HomeMy WebLinkAbout13142-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. Z13121 Date ,. Jan. 10
................................................ 19.85..
THIS CERTIFIES that the building Addition
Location of Property 4900 Nas. sau Pt.. Rd. Cutchogue
h$$$'e 'Wo[ ...................... 'S'~re$i ....................... h$rbt'ol
County Tax Map No. 1000 Section ...1. ,1 ~1 ...... Block ...98. .......... Lot...1.1..&.l.2. ........
X
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore fried in this office dated
May 17 19 .8.4. pursuant to which Building Permit No. 13142 Z
dated ........ M.a.y .....1.8 ........... 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 .........
Deck Addition To Existing One Family Dwelling
The certificate is issued to JOHN & SUSAN GANTLY
(owner,/~K~e.~
of the aforesaid building.
Suffolk County Department of Health Approval . .N./.A. .....................................
N/A
UNDERWRITERS CERTIFICATE NO ..................................................
Building Inspector
Rev, 1/81
lrO~ NO. ~
TOWN Of: $OUTNOLD
BUILDING DEPARTMENT
TOWN HALl.
SOUTHOLD, H. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 13142 Z
Permission is hereby granted to'
..~...~,¥....~...~.~....~.~......~...~~....~.~.~...~i ..........
at premises located at .....~..~..~...~ ...... ..~...~.~...~...~.:......'~..- ' -.~ .~.. ....... ~~.~,'~..... ...........
County Tax Map No. 1000 Section ..... /.,(.! ............. Block ~ Lot No.
~ur, uont to app,,co,,on da,~ ~.~...~..~ ................................... ,1,..~.~.., and appro,,~ by the
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 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 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 .. ~.a~l~...~. ~ ~...~. ....
New Building .............. Old or Pre-existing Building ....~ ....... Vacant Land .............
Location of Property....~..~..~..~/. ..... .~. ~...~;4~.:. - ~
House No. Street '~Ham/et
Owner or Owners of Property .~1~;~.'..~:~' ...~....4.~...~.~ ......... .....
County Tax Map No. 1000 Section . .~.(.~/I ......... Block .... ~.. ........--Lot../.~ ............ 'i'
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No. .. Date of Permit pplicant .........
Approval '~ Labor Dept Approval '-
Health Dept ............................... ' ...................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate.....................~ FinalCertificate .~.....~ . ...........
Fee Submitted $..~'.-;/7'i). ....................
Construction on above described building and pe, crnit meets all~pplic_able codes and regulations.
App,,cant .....................
Rev, 10-10-78
FIELD I,l.~t gCTIOl~ COH~h~NT~
" '"" I t)
FOUl] D A'i- ]70U ( 2nd )
2.
FRAME &
PLUMBING
3.
JUSU[,ATJON PER N.
STATE ENERGY
C.ODE
ADD1TIOi'IAL COMMENTS
FORM NO. 1
TOWN OF SOUTHOLD
BUILDtNG DEPARTMENT
TOWN HALL
sOuTHOLD, N.Y. 11971
TEL.: 765-1803
Examined..~V~ ~.~.~...
Disapproved a/c .......................... '. · .' ........
Application No ..................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
iNSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and sitbmitted in triplicate 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 [o adjoining premises or public streets
or ar~as, 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 issue 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 Occupahcy
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 buildings for necessary inspections.
..... ........
(Sign~a. tur~q of appll~_~t~o{ name, if a corpor t'o
(Mailing address of Tapplicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises..~.~'-.."/..~*~.'.~'. - ~ .e~..~ ............... ~(~ .........................
O (as on t~fe tax roll or latest de )
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No ..........................
Plumber's License No .........................
Electrician's License No .........................
Other Trade's License No ......................
1. Location ofland on which proposed work will be done. h...6~-.~.{/./~''' .................. :': .....
........ ........ ......................
............ Hamlet
ltouse Number Street
'' ~ Lot 1%~P.
C~hnty Tax Map No I000 Section Block '
Sobdivision .~ ~.~. ~~.~ .'.. Filed Map No ............... Lot ...............
2. State e~isting use and ~ccupancy ~f premis~s ~nd intended use and ~ccupanc~ ~f pr~p~sed c~nstructi~n:
a. Existing use and occupancy ........ .... ..................
b. Intended use and occupancy . · .O....~.'Tr~. ~.~'.~...~"~.,~.;~ ~,.,e~l*. ..... ~ ................
3. Nature of work (check which applicable): New Building .......... Addition
....... Alteratio, la ..........
Repair .............. Removal .............. Demolition ........... Other.._W°rk. ~ ......
~, ~ (Description)
Estimated Cost ~.. ~¢¥:a. Fee h ~ :i ~ ~ ..................
4 ' filing this application)
(to be paid on
If dwelling number of dwelling units Number of dwelling unitls on each floor ................ '
If garage, number of cars ............................................ ,
6; If business commercial or mixed occupancy specify nature and extent of each type of use ...... ,., ..............
Rear Depth'.
7. Dimensions of existing structures, if any: Front ...................... ~ ....................
Number of Stories ' '
Height ........................................... ~ ...........................
or additions: Front ~ Rear
Dimensions of same structure with alterations ..................................
Depth ...................... Height. ...................... Number o(, Stories ......................
8. Dimensions of entire new construction: Front ............... Rear ........ ; ....... Depth ...............
E[eight ............... Number of Stories ............................ : ............................
9. Size of lot: Front ...................... Rear ...................... iDepth ......................
Name of Former Owner '
0 Date of Purchase .............................. ...........................
1. Zone or use district in which premtses are muated .....................................................
' ordinance or regulation: '
2. Does proposed construction violate any zoning law, · ...............................
3. Will lot be regraded ............................ Will excess fill be removed from premises Yes No
Owner of premises Address ' Phone No
,l. Name of .................................. ' ....................
Address ; Phone No
Name of Architect .............................................................
Name of Contractor .......................... Address .................. Phone No ................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and, i~dicate all set-back dimensions from
~roperty lines. Give street and block number or description according to deed, and shdw street names and indicate whether
nterior or corner lot.
DATE: B.P.
FEE: BY:
765-1802. c,,, AM TO .t. PM FOR THE
FOLLOWING ~h, cyF-' I'IONS:
1. FOtJN[~A7Ir)N - iWO REQUIRED
FOR ~ Jl.., CONCRE'FE
2. ROLJG~t - FRAMINQ & PLUMBING
4. FINAL,. ~-' .... ~ ~IQN MUST
THE REOiPErMIN'1S OF TIlE N.Y.
STATE C~NE:TRUCTION & ENERGY
CODES. NOT RESPONSIBI.~
DESIGN ~ CONST~UCmlq¢
STATE OF NE~RI~/// .~./ ~ o -x
........ ~:.~ ~..~~.~ .~..t,~. · being duly sworn, deposes and says that he is the applicant
(Name of individ~gning contract)
above named.
lte isthe .................. ~~,age~t c~rporateof~i~er~ ' '', '"''''' ''"',et~.~ .......................... ''
of said owner or owners, ~d is duly authorized to perform or have performed tho said work and to m~e and file this
application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the
work will be perfo~ed in the m~ner set forth ~ the application filed therewith.
Sworn to before me this
'~'- -~ ...... - ~ ~OTA~~N~Y~ ..... ~'~ '' ' ......