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HomeMy WebLinkAbout13361-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z12967 Date November 8 198..4. THIS CERTIFIES that the building Pool & Fence Location of Property 1455 Old Shipyard Lane Southold t:t~s'e Ho: ..................................................Street h~l'el County Tax Map No. 1000 Section .. 0..6.4 ....... Block ....0 .5 .......... Lot ....0 .2.8. .......... Subdivision ........ X. ...................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·...A. uq, ..... ~[.4 ......,19.8.4. pursuant to which Building Permit No ..... 1.3.3..6.1.Z. .......... dated ...... ~cj ............ .1.7 ......19.8.4., 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 ......... Above Ground Pool & Fence The certificate is issued to .. VIRGINIA M. GOHIER (owner,-le~ee er.-tece~t.~ of the aforesaid building. Suffolk County Department of Health Approval ........... .Nf.A. ........................... UNDERWRITERS CERTIFICATE NO ................... NJ.A. ........................... Rev. 1/81 Building Inspector FORM NO. O TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13361 Z Permission is hereby granted to: . ...~.~..~.....~.....~..~ ....... .... !.~..~.....~...~.~....~ ©~..~...~.:.~.....~..~.~.~../. ,o ..~...~......~...-....~..~...~...~~ ....... at premises located at ............................................................................................................................ to opp,i¢o,,on doted ...... ~-.Ld:~....~.......~..~.. ........... , 19.~..1~.., O.d approved by the pursuant Building Inspector. Building 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'ink, and subm~tted~up' '- ' ...... ':~'~ 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 Fines, 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 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 3, Copy of certificate of occupancy $1.00 use--Pre-Existing C.O. $15.00 Vacant land C.O~ $ 5.00 Date New Building ............. Old or Pre~existing Building ............ Vacant Land ............. Location of Property .../', ,/~/.~'~,~,, ........... ,~,, ,~-,~,,, .~', h !.r.~. ,~, ,~,~.,, ,/~' . ,~--,, ./~..~-., l ,~.',°.~?? House No. Owner or Owners of Property .......... ~ County Tax Map No. 1000 Section . ~ ~ ~. Block ~ ~, Lot .... ,~, Subdivision ................................. Filed Map No ........ -..Lot No.../'. ?..~.. Permit No..~. ~.~f/.~DateofPermit ~Applicant..~4/..~4~~ . .~.,.. ~.'.~.~.~... Health Dept Approval Labor Dept Approval Underwriters Approval Planning Board' Approval Request for Temporarg Certificate ..................... Final Certificate ....................... Fee Submitted $..~.~ .~-. ....................... Construction on above described building and permit meets all applicable code~and regulations. ~ ~t ~ Applicant.~~~.t ~L~ - .................... Rw, 10-10-78 F ~-,?LI~ INSI~ECTION 1. FOUNDAT%ON (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY 2ODE o FINAL COMMENTS ADDITIONAL COMMENTS: ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examiner.S... ~. !]..., 19~. ~.t. Approved~.~.~-..}.-)..., 19~.q. Permit No. J..~. '.'~.~. ! .~-~.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Rec, a. This application must be completely filled in by Wpewriter 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 s~'ieets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this at?pli- 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 regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Mailing address of applicant) State whether applicant is owner, 1}F, see~age~tr,--architecI~gngin~e~,--~m~traqtm'7~lc~'tricia~r-orr~iidm'. ......... ?/ ................... ,. ...... ',""i ...................................................... Name of o~vner of premises ...... .~..'[..~'..%\ .~.\.~...%.:...~.. ~:X~,~ ~..-~..~. .......................... (as on the tax roll or latest ~e~4~,----~'~ DATE: ~B.P. If applicant is a corporgtion, signature of duly authorized officer. .................(Name and '~c~~y)' 0R .... Builder's License ~{}2~',.. g~'}.~.. ~ ~ ~.~. ~/[~. I[I Plumber's License~G;i,t,.~',.,.~.*:'. .,t"~ ." ~:.=?~" :,~,L~" v~, .---- Electrician'sLicen~[ [/g~t~(~ ~.. g.dlli[igAl[ FEE: )_~_~."~ -- BY: ~ ~' ~' NO-CiFY gl/ _DING DE'~C~RT~ENT AT 765-180~ 9 AM TO 4 PM .FOR FOLLOWING ~hlfi, PECTIONS: 1. FOUhI~ATION ' TWO REOUIRED' FO~ ¢~JRED coNCRETE 2. ROD~4 - F~ING ,~ PLUMBING 3. INcU~ A ~ ALL C'"*'~ '~' :C'~I'QN D'iALt. hAEET 1. Location of land on whicli proposed work will be done .............. TH£. · · ~. ~ ................................ /'' '/' ............ ~¢~ ........ ":,;;~ i¢~K~' RRO~b ' ' House Number Street -- / D~R CO~3~mu~ ..... E . Co,n~ ~ax ~,p ~o. ]000 Seot~on ...Q.¢.¢ ....... mock ...~ff .......... rot...¢. ~ % ........ Subdivision ..................................... Filed Map No ............... Lot ........... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: occ, ...... b. Intended use and occupancy ........ ( % ........... ~'~m~ ¢~;~',:' ..: ...... 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .. Repair .............. Removal .............. Demolition ........... ....... Alteration .......... ·. Other Work ............... 4. Estimatefl'C6st ..... Y.~7i.t~,~.~-4... ........................ Fee ...... :. '.'77'. ........................... · J'.! i~ % (to be paid on filing this application) 5.' ~If dwelhn~nur~ of ~:$~llinglunits ...... Number of dwelling units on each floor ................ If garage number of ch~}{i 6 ':" '~" · ~ ~ ' !d occupancy specify nature and extent of each type of use · xf gu t . j t .til r l e ............. 7. "Dtmens~on~o~~ctures ~f any: Front Rear Depth lleight Number of Stories Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth,. ..................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stones .................. :, ................... y .............. 9. S~ze of lot: Front ........ ~..[ ......... Rear .......... [ ~ i~.. ...... Depth . .I.~57.2 ............... 10. Date of Purchase .......... ~ .................. Name of Former Owner ............................. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: 13. Will lot be regraded ........ ~ ......... , .......... Will excess fill be removed from premises: Yes .. No 14. Name of Owner of premises .~{'~ .~.~ .~.~.. .... Address ................... Phone No..q~...5~..'~..~.~... Name of Architect ......... , ................. Address ................... Phone No ................ Name of Contractor ........ ~ ................. Address ........... Phone No PLOT DIAGRAM Locate clearly and distinctly all 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 interior or corner lot. STATE OF NEW Y, DRIO, ~, ~ ~ COUNTY OF. , % ,, (NtCaa6e of individual gigning contract) above named. being duly sworn, deposes and says that he is the applicant He is the .......... ~.: ................................................................... : (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 work will be performed in the mann4r set forth in the application filed therewith. Sworn to before me this_ : ............ · ~'..~. · .'~-. ....dayof ..... ~-af~.., ! vaa, .... // ................ ^_?..$I~:0 ~-4~ 8u~lk Ceu~ ~ (Signature of applicant)