Loading...
HomeMy WebLinkAbout13310-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Sou(hold, N.Y. Certificate Of Occupancy No.Z15552 Date April 2, 1987 THIS CERTIFIES that the buildin$ ..... A..c.c.e.s..s 9,r.Y. ................................ Location of Property .. 2. .4.0..B..a .y..R.o..a .d.. G r e e n p o r t Hou*e No. ' ........... 'Sb:e$i ....................... h$~iei' County Tax Map No. ]000 Section 04 3 .Block 5 ..... Lot 9 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated · i..,l.u.t.¥..2.3. ,...1.9,8.4... ~,. pursuant to which Building Permit No.. ! .3.3.1.0. Z. ............. dated ...J.u.l.Y...3.0.,................,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 ......... Metal accessory building in rear yard. The certificate is issued to GEORGIA ARMSTRONG, BARBARA !glTENKO, STEPHEN WITENKO (owner, I~,~l& of the aforesaid building. Suffolk County Department of Health Approval N/A UNDERWRITERS CERTIFICATE NO ................ I~/. 6 ............................... N/A PLUMBERS CERTIFICATION DATED: Building Inspector Rev. 1/81 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13310 Z Permission is hereby granted to: * . ~ I ..~.~ ...... .~...~..~ ........... ..~.~..o.......%..~...~ .............................. "~'~'"'~':'~'"'""/"~'~"~ ...... ,4,. ot premise~s ,ocoted ot ......~....~..~....~..~. ...... ,...~..~ ................................ County Tax Map No. 1000 Section ..... ..C~.....~.....~.. .... Block ....... .~.... ........ Lot No ........~ ............... pursuant to application dated ....... ~......~......~... ................ , 19..~...~..,---- and approved by the Building Inspector. Building Inspector Rev. 6/30/80 Building Departmont Town Hall Southold, N.Y. 11971 .... 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY' Instructions This application must bo filled in typewriter OR ink, and submitted c~ ~ to tho Building In,poe- tar with the following, for new buildings or new use: 1. Final sur~ay of property with accurate location of all buildings, property l~nes: 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 bui'ldlngs and instalia- tigris, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requ~remont's where appi'cable.. For existing buildings (prior to April 1957)0 Non-conforming uses, or buildings and "pro-ex st n§' land uses: 1. Accurate ~urvey of property showing all property lines, streets, buildings and unusual natural or topographic features. ' ' n 2. Sworn statement of owner or previous owner as to use, occupancy and condltto 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. Cer6ticataofoccupanc¥ ~cw Dwetttn[~.$25.00, Accessory ..$10.00 Busines;~ $50.00 2, Certificate of occupancy on pre-existing dwelling $ .50.00 3. Copy of cartificate of occupancy $ 5,'00, over .5 year~ $10.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Data .......................... 6. hlteration $25.00 NewtOnS t~uc ~ion ...... Old or Pro-existing Building ............ Vacant t~nd ............. ' .... Location of Property .~~ ............................... '~'' · House No. Sr~'cer Ha/n/et Owner o'r Owners of Property ~T'..t:¢'. · .~?.~. L t ........ ; .?.o. ? County Tax Map No, 1000 Section ,0, ~ '5 · O o Block O ~' , E)O o (DOC[ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Perml~,. ........ Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Planning Board Approval Underwriters Approval .............................................. Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ .~.O. .......................... Construction on above described building and permit meets all applicable codes and regulations. Applicant FIELD %NSPECTION 1. COMMENTS FOUN DA_.T I O__N --. ( 1 s t ) FOUNDATION ? (2nd) ROUGH FRAME & PLUMBING INSULATION FERN. Y. STATE ENERGY {ODE ADDITIONAL COMMENTS: - FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved . ~..., 19~..~. Permit No.]..~..~.)..O.[i~.. Disapproved a/c ..................................... Received. (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 o[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, 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, housingJiode, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections._ .. ~ (],¢.,_/_7%_,~. ~ jO/_ (Signa~/r'e';~ ~l~a'nt, or name, if a corporat'o ) - (Mailing address of applicant) "~ State whether applicantAs owner3,.lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................. Name of owner of premises ............... a .... ........................ (a~ on the tax roll or latest de~j RC ~'7,~ AS NOTED If applicant is a corporation, signature of duly authorized officer. DATE: '~(~l tt t{ B.P ~ / ~,A ~ O 7= (Name and title of co,rporate officer) Builder's License No ................ Plumbe~ense No ......................... Electrician's ~ No ....................... Other Trade's Licen~o. ...................... NOTIFY BiIII_DING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE /:OL!,rl~^/ING INSPECTIONS: 1. FOUN'~'ATION - TWO REQUIRED FOq Pr"HRVD CONCRETE 2. ROUGH - FRAMING & PLUMBING 4. FIF,!^' . ,'"r~"'STI~I!CFI,")N MUST B[~ "' ~m"-rc FOR C © ALL C ....... ~'*~'TI©iN g'4ALL MEET THE P ........ : .... ~,'rg CF 'THE N.Y. I. Location of land on which proposed work will be done ................. STATC' '¢';'~'c~-'RX)C'TION' 'g · EN._CRG¥ ' ' .?,...%0 ..... co _ OR ........................................ ES i q rCL J1% ' Sc House Number Hamlet County Tax Map No. 1000 Section ...C5 .~. B ........ Block .... CD..~ .......... Lot....O..0.~ .......... Subdivision ....... ~. ............................ Filed Map No .... .~ .......... Lot .... X ......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......... C/ID.C.,...4i'-.~o~:/t,¢... ~6O.~.[.~[.ffEq ........................... b. Intended use and occupancy ......... ~OJGq ~... ~. ~:~fO~ .... .QL0.X2 ~. ~(~.¢c-. y..~ ~ ,~, ~,<:~, ............. 3. Nature of work (check which a .plicable): New Building ..... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... 4. Estimated Cost ........................... Fee *" (to be paid on filing this application) ~./'Ifd' b ll'gi' $ b fa · · hr welhng, num er of dwe in umts ............... um er o welhng units on eac eot ............... Y,,If garage, number of cars .... i .................................................................. ~.~ If business, commercial or mixed occupancy specify nature and extent of each type of use .................... (7. kD .... i .fa R pth nnens~ons of exlstlng structures, 1 ny: Front ............... ear ........... ... De .............. }{eight ............... Number of Stories ....................................................... Dimensions of same structure with alterations or additions: Front ................. Rear ................. Depth ................... i.. Height ...................... Number of Stories ..................... (~ I)imensions of entire new construction: Front Rear Depth Height ............... Number of Stories ........................................................ 9 Size of lot: Front i Rear Depth 10 Date of Purchase ~ Name of Former Owner 1 I. Zone or use district ~n which pr~mxses are situated.../~.. J~ ~.-5 ic~ioAO:./J[.~r.~.a~ { :-/-z44'AJ~. ~'a-,'u~,.. 12. Does proposed construction violate any zoning law, ordinance or regulation: ....... ~ ~. ................. 13. Will lot be regraded ...... g[,~ ................... Will excess fill be removed from premises: Yes ~) 14. Name of Owner of premises .. 4 ................. Address ................... Phone No ................ Name of Architect ......... i ................. Address ................... Phone No ................ Name of Contractor ~ Address Phone No PLOT DIAGRAM Locate clearly and distinctly alI buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give s g or description according to deed, and show street names and indicate whether interior or corner STATE OF,NEW YORK, id S Oh~ ' --~ COUNTY OF ................. i~' ~ ............................ i .................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ..................... ~ ................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duiy 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 work will be performed in the manngr set forth in the application filed therewith. Sworn to before me this ........... .~..~.. ,/h~ ..... day of ..... ~ ......... , 19~..~ Notary Public, ..... ~...~.:..~..gl..~/ .4~..... Count9 HELEN g NO'rARY ?L~BLIC, State ~ New York ......................... No. 4707878, Sutf01k 00uety. ~ (Signature of applicant) ! Term Exp es March]30