Z ...................... . pursuant to which Building Permit No ...................... · dated ..... ~[e.b..r.u.a.r.~..1 ........... 19 .8.4. , was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy ~r w~ch t~s certificate is issued is ......... a deck addition to dwellin~ & ~cces~gr~ storage building. The certificate is issued to ...... BARBARA J. KO. CH (0 wrier, of the afbresaid building. N/,A. Suffolk County Department of Health Approval ......................................... UNDERWRITERS CERTIFICATE NO N/A Building Inspector Rev. 1/81 FO~ NO. 2 TOWN OF SOUTHOLD ~UILDIIqG DEPARTMEHT TOWN HALL SOUTHOLD, N. Y. BUILDING PERA41T ('rillS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) 12853 Z Permission is hereby granted to: ....... ~~.~.~.....~ .....,..-.<~.~.: ..... ...... z~O.....~.....~~.~..- ......... '""" ........................... ?7'_' ........... z'",;:" -, . ,o ...~z.~. .~..~. . ... ~s : ~ ~..... . ~w.w.~`e`.`.`.`.`.`.`.`.`~.. .. ../. ~.. .... ~. ~..~. .~. . .~. . .7.. · ..~.~.~.~.......~.~.~__, ,,~~'.: .................................... .../..... ........ at premises located o,../..~...~..O.. ....... .~...~../....'....~:a~...~-.~..~.~.......~././~: ............................ County Tex Mop No. 1000 Section ...~....~...~'.' ......... Block ......~.~..'.ff.... ........ Lot No....~.../~........O...O..~-- pursuont ,o opp{icatio, dated ..... .l~-~"'~/~.....~ ........ , ]9.~...~ and approved by the Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be fil~ed in typewriter OR ink, and submitted in duplicate 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. B. 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. C. Fees: 1. Cert[fleate 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 VacantSand C.O. $ 5.00 Date.. ,~,,~. ()/~, .~, ·'/ ............ New Building ............. Old or Pre-existing Building~ . ........... Vacant Land ............. Location of Property, ./. ~...~,O........~ .~.~//."'-- ~ ..... ' Owner or Owners of Property .... ,/~.-~,~. ~-~... J;.. ...................... County Tax Map No, 1000 Section .. I~.~."../ ....... Block .... (~..~. ...... Lot ........ . .Z~---... p No ...... Lot No ..... Subdivision ............................ * .... Filed Ma ..... · ........ Permit No./..~Z~.'~.. ~D ate of Permt .~..~.~,/~. Applicant . .....,. .. ~'"/~----~. · · .~.~ ...... - -~ Approval Health Dept. Approval ........................ Labor Dept ......................... ..... Approval Underwriters Approval ........................ Planning Board ..................... Request for Temporary Certificate ..................... Final Certificate ~ ................... Fee Submitted $ ............................. Construction on above described building and permit meets all applicable cod_.es and regulations, Applicant ...~.~ ............... FIELD I~SPECTION 1. FOUNDATION (1st) COMMENTS FOUNDAT%ON (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE o FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined.. /, .......... ,l, ? ::_: Approved..?"-.?f./' ........... 19 .~. Permit No../.~.~. · . 7' Disapproved a/c ......... ......... _- ...................... ::~ .~,..~ · . (Building Inspector) APPLICATION FOR BUILDING PERMIT Received..~.7/..~. .... ,19 .¢~. L INSTRUCTIONS a. This application must be completely filled in bY WPewriter °r in ink and submitted t° the Building Inspect°r' 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 °f 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 co_de, housing code and regulations, and to admit authorized inspectors on premises and in building for necessary inspec~~.~ ~~ '~.. - ~. - ........ ' ...... .;;': ii io' .... (Sign~'f'~p¢Sc~, or name, ifacop r t' ) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ . ............................................................... Nameofownerofpremises ...."~..Q'?.~.,q~.O..¢. /4Q¢'./~/ ....................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title o? corporate officer) Builder's License No .... .~.~r~. .......... Plumber's License No ......................... ~ Electrician's License No ....................... Other Trade's License No ...................... I. Location of land on which proposed work will be done...Z..~W~.77.. ~./p.~..../.~..r....'~.~.~..%,~.;q.... 4~.~:-. .......... House Number Street Hamlet County Tax Map No. 1000 Section .... ©..~./. ......... Block .... ~. ............ Lot..~.'F2~-.~.. O~.....-T... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing rise and occupancy 6'h0/J',Ve.~2' .... :,. .............................................. b. Intended use and occupancy /--~/ra:,.o~-,v'~zZ .,,~ .... ~ . ... .................................. 3. Nature of work (check which abplicable): New Building . ...... Addition,. ~.. ...... Alteration .~. ........ Repair .............. Rempval ............. Demohhon w ......... i ' ' ' Other Work. 7 ............. ' Io ~,,akO I ,x~c<-~] (Description) (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling unlts on each floor ................ number of cars If garage ...................................................................... 6. If business, commercial or mixed occupancy, specify natur~ and extent of each ty~pe of use . .~:...; .............. 7. Dimensions of existing structurps, if any: Front ..... .~..q- ...... Rear ... X ~ ....... Depth . . ~" .......... Height .. rg.~ ~. ........ Number of Stories ..... ,~, .................... l ............................ Dimensions of same structure with alterations or additions: Front ...'/~'.~....i. .. Rear . .'/~.~. ............ oZ , . Number of Stories ... ,2~ ......... Depth .... ,,~../o ............ !... Height ... (~ ' 8. Dimensions of entire new construction: Front ............. Rear . .~... ~,~....~J ?. Depth . '.~ .......... 9. Size oflot: Front ...,~-./e..~...~l. 10. Date~fPurchase .. (,,]~1 ! "'. ...... NameofFormerOwner i.b[.qd~ ...................... 11. Zone or use &strict m which p[emmes are s~tuated...~g 6.~ P. ~. ~.TJ.. ~ ........ i. ,~]' .......................... 12. Does proposed constructionyidlate any zoning law, ordinance or regulation: ...i.~.*. P ......................... 13. Will lot be regraded r,/.~ , . Will excess fill be removed from premise Yes ,No 14. Name of Owner of premises ~0~,0t2,4 . .~O .e,,O .... Address /~r..~¢ .~z.O# ~).~ tx... Phone No. ).G.~.~.. ~.~, . . Name of Architect ......... i.~ .............. Address ..... · .~-~'.. ...... ! .....Phone No. PLOT DIAGRAM ctly ~1 buildings, whether existing or proposed, and, indicate all set-back dimensions from t block number or description according to deed, and Nh, ~w street names and indicate whether Locate clearly and disti~ property lines. Give street an interior or corner )t. ~' % ~<'£e-F: od/ STATE OF NE&RK, ...... above named. ' ' ' being duly sworn, de~ ,oNes and says that~ the applicant e is the, , '~' (Contractor, agent, corporate officer, et?.) of said owner or owners, and is duly authorized to perform or have performed th. said work and to make and file this application; that ail statements cofitained in this application are true to the best~wledge and belief; and that the work will be performed in the manaer set forth in the application filed therewith. Sworn to before me this ' ........... ...... daytf ....... l,.¢. ,X,O N°_tgz3&P,u, blic .... ,~ ./', .... .~z~./'~' '~'~' County ///'~~ Alan NB/IL& ~ ....... , · .......... . . ("-~~c'~''('''''4'/~'°r~ ~1~8;1~ (Signature' of applicant)