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HomeMy WebLinkAbout12868-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building InspeCtor Town Hall Southold, N.Y. Certificate Of Occupancy No..Z131/42 Date Ja, nuary 16. ., 19.8.5. THIS CERTIFIES that the building .... .g.~ ~ ~ ....................................... Location of Property 625 Monsell Lane Cutchogue House No. Street Hamlet County Tax Map No. ! 000 Section ...0.9.'~ ...... Block ...8 ............ Lot .... ~. 7 ........... Sub division N o r w o 1 d ..... ............................... Filed Map No. 1 .2.7.5. .... Lot No..3 .q r.3.5,.. conforms substantially to the Application for Building Permit heretofore fried in this office dated .... ~.'.e.b.... 9 ........... 198..~. pursuant to which Building Permit No..1.~3 ~ .8.~ .............. dated ....F.e.b.:..1.q ........... 198.6.., 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 ......... .... .~p?..~...d.e.c.g..~.o..~ ~-~.~ ~g..c~veZ.L~,~g ........................................ The certificate is issued to . Cavy D Dovosk± .................. ................. of the aforesaid building. N/A Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO ................ .N/.fi. .............................. Building Inspector Rev. 1/81 FOK~ NO, 2 TO~N O~ $OUT~OLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12888 Z Permission is hereby granted to: ~, - i. . , . ~~~x..~.,...~..xx~.~:-''- ..~.~ ........ .'~...,.~.~;........~. ............................................................... County Tax Mop No. 1000 Section .....~....~.....~... .... Block ..... ~.. ............ Lot No.....~....~.... .... ~.,~,~,,,, ,o ,,,,,,,,~,,,,o, ,,,,,,,, .~....~, ........................... . ,,~x ,,,,,, ,,,,,o,,.,, ,,, Building Inspector. lluildlng 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 nk, and submitte~p'Tcctc 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. 15.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-ex'sting" land uses: 1o 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: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling / land use --?re-~;×±s C±ng C.O. $15.00 3. Copy of certificate of occupancy $1.00 '¢'ac&nf, 3. and C.O. $ 5.00 Date ...... .~.~ .......... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ........... ~ ...... c Hou~ No. Street Ham/et Owner or Owners of Property County Tax Map No. 1000 Section .... .,,,.OR 3...,, Block .,-~. .... · · .... Lot..¢~.~.,. ....... Subdivision ...... ~[~.v..~¢.~.f .Filed Map No. J .~..~.~ .'~., .Lot No, ..-~ I.; ~...~..~.. Permit No ...... Date of Permit , , ,Applicant ~-o ' Health Dept, Approval ...................... · · Labor Dept. Approval ..................... · · Underwriters Approval ........................ Planning Board Approval Request for Temporaw Certificate ..................... Final Certificate ..... Fee Submitte ........................... Construction on above described building and permit meets all applicable codes and regulations. Applicant . . FIELi~ ~NS,PECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION FERN. STATE ENERGY C,ODE FINAL COMMENTS ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT ~ TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Exanlined.' .~. ~.. ·/.d?..., 19 ~(7z Approved .~...~./·../..~. .... 19~..~/Permit No. / w'~ ff. (~" Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERM IT Date ~- q 19~..~ INSTRUCTIONS a. This 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 ~l~&l~i~fi'~t~'tl~i~t~ b~..~.~gs, additions or alterations, or for removal or demolition, as herein described. The applican~ ~r~[~.i C~Sl~l ~tx a~l~licable laws, ordinances, building code, housing code, and regulations, and to admit authoreSS, igC, P~Q,~[ ~Jh~'~,~r~ise~a~in building for necessary inspections., c--, .~.~.. ~.: L .' t, ~ ~J~ ~ [$[~ (Signature of apphcant, or name, ~f a corporation) State whet p,~,~,~,~,~l~ agent, architect, engineer, general contractor, electrician, plumber or builder. ......................... ............................................................. Name of owner of premises ..... ~.~..A.~.~...'--q'~ ' -- ~-' ~,P.P~,~APP ~VLD~,<__AS (as on the tax r~&T~[at~st'~ge'~Jff, p. :~ _[ If applicant is a corporation, signature of duly authorized officer. FEE:~,~7_~_/~ BY: NOTIFY BUILDING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR (Name and title of corporate officer) FOLLOWING INSPECTIONS: ~/ l. FOUNDATION - TWO RE©IHRED FOR POURED CONCRETE Builder's License No .................. 9. ROUGH - FRAM NG & pI. IJ,~,~ING Plumber's License No ......................... 3. INSULATION 4. FINAL - CON'STRU'~.~''N P.%.%eT Electrician's License No....~..~...c! !.Z .~. ........ BE CqMPl ETE FOR C. O. ALL CONSTRUCTION F~,Afl A4[FT Other Trade's License No ...................... THE REO[UREMENTS OF THE N. STATE CONSTRUCTION & FNERC;,¥ 1. Location of land on which proposed work will be done ........... C._.O~.~.S:..[SIG~ 'N' 9T' ' ReSPON~ISkr.. .---- D i'~ O~R CONSTRUCTI?,N House Number Street Hamlet County Tax Map No. 1000 Section . .C)..%.. '.) ............ Block ...8 .............. Lot...~..~. ............. Subdivision....~.O..~..67.o. }) ...................... Filed Map No..[..~..~...S~., .... Lot, .$.\ 7. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... . .~.~.~s .~..[': ............................................... b. Intended use and occupancy ........ .~.. ~.~J:x~ . , ~.. .... ~ ..................... 10. 11. 12. 13. 14. Nature of work (check which applicable): New Building .......... Addition . .~....... Alteration .......... Repair ...... ,. ..... Removal ............ Demolition ............... Other Work..~.~. C..I.~ i ~/~, ~ (Description) Estimated CostZ~/.t~...~.~. '~...~__~ ~/~ ....................... Fee . .__..., ............................ (to be paid on filing this application). If dwelling, number of dwelling ~nits. .............. Number of dwelling units on each floor ................ If garage, number of cars ..... I.. ................................................................ commercial or mixe,d occupancy specify nature and extent of each type of use If business ...................... Dimensions of existing structurqs, it' any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories.. ....................................................... Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... ,.. Height ...................... Number of Stories ...................... Dimensions of entire new consti action: Front ............... Rear ............... Depth ............... Iteight ............... Nurr her of Stories ........................................................ Size of lot: Front ...'~ 7..C,.. ~ .......... Rear ....~ .q. 9 .............. Depth ./.C°.....b-.. 7.6. ........ Date of Purchase ............................. Name of Former Owner ............................. Zone or use district in which pt ~'mises are situated ..................................................... Does proposed construction~o!ate any zoninl law, ordinance or regulation: ................................ Will lot be regraded .... :/./. ~, ................... Will 6xcess fill be removed from premises: Yes No Name of Owner of premises ................... Address ................... Phone No ................ Name of Architect ......... , ... Address ................... Phone No ................ Name of Contractor ..................... Address ................... Phone No .............. Locate :clearly and distinctly all property lines. Give street and block inter/or or corner lot. PLOT DIAGRAM 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 STATE 0F NEW~ORK, . COUNTY OF~ ..... i .................... fi(Name of individual sig~ing 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 file this application;that all statements contained in this application are true to the best of his knowledge and belief; and that the being duly sworn, deposes and says that he is the applicant work will be performed in the mann~ Sworn to before me this ~r set forth in the application filed therewith. ...... ~o. 467~06 · ~.oa Co.~,~ (Signature of applicant),