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HomeMy WebLinkAbout13166-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...z.1.2. 95.0 ......... Date .... .0.c.~ o b~.r:..3J ................. 19.84 THIS CERTIFIES that the building ...... ~ .d.O.~.~. $ 9p ................................. Location of Property ...zt. 2. ~9.5..c..~y....~. 9.a.d. /.t .4.~ ................ ~.o.~bo2.d. ............. t~ouse rye. ' Street Hamlet County Tax Map No. 1000 Section©.5.9 .......... Block . . .3. ........... Lot ..... 2. .5 .......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated May 18 ..... 19.8.4 ................. . pursuant to which Building Permit No .... ! .3 .~.6.6. Z. ........... dated ...M..a 7..2.6. .................. 198..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 ......... Closed in Greenhouse on existlng.p..a.t.i.q: ............................. James C. Mott & Matilda i. Mott The certificate is issued to ..................... io~,,'e;', ~e~'~fX'X .................... of the aforesaid building. Suffolk County Department of Health Approval ....... ~ ./.~ ................................ UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 I~OB~ NO. B TOWN OF $OUTHOLD 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? 13166 Z Permission is hereby granted to: ~ ~ .... _~~ ~. ....... ~..~· ...... .... ~...~.~.....~......~..~. ...................................... ~~....~.:...?..:~...~..~.~.~../. ..... ~ . ....... at premises I~ated at ............... ~~...~.....~ .......... .~.~ ................ County Tax Map No. 1000 Section ..... C~...~...-~..~ ....... Block ....... ~.~.. ........... Lot No. pursuant ,o application dated .......... ...~.~..~.~. .................... , 19.~..~...,-- and approved by the Building Inspector. Fee $...~.. .................. 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 b ' ' .~; .... tor with the following; for new buildings or new use: su mltted-Jecd-,., ...... to the Building I nspec- 1. Fina[ 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 requ ired to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 ~ 2. Certificate of occupancy on pre-existing dwelling / land use 3. Copy of certificate of occupancy $1.00 --Fre-Ex±$ting C.O. $15.00 Vacant land C.O. $ 5.00 Date .... · ......... . .. New Building ............ . Old or Pre-existing Building ............ Vacant Land ............. Location of Property ~, ,J?,~, ~, .~? ~,'~,"',..C. ,~/~,. ,~:>..,.~,,, ,,~.~, Hou~ No. ~treet ......................... Ham/et . i'J'3' ............... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .Applicant ¢'~ ~' o Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ............... Fee Submitted $ ..... .~. ..................... ' ....... Construction on above described building and p~ermit meets all app_licab~e codes and regulations. R~. ~o-~o.78 ~.~ ~ d~-/// ! / FIELD INS?ECTION (lst) L~ N ],q't ~'Oll ( 2nd ) FHAME & PLUMBING 3. ]USULATION PER N. Y. STATE ENERGY CODE .,OFhlt,N r~ ADDITIONAL COMMENTS FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL,: 765-1802 Disapproved a/c ..................................... (Building Inspector) APPLICATION FOIl BUILDING Application No .................. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted 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 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 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 j~spections. ('~/i~i'g~;it;r'e'!~.~ appli~''% '~a'n~' ~r name, ........... i~fva corpgra'~ 'ti(~) .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, pluinber or builder. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ............... ........... Plmnber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. x ...... ¢.7. ............................. ........................ ~ Street Hamlet . House Number · C~>hnty Tax Map No. 1000 Section ..... .~. ,~.~. ...... Block ....... ~,~. ......... Lot e~ ~ Subdivision ..................................... Filed Map No ............... Lot ....... . ........ (Name) 2. State existing use and ~ccupancy ~f premises and intended use and ~ccupancy ~f pr~p~sed c~nstructi~n: a. Existinguseandoccupancy ...... .~.~...~..-~-. .............. ' .......................... iiiiiiii · b. Intended use and occupancy ~ .... .~. !/..~./.'.~. · .~..'. ......................................... 3. Nature of work (check which applicable): New Buildivg .......... Addition'· ......... Alterat_ipn ........... Other Work .~..Z.~.../..~.~.../../~' Repair .............. Remoyal .............. Demolition . / ~ ~ ~ ~ ~;~,~ ~ '~- (Description) 4. Estimated Cost .......... ~ ....................... Fee ................ ~ (to be paid on filing this application) If dwelling number of dwelling units Number of dwelling units on each floor ................ If garage, number of cars ........................................................................ 6. If business, commercial or mixed occupancy, specify nature alad extent of each type of use ............. , ....... 7. Dimensions of exi~sting strnctures, if any: Front ...... ~..~.~ .... Rear .... ~. ...... Depth ............... Height .... 2~' ......... Numiber of Stories '. ......... ./. .......... ~.' ',1 't ............... .~ ~' ........ Dimensions of same ~rncture w~th alterations or acklit~ons: Front ..... ,~'..~. ....... Rear .... ~; ............ Depth. ...... /~..~ ......... i . Height ~.. .... Number of Stories ....... ./.. ........... · ' F 0 ~ D pth 8. Dimensions of ent~re new constructlOn r nt ............... Rear ............... e .............. Height ............... Number of Stories ....................................................... ' D pth 9. Size of lot: Front ........... ........... Rear ...................... e ..................... 10 Dateo~Purchase.........,.,'..................NameofF°rmerOwner ............................ 1 1. Zone Or use al{strict in which premises are situated ............................. 21'fi~ .................... 12. Does proposed constructio~ vioiate any zoning law, ordinance or regulation: ........ t.~..~ ..................... '~':11 lot be re-raded . ~..0 ~ .. ,~t ~ ., Will excqss fill b~ removed from premises: ~ Yes .~ ~_N9 14.13' I~e of Owner of pr~is;s' ~ ."~"..~...~..~.' ~..~.* i './~.~.~...~ddress ~.q&~.~f. 7~..~..~ .... Phone No.~. ~4~. · .-/.~. 7./. Name Of Architect .. '~'-'z .... :. · .~4. · .~ ,~. · :,~.. · · Address ................... Phone No. '~'2'1~' ' Name of Contractor .'~.../-~.~./~..~'?...~.~.~.4.r/. f. Address ................... Phone No. ~.~'~...."../.~. PLOT DIAGRAM Locate clearly and distinctly alI buildings, whether ex~st~ng or proposed, and, anti,cate all set-back dmaens~ons 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 YORK, S.S COUNTY OF .................. ............................ ~ ..................... being duly sworn, deposes and says that he is the applicant (Name of individual siglning contract) above named. He is the ~ .................... i (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dOly 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 manner set forth in the application filed therewith. Sworn to before me this Nota, Publie,. ...... ........ ;.County. V,/,,X/t, . NOTARY PUBLIC, State df New Yor~ ' ' , No. 4707878, 8u[folk'County , Term Expires March ~0,