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Home My WebLink About13196-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.Z. ~..2.6.9.1 ........... Date ...... .S.e.p. ~..e .m.b.e.e...2.4 ............. 19 .8.4. THIS CERTIF1E S that the building ........ 5..~ .i.m.m. $ .n g..P.o, g .~ ......................... Location ofProperty~/~t~s~/o~ 1170 Bay Avenue East Marion. Street Hamlet County Tax Map No. 1000 Section ....... .0.3.1..Block ..... 0.8. ........ Lot 0 1 8 Subdivision ......... XX .Filed Map No. .X.X Lot No. XX conforms substantially to the Application for Building Permit heretofore filed in this office dated ·..gpp.5.1.23 ......... ,1985. pursuant to which Building Permit No ...... q. .3 .1. 9. 6. .Z ......... dated ............ d.~n e. 7 ......... 19~ 5., 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 ......... ~gr, g.u.n,d. ~wimming pool The certificate is issued to Victor F. Novak and Doris Novak (owner, ~*e~J,~e~ X of the aforesaid building. Suffolk County Department of Health Ap!5i'o'Cal N/A UNDERWRITERS CERTIFICATE NO ................ ~.5 ~t ~ .62 .......................... 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? 13196 Z Permission is hereby granted to: ..... /z...Z~....~..e.....~ ........... i ....... " ...... ~,~-....~..,~zz.o..~..,....~./.:..~ , , at premises located at ...Z/. ................/~,.~....~... ........... ~.. ..~D '9- ~..z~ ,,z"~ .~/ County Tax Map No. 1000 Section .... ..-~......-r..,... ...... Block ....~...~.... ...... lot No ............... ~u~n, ,o ~,,~,,on ~,~ .~~......~. ............. ,1,.~ ~.~ ~.~ov~ ~, the Building Inspector, /~-~ ~ / Fee $ ...................... / ~ ..... ....... ' 8u[Idin~ I~tor Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ,~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted-J~p[[cct= 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. 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. 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 --Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 New Building ............. Old or Pre-existing Building ............ Vacant Land ............. · ., . .............. Location of Property ../l ~ ..... .B~ . V.. N...~... ~ ~/~ ~ Hou~ No, Sleet Ham/et Owner or Owners of Property .. ~1.~.~. ~. ~¢. ~.~.~..~.~. · ~...~C~ ~ ~ .... CountyTax Map No. I000 Section ~./ ......... Block .~.~ ......... Lot..~.~.~ ........ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No, Z~./.~.~. Date of Permit .~/,~. ~.Applicant.. ~,j. ~ ~.~... ~..'../.~'.~. ~', .~./~,.. Health Dept. Approval ........................ Labor Dept, Approval ........................ Underwriters Approval ........................ Planning Board Approval .................... Request for Temporary Certificate ..................... Final Certificate ..................... Fee Submitted $ ~.~, .~. ,~.. Rev. 10-10-78 Construction on above described building and permit meets all applicable codes and regulations. I ] ELD, INSF~ECTION FOUNDATION (lst}~ COMMENTS FOUNDATION 2. (2nd ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C~ODE FINAL ADDITIONAL COMMENTS: 765.18~Z BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION FRAMING ~] FINAL REMARKS: DATE ~INSPECTOR TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~OUTHOLD, N. Y. ,~proved ...J~.~/.~: ........ Z ........ , 19~...~. Permit No....?.~ ..................... Application No ................................. APPLICATION FOR BUILDING PERMIT 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 al areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. 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 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 ir~ buildings for necessary inspections. ........ ................................ (S'gneturei~ '~ ~~or applicant, or name, if a corporation) ..... -? ) - ~'-/~ (' '~i~'~;~ ~ ~ii~'~'f)' '"~??, State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...................... ~../.~..~...r_.<~... ....................................................................................................................................................... Name of owner of premises .~.Z'. ~.~.~.. ~...J~.. ...... .~..~././..~../~ ........................................................................ If applicant is a corporate, 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 ............................................... Location of land on which proposed work will be done~ Map No.: ................................. Lot No .............. ........... Street and Number Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ......... ..~...~...~...: ....~..~... .... = ....................... ~ ~' ....................... b. Intended use and occupancy ...~.~'~.~j~*~).~t~............~X~..~./~./~.......~..~...~.....~.~.Z.' / property lines. Give street and bldck whether interior or corner lot. Repair .................. Removal ' Demolition .................... Other Work ...¢~.~Z.~....~,J~.~..~.q..~-- ~'L~' ............ ~ (Description) 4. Estimated Cost ..... ~... .... (~..~....~.. ................. : ....... Fee ........................................................................................ : (to be paid on filing this application) 5. If dwelling, number of dwellifig units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ...... ~ ...................................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structu(es, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structurejwith alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number i of Stories ..................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase .................. ...................................... Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction viglate any zoning Iow, ordinance or regulation: ........................................................ 13. Will Iht be regraded . .............. [ ............. Will excess fill be removed from premises: ( ) Yes ( ) No 14. Nome of Owner of premises ..... i .............................................. Address ................................ Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............. t .............................................. Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and indicate all set-back dimensions from number or description according to deed, and show street names and indicate STATE OF NEW YORK, iS.S COU'NTY OF ................................ ' ................. .~./.~¥~/.~-~2:~ ......... .~.d~.~.~rg.Z~. ............................... being duly sworn, deposes and says that he is the applicam (Name of individual signing contracf) above named. ; He is the ~ i (Contractor, agent, corporate officer, etc.) of said o~yner or owners, and is dgly 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 '~he manner set forth in the application filed therewith. Sworn to before me this /q : ,~ .......... ....... day of ...... ....... , _ ,/ Noto Pub,c, .......... .............................. ' .~// ' gL/ , ~gl~oTure or applicanT) -ff ! I / ~I~.PPRO, VED ~S 'NOTED 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: I. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMI31N6 ;3. NSULA~ION 4. FINAL ~j ~SN'STP'UCTION MUST ALL CONSTRUCTION SHALL THE REQUIR~MENT~ O~ TH[ N,Y, ~ATE CONSTRUCTION & CODES, NOT RESPON~I~L~ D~SIGN OR CONSTRUCTION E~O~, , I