HomeMy WebLinkAbout13345-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. z-15993
Date July 27, I987
THIS CERTIFIES that the building .. R..e .f.r.a.m..e..&.. C..o p.s.t.r..u.c.t., n..e .w..r..o 9.f .............
Location of Property 805 North Oakwood Road Laurel, New York
House No. Street Hamlet
County Tax Map No. ] 000 Section 127 ...Block 7 13
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
August 9, 1984 pursuant to which Building Permit No. 13345Z
dated.....................August 13, 1984 ....... 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 .........
REFRAME & CONSTRUCT NEW ROOF ON EXISTING ONE FAMILY DWELLING AS APPLIED
The certificate is issued to DAVID & ROSEMARY NOSTROM
..................... .....................
of the aforesaid building.
Suffolk County Department of Health Approval N /A
UNDERWRITERS CERTIFICATE NO. N/A
PLU1RBERS CERTIFICATIOIq DATED
Rev. 1/81
/ B~,ffding Inspector
~OBM NO. ~l
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
N?
BUILDING PERMIT
(THIS pERMiT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
:[3345 Z Do,e ....~....4~....~.......J....~. ........... ,
Permission is hereby grante~cLto; .~
~...~ ...... ~.: ...... ~.~ ..............
............
~~......m~.: ........ t.~..~..~..t ...................... , ,
' ~..~.~ ~ , ..............................................
ot prem,ses located ot ...... 1 ............................. ~ ....... ~...~ ...... ~....0,~... ......................
pursuant to application doted ...~,~.~.......~. ................. , 19.g..~.., and approved by the
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
A. This application must be filled in typewriter OR ink, and submitted ~ ~ 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 pzoperty 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 $25.00 -- BUSINESS $50.00 ACCESSORY $]0.00
2. Certificate of occupancy on pre-existing dwelling $ 50.00
3. Copy of certificate of occupancy $ 5.00, over 5 years $]0.00
4.Vacant Land C.O. $ 20.00
5.Updated C.O. $ 50.00 Date June 8, ]987
New C on s t puc t i on,., .x.. Old or Pre-existing Building ............ Vacant Land .............
Location of Property 1900 North Oakwo6d Road Laurel, New York
House No. Street Hem/et
Owner or Owners of Property DAVID & ROSEMARY NOSTROM
County Tax Map No. 1000 Section ! 27 Block 6 ,7
Subdivision ................................. Filed Map No ........... Lot No ..............
8/]3/84 A ,. Robert W. Gratt
Permit No. 1.3345Z Date of Permit ........ ,~pp.cant
NA
Health Dept. Approval ......... .N.A ............. Labor Dept. Approval ........................
Underwriters Approval NA NA
........................ Planning Board Approval ......................
R eq uest for Tern po rary Certificate ..................... Final Certificate ...x ....................
Fee Submitted $ .... 2.5,..0.0. ....................
Construction on above described bui{ding and.permit ropers al~ applicable codes and regulations.
David Nostrom ' (
FIELD INSPECTION
FOUNDATION
1st)
FOUNDATION
2.
ROUGH FRAME &
PLUMBING
2nd)
COMMENTS
INSULATION
FERN.
STATE ENERGY
ODE
FINAL
ADDITIONAL COMMENTS:
TOWN OF $OUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL. 765-1802
To Whom This May Concern,
We are unable to complete your Certificate
of Occupancy because,of the following reasons.
/
/~An_ application for Certificate of Occupancy
not on
/~/No Underwriters Certificate on file.
/Z~ The check is(otr3~d/not on file.)~,Q~.~
/5/ No Health Dept. Approval on file.
/5/ No final inspection has been made.
Please contact our office on this matter.
Thank you for your cooperation.
.-Building Permit # -/ -3 ~D ,~ Z
Building Dept.
***/5/ No Plumber Solder Certificate on file.
( all permits involving plumbing being
issued after April 1,1984 )
TOWN OF SOUTIIOLD
OFFICIi OF BUILDING INSPECTOP,
P.O. BOX 728
TOWN tIALL
SOUTtlOLD, N.Y. 11971
TEL. 765-1802
'£h~; is co advlne you chat tho job under buildlng
perml, t no. 13345Z indued to David Nostrom
on 8/13/84 for 'Alteratlon is completed
a fi. rial innpectlon has ( ) has ~ot (-~---~-~--~'been done.
and
[n order to complete this file, it is necessary that
;~ Certificate of Occupancy be issued. Please fill ou~ the
enclosed form, return same to the above office with a check
for $025.00payable to the Town of Southold. Please indicate
to Whom tho Certlfieate of Occupancy is to be mailed, and
arrange w£th this office for an inspection date
Occepancy or uae ia unlawful without a
Occupancy. Please. hol. p ns to clenr up this
legal action does not have to be taken.
Certificate of
matter so that
Thank you for yet)r prompt attention.
Very truly_~,
Victor Le~sard
Executive Administrator
VI,: g n r
encl .
'FORM NO, 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 755-1802
Disapproved a/c .....................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
Date ........... 19...
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, 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, housing code, and regu/l~tions, and to
admit authorized inspectors on premises and in buildifi~' fdr necessary inSPections. ~, ,, ~ // ~
. ....... ....
(Signature of applicant, or name, if a corporation)
I.Oo. L ~j;es.~'.cP.r.'~c e.( t... ~ (_.c~j.¢..~ X...
(Mailing address of applicant) } ) (~/~1
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
........ en.er..a / .... c ¢. ........ .............................................
Name of owner of premises..~'"--~ ~.{.).[.~....~...~0.~ .~'...[~1~ ~.~.....,w~.....~.0.~.~...C~. [.'Y% .............
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Buildgr's License No....~. IDP. J.i.~....~. c.c. ......
Plumber's License No ....... ~ ...............
Electrician's License No ..... ~ ...............
Other Trade's License No.....~...., ...........
1. Location of land on which proposed work will be done ..................................................
................ . o,>.4?. . ............. .........................
House Number Street Hamlet
County Tax Map NO. 1000 Section 127~.~ .... a~o~k ...... .~ ......... not..~.~ ..........
Subdivision Filed Map No. ~J2 ......... Lot
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ..... ~ ~ ~ ~. h .... ~ .¢. ~ .~ ~ ...........................................
b. Intended use and occupancy .. ~e ;' '~ ~Cb~ ~;~5'--'~]~/~/m~ ~5 '~' '~ 'pi~'*~
3. Nature of work (check which aplplicable): New Building ..... ' ..... Addition .......... Alteration .~....
Repair' Remqvai Demolition Other Work
r (Description)
~;stm~ated Cost ~fi/[~/~. C~.C~i '..
, 4, (to be paid on filing th~s application)
5. If dwelling, number of dwelling knits .... ~ ........ Number of dwelling units on each floor.. ~ ..........
If garage, number of cars ..... ~ .........................
I '
6. f business, commercial or mixe~ occupancy, specify nature and extent of each_I.ype of use . ~ ................
7. Dimensions of existing structurqs, if any: Front.. ~] .......... Rear .. ~J.. / ..... Depth. ,o~.~ ..........
Height ! ~.. Number of Stories
Dimansions of same structure with alterations or additions: Front ...~'t~.¢ ........ Rear . ,,~m e ...........
I)epthl ....S~m ¢ .......... I. · Height ... ~,~z,. ~ ............ Number of Stories .~'~z~ .' ..............
8. Dimensions of entire new construction: Front....,,:ff.. Rear .~ .... Depth
· ' '
. tte~ght ....... ~ ..... Nun~ber of Stones ...................................................
9. Size of lot: Front ..... ':~O...I ........... Rear ...... O ............. ~Depth ...............
10. Date of Purchase . . i ............ Name of Formar Owner ,5;gr~ae/.~'./~J/.~t*,'x.
11. Zone or use district in which premises are situated .....................................................
12. Does proposed construction viotate any zoning law, ordinance or regulation: .... ~C). .......................
13. Will loti be regraded ......... · i ........~ ......... Will excess fill__ ,, ~r~-be remov~ckfrom premises: ~ Yes No
...; ]~0~ .~¢*m ....... Address f27.. 0OA~a~.~.~,,~. Phone No~f/~,':,fflO.~. .....
14. Name of Owner of premises
Name of Architect ....... ,~, ............... Address ........... /ff.o.e.~c/.. Phone No ..... ~ .........
Name of Contractor .~/~... ddress $'[ .rf¢fi~,~.. Phone No.7~.~. "~.~/....
PLOT DIAGRAM
Locate clearly and distinctly alll buildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interioror corner lot.
STATE O F, NEW Y~ R
.......... (~n~; ~'findividual si ntra'c~i .......... being duly sworn, depose? and says that he is the [pplicant
above named, x.
He is the ....... ~ .............................................................
i (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
applicationl 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 manner set forth in the application filed therewith.
Sworn to before me this :
I NOTARY PUBLIC, State of New Yor~ . . /.~ . [ .............. ~ ,.,~,,~ .......
N0. 4667204, Suffolk County (Signature of applicant)
t.o~ 'b~
NOTE '*
~ = MONUMENT
MAP OF 5USDIVISION FILED IN THE
OFFICE OF THE CLERK OF SUFF. CO.
ON DEC. 21,1950 AS NAP N0,212.
SURVEY FOR
DAVID NOSTROM
LOT NO. :53
"LAUREL PARK"
LAUREL
TOWN OF SOUTHOLD
SUFF. CO., N.Y.
SCALE= I"= 50'
AUG. 25, 1965
GUARANTEED TO:
HOME TITLE DIVISION OF
CHICAGO TITLE INSURAf'~CE
CO.
SECURITY I'~IATIONAL SANK
OF L.I.
PRO F E S SI O~l;~.,E N GIN F~R AND
LAND SURVEYOR,N.'Y.S.L'IC, NO. 12845
RIVERHEADt N.Y.