HomeMy WebLinkAbout16250-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. Z-15960 Date July 20, 1987
THIS CERTIFIES that the building DECK ADD ITION
L ..... 5180 Peconic Bay Blvd Laurel, N Y
ocauon o~ rroperw .............................. : .................... '.. · ..........
House No. Street Hamlet
County Tax Map No. 1000 Section 128 .Block 02 .Lot 18
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
June 30,. 1987 .. pursuant to which Building Permit No. 16250. z
dated .... J..u. ~ .y..2. 0. :..1.9.8. 7. ......... 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 AS APPLIED FOR
The certificate isissued to VINCENT & LINDA FALCO
..................... .....................
of the aforesaid building.
Suffolk County Department of Health Approval N /A
N/A
UNDERWRITERS CERTIFICATE NO ..................................................
PLUMBERS CERTIFICATION DATED: N/A
Rev. 1/81
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*_ 1~2~0 z
Permission is hereby granted t~ . ,/'1 ·
.o~....~..*...~..Y.. ~...~..~.~ ............
..,~ .......... ~. ~..~ ........ ~. ........... ~ .........
0, pre,,ise, ,~,,~ ~, ..~.~...~~.~..~.,.....~~ .......................
County Tax Map No. 1000 Section ..... /...~..~. ....... Block ....... ..C~......~..., .... Lot No ...... .~..~ ............
pursuant to application doted .......~,~....~. ........................ , 19..~...~.., and approved by the
Building Inspector,
Fee $..~.~....~...~ .....
Building Inspector
Rev. 6/30/80
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Soothotd, N.Y. 11971
765- 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted m ~ 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 p~operty 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: Additions $25.00
1. Certificate of occupancy New Dwelling $25.00, Accessory',,$10.00 Business $50.00
2. Certificate of occupancy on pre-existing dwelling $ 50.00
3. Copy of cerdficate of occupancy $ 5.00, over 5 years $10.00
4.Vacant Land C.O. $ 20.00
5.Updated C.O. $ 50.00 Date .%~.~.z;.~..~..~.d.; ./??~, .7. .....
NewConstpuction ...... Old or Pre-existing Building ............ Vacant Land .............
House No, Street Ham/et
Owner or Owners of Property r_ , . .?
County Tax Map No. 1000 Section . ./.~. ?. ......... Block .. ~ ........... Lot..Q./~.; q.O. ......
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No.l~c~0, ~. Date of Permit ~t/$¢J/~. Applicant ~( .N.~.~.~.T..
Health Dept. Approval ...... .~JJ~ .............. Labor Dept. Approval ....f[,/.J.~ .................
Underwriters Approval ..... ~. I.f~. .............. Planning Board Approval . ~/J J~r ................
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $ .o~,~.,. ~ .....................
Construction on above described building and permit meets all applicable codes and regulations.
Rev. 10-10-78
UNDATION ( 1 s t)
UNDATION (2nd)
UGH FRAME &
PLUMBING
SULATION PER N.
STATE ENERGY
CODE
F~NAL
ADDITIONAL COMMENTS:
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING
REMARKS:
[/-~'~NAL
BLDG, DE?L ~
row o . LUmo _ o
BOARD OF HEALTH ......
3 SETS OF PLANS .......
'FORM NO. 1 SURVEY ..........
TOWN OF SOUTHOLD CHECK ..........
BUILDING DEPARTMENT SEPTIC FORM .............
TOWN HALL NOTIFY ·
$OUTHOLD, N.Y. 11971 ~. ~,~.----,~./.q
TEL,: 765-1802 CALL
~AI~
Disapproved a/c .....................................
; ,
~ (Building Inspector)
APPLICATION FOR BUILDING PERMIT
........ 19g.7.
INSTRUCTIONS
a. This application must be completely tilled 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 buildh~gs 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 regulations, and to
admit auth°rized inspect°rs °n premises and in building f°r necesi~7.~~. Z~..~~~ ....
(Signature of applicant, or name, if a corporation)
(Mailin=o~aaddress of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Ow u C'
Name of o,vner of .........................................
(as on the tax roi1 or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer) -
ALL CONTRACTOR'S HUST BE SUFFOLK COUNTY LICENSED
Builder's License No ..........................
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No ......................
1. Location of land on which proposed work will be done~ 6'~/~O .........................
...... .c<,. ............... .[. . :/,.
House Number Street Hamlet
County Tax Map No. 1000 Section ?.~..jr ............. Block .~. ................ Lot. ?/..~.,. O.O .........
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .......... 0..% .. ¢,~ ..............................................
b. Intended use and occupancy ....................................................................
3. Nature of work (check which app icable): New Building · Addition ~ Alteration
Repair .............. Remov~l .............. Demolition ......... iiiii 6;~e'r Wc~l~.i{0,~
i . · (1Jescnp~tion)
4. Estimated Cost .............. ; ....................... Fee ......................................
' (to be paid on filing this application)
5. 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 and extent of each type of use ... ". .................
7. Dimensions of existin structures 'fan · Fron ~e, ~'t~c~¥ /q7~'~r ~ Danth ~
g , ! Y. t ~ ......... l"" '."v~' ................. r~ ...... ~ .........
Height ............... Number of Stories ................................................ , ........
Dimensions'of same structure withl alterations or additions: Front .~.~ $'.qf.v.~?.
Depth ...................... ' Height ...................... Number of Stories ......................
8. Dimensions of entire new construchon: Front .......... . ..... Rear ............... Depth ...............
Height Numbe'r of Stories
9. Size oflot: Front ............ 3 ......... Rear.~..........~ .......... .... Depth ......................
10. Date of Purchase .~¢.c.,&g. 1 .).~..~.~. .............. Name of Former Owner ~.~.,fffl. 44...,,~qf.o.~.: ..........
ll. Zone or use district in which prem{ses are situated..~ .~r.~. ~....$~.'.g':.././.~..5/.~. .........................
[2. Does proposed construction ¥iolatd any zoning law, ordinance or regulation: ..,:u{..O ............................
t3. ~,--Will lot ~b~regrade~ ...."~'D 'O-"' '"'/'~ 23~),~ ' fa7 ..... Will excess fil[be removed from premise~: Yes No
i4, t~ame o~ owner o~ premises Iqt)ql,,O .......... .~.. Address ('./;gO lJ.~.~.,~¢ .~.q/t .~/.~. Phone N~'Zf~'.-~'t'o. ¢
Name of Architect ........................... Address ................... Phone No ................
Name of Contractor ........... ............... Address ................... Phone No ................
[5, Is thio property located within 300 feet of a tidal wetland? *Yes ..... No .~'....
· If yes, Southold Town Trustees Permit may_ be reguired.
' PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, an& indicate all set~back dimensions from
>roperty lines. Give street and block number or description according to deed, and show street names and indicate whether
nterior or corner lot.
]TATE OF NEW YORK, S.S
2OUNTY OF .................
................................. , .............. being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
~bove named.
is the .......................... I ...............................................................
I (Contractor, agent, corporate officer, etc.)
said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
~pplieation; that all statements contained Ln this application are true to the best of his knowledge and belief; and that the
york will be performed in the manner set forth in the application filed therewith.
iworn to before me this
HELEN K. DE VOE
NOTARY PUBLIC, Stste of New York (Signature of applicant)
No. 4707878 Suffolk CountYc,,~
T~rm Exp res Match 30,
SURVEY FOR
Gl'NAN ASSOCIATES
AT LAUREL I
TOWN OF SOUTHOLD
SUFFOLK COUNTY, NEW YORK
OWNEF
DATE : MAY 8~
SCALE: I" r. 30'
NO. : 81 -
GUARANTEED TO=
CHICAGO TITLE INSURANCE COMPANY
GENAN ASSOCIATES