HomeMy WebLinkAbout16288-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. z16073 Date August 18, 1987
THIS CERTIFIES that the building .. A. 9.c.e. s, .s 9.r.y. ...................................
Location of Prop~,, 480 STERLING PLACE GREENPORT
County Tax Map No. 1000 Section 0 34 ,Block 0 3 ..... Lot 18
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
· .4 u. ~t y..~ 7. o.. 1.9. 8. 7 ..... pursuant to which Building Permit No... 1.6. .2 .8.8.z. ............
dated . .J.u. 1. .y..3.0. :..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 .........
· .a.c..cp.s.s. pTy' .b..u.~.l.d. ~..n g..a.s...ap.p. 1..J ?.d..f. 9.r.. ......................................
The certificate is issued to STELLA K. BERTOLINI
..................... ?o¥.'o'r, X X X .................
of the aforesaid building·
Suffolk County Department of Health Approval ......... .N·/.A. .............................
UNDERWRITERS CERTIFICATE NO. N/a
PLUMBERS CERTIFICATION DATED: N/A
Building Inspector
Rev. 1/81
FOR~ NO. B
TO~H OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
~HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N9 16288 Z
Permission is hereby granted to:
..... .*....~.~....~.~.~.,~.~ ..............
..
at Dremises located at .................................
County Tax Mop No. 1000 Section ....~,..~.~. ....... Block .....,~.,,~ ......Lot No....]..~. ...............
approved by the
pursuant to application dated ...... '"J/~...'~.,~,6t.......~...~ ................... , 19.9...W..,°"~ and
//
Building Inspector.
Building Insl:~ector
Rev. 6/30/80
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
765 - 1802
TOWN OF SOUTHOLD
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
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 topograpt~ic 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~tOperty 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 3ertinent informa~
tion required to prepare a certificate.
Fees: Additions $25 .00
1. Certifieate of occupancy New Dwelling $25.00, Accessory ,~$ ]0.00 Business $50.00
2. Certificate of occupancy on pre-existing dwelling $ 50. O0
3. Copy of certificate of occupancy $ 5.00, over 5 years $]0.00
4.v.o .tLa.d c.o. 2o.o0
5.Updated C.O. $ 50,00 Date .................
New 0 ons tmuc ~; ion ...... Old or Pre-existing Building ............ Vacant Land .............
House No. Street Ham/et
Owner or Owners of Property , ,~,~,~,~. ,/,/,~,....%~/.. ~., ,~., ~ ,~, .~,/~/, .........................
County Tax Map No. 1000 Section . .~, ,~, ~., ...... Block ~Q ~ Lot...
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No./~¢?~..~..~... Date of Permit.?~?.¢z~.2Applicant..'~'../~'.~/.~./..~...~.....
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $ ~/?. ~...~. ......................
Construction on ab eve described building and p.p.~~~a~ codes and regulations. Ap plican t~2/~-...~-f~...-,~....~7~%-...¥ ..........................
Rev. 10-10-78
C.d.
UNDATION ( ~ st)
UNDATION (2nd)
UGH FRAME &
PLUMBING
SULATION PER N. Y.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS:
~ SALT BOX
Derived from the simple, yet classic lines of the
traditional New England structure that inspired
it. This building, like the others, may be cus-
tom/zed to your needs.
Another very popular model, which wil~ surely
Complement the natura~ landscape of your prop-
erty. Like other models, the double doors are 5'
wide and 6' high which will accomodate every.
thing from your tools to the heavy lawn & garden
tractors.
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
TEL.: 765-1802 CALL ................
MAIL
Examined .~. ~(~ .~:~.., 19'~."~
Approved.~. ~ .~.., 19~.~. Permit No. 1..~..~...~. ~..~
Disapproved a/c .....................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date ................. , 19
INSTRUCTIONS
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 a
or areas, and giving a detailed
cation.
c. The
d. Upon approval of 1
shall be kept on the
e. No buildin
shall llave been
APPLICATION
Building Zone Ordinance o
Regulations, for the
The applicant agrees to
admit authorized inspectors on '~
premises, relationship to adjoining premises or public streets
must be drawn on the diagram which is part of this appli-
issuance of Building Permit.
a Building Permit to the applicant. Such permit
work.
tort for any purpose whatever until a Certificate of Occupancy
~artment for the issuance of a Building Permit pursuant to the
Suffolk County, New York, and other applicable Laws, Ordinances or
additions or alterations, or for removal or demolition, as herein described.
applicable laws, ordinances, building code, housing code, and regulations, and to
in building for necessary inspections. ~ ~
(Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
(Name and title of corporate officer)
ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSgD
Builder's License No ..........................
Plumber's License No .........................
Electrician's License No .......................
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
................................................. . ....................................
Nrnne of owner of premises..c~..~.~..~.~. · · ?~. ~..~. ·~.~. .'~. · .~. .~. ~. ..... ~..~. ~~'~!
(as on the tax roll or lat~s~.,¢eed)~/~ 7
Ir'applicant isa corporation, signature of duly authorized officer.
Other Trade's License No ......................
I Location of land on which proposed work will be done ..................
...... .... ...........
House Number Street Hamlet
County Tax Map No. 1000 Section ..... ~.~' ........ Block ..... ~. .......... Lot .... ~ ...........
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 .....................................................................
b. Intended use and o'ccupancy ..................................
3. Nature of work (check which applicable): New Building ......... Addition .......... Alteration ..........
Repair .............. Remloval .............. Demolition .............. Other Work ...............
i (Descrip~tion)
4. Estimated Cost...~. ~.~.. ~. V. ........................ Fee ......................................
i " (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 ty/pe of use . .' ..... ..............
7. Dimensi0n~ o~'~existing structures, if any: Front...~.~../. .... ~... Rear ..
Helgllt ......... Number of Stories
Dimensio~lll~ll~ ~l~cture wit alterations or additions: Front ................. Rear ..................
Depth .....~J~.. ?..'~ ......... !... Height ...................... Number of Stories ......................
Dimensions of entire new construction: Front .......... . ..... Rear ............... Depth ...............
Height ............... Nu/nber of Stories ........................................ .. ...............
9.
Size
of lot:
Front
11. Zone or use district in which premises are situated .....................................................
12. Does proposed construction vi,o~ate any zoning law, ordinance or regulation: . ~ ......................
13. Will lot be regraded ............................ Will excess fill be removed from premises:
14. Name of Owner of premises ................... Address ................... Phone No ................
Name of Architect .......................... Address ................... Phone No ................
Name of Contractor ........................ Address .... ; .............. Phone No ..............
15. Is this property located within 300 feet of a tidal wetland? *Yes ..... No ...~.'
*If yes, Southold Town Trl.stees Permit maybe required.
PLOT DIAGRAM
Locate clearly and distinctly ali buildings, whether existing or proposed, an& indicate all s~t-back dimensions from
property lines. Give street and blocl~ number or description according to deed, ahd show street names and indicate whether
interior or corner lot. .. _
I
STATE OF NEW YORK, I S.S
COUNTY OF .................
................................................. being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
fie is the ..................... ~ ...................................................................
~ (Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duty 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 knbwledge and belief; and that the
work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
............... q~'7 ...... day°f ......
~ PUBLIC, State of New Yedl (Signature of applicant)
Term Expires March 30,1.