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HomeMy WebLinkAbout15950-zFORM NO 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No .... Z. 1.5772. ..... Date May 21, 1987 THIS CERTIFIES that the braiding .en.clo. s .e.d..po..r.c.h..o..n..a.c.c..ess. o.r.y..g.a.r.a.g.e .... Location of Property 2700 ..... B.r.ay. Ave. Laurel H~use'No .... Street ................ I~laml'e~ County Tax Map No 1000 Section . . .1.26. Block 10 . .Lot 08 Subdivision ..... X ......... F~led Map No.. X . .Lot No. X conforms substantially to the Application for Building Permit heretofore filed in flus office dated ...Ap~r3,],. 28, .19.87.. pursuant to which Bmldmg Permit No . .15.9.5.0..Z ......... dated . . Ap.~%$. 2.9, ~_9.8.7. .... was issued, and conforms to all of the reqmrements of the applicable provisions of the law The occupancy for wluch this certificate is tssued is ...... ......... ara e. ~nclo~ed.pD. rch on ¢~%stinq accessory .g...9 .................. The certificate ts ~ssued to ....... ~r ~,..Lqu. i s.e Fo.x ................. {ownet'XJJ~/.l~K~fE of the aforesaid bmldkng. Suffolk County Department of Health Approval ............. N./.A .................. UNDERWRITERS CERTIFICATE NO ................ N/A PLUMBERS CERTIFICATION DATED: ( ~ufldtng Inspector 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 A. UTHORIZED) N9 15950, Z Permission is hereby granted to: ~ ~ / , ..... ~.....©~.~..~ .................. ...~~.....~.:~.~....u..~.~.~- ,o..&~,~..o.~... ~ ~.~~.~..~~ . ...~.. ...... ; ................................ ~. ............. ...................... ............................................. ~, ,,m,,, ,~,~ ~,...~..~....~..~.. ...... ~~ ............................ ~.~ ~,x M~ ~o ~00o s,~,~o~.J.A.& ....... ~,~ ........ ~.~ ....... ~ No....~...~ ............. Building Inspector. Rev. 6/30/80 FORM NO 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This apphcat~on must be hlled m typewmter OR ~nk, and submitted ~ ~ to the Building Inspec- tor with the following, for new buddings or new use 1. Final survey of property with accurate location of all buddings, property lines, streets, and unusual natural or topographic featu res. 2. Final approval of Health Dept. of water supply and sewerage dmposal-(S-9 form or equal). 3. Approval of electmcal installation from Board of F~re Underwmters. 4. Commermal buildings, Industrml buddings, Multiple Remdences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responmble for the building. 5. Submit Planmng Board approval of completed rote plan requirements where applicable. For exmt~ng buddings (prior to April 1957), Non-conforming uses, or buddings and "pre-ex~st~ng" land uses: 1. Accurate survey of pZOperty showing all property hnes, streets, buddings 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 ~nforma- t~on required to prepare a cert~hcate. Fees' 1. Certificate of occupancy $5.00 2 Certffmate of occupancy on pre-exmtmg dwelhng 3. Copy of cert~fmate of occupancy $I .00 4.Vacant Land C.O. $5.00 5, Updated C.O. $15.00 New Building ........... Old or Pre-existing Budding $15.00 Date ......... / ~'/ 0~7 · .X ..... Vacant Land ............ County Tax Map No. 1000Sectlon .../.~".~ .... Block ..../.~ ........ Lot ...O.~. ......... Subdivision ......... - .......... Filed Map No .... ..;...Lot No . - ........... Perm,t No./~.?.~"~. ~. Date of Perm,~ .~' ~I~c .~pp I,cant .~/~.'~. ~ ~ ....... Health Dept. Approval ...~.~' ............ Labor Dept. Approval ~ ,~' Unde~mters Approval...~ :.~'. ............ Planning Board Approval .~; .'~' ................ Reque~ for Temporaw Certifmate ................. Final Certificate .. ~..~ ......... Fee Submltted$../~,~ ./~.~.. Construction on above described building andjz.ermlt meets all a_pph.c,able codes, and regulations ~,0 ~i:~ "~ ~5'"i -~ '~ Applicant. ~'~.~ ...................... Rev 10-10-78 OUNDATION ( ls t) OUNDATION [2nd) OUGH FRAME & PLUMBING NSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIOr;AL COMMENTS: FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT SEPTIC TOWN HALL NOTIFY P~OUTHOLD, N.Y. 11971 TEL.: 765-1802 CALL MAIL Examined ~C~'-. ,-~ e]~., 19~'7 Approved ~ .~'~, , 19~..eermit No Dxsapproved a/c . (Building Inspector) APPLICATION FOR BUILDING PERMIT IN STRUCTION S BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... CHECK .......... FORM ............. : TO: a. TIus apphcation must be completely filled m by typewriter orln mk sets of plans, accurate plot plan to scale. Fee according to b. Plot plan showing locaUon of lot and of bufldm or areas, and gwmg a detmled description of layout cation. c. The work covered by flus apphcatIon may&a~ d. Upon approval of tins apphcation, the shall be kept on the premises available for msl~ri ti No u dmg occupied or APPLICATION IS HEREBY MADE~t"-~g~to Bulld~ng Zone Ordinance of the Town of Regulations, for the construction of buildings, a~ The applicant agrees to comply with all apphcabl~k admit authorized mspectors on premises and m bulldm an.d submitted to the Building Inspector, wit s~dule.,~% . ~, lgt"~l'%"!~re,~'~(~¢'re~i,I't~i~htp to adjoming premises or pubhc str~ .'~Lt~%l~n on the dmgram winch ,s part of tins ap :Ik~i~fl~c~'%l*ore issuance of Buildmg Permit ~.~O~..,~a BulldmgPe rmlt to the app h cant Sa ch pe~ ~' ~ !~"[~o_~urpose..~,l~_ whatever until a Certificate of Occupm [~p_~t for the issuance of a Bml&ng Permit pursuant to o~,y, New York, and other appl,cable Laws, Ordmance- <~g~Tt'eratmns, or for removal or demolmon, as herein descnb mrEinances, building code, housing code, and regulahons, and necessary u)sKecJd'ons. ,.~ /~% p (Ivlalhng address of applicant) State whether appbcant is owner, lessee, agent, architect, engineer, general contractor, electrlcmn, plumber or build_ Name of owner of prermses ].-. a..~ ~ .~'~' . ~p..~ .ae, rr _.. (as on the tax roll o~ lal~t deed) If applicant is a corporation, signature of duly authorized officer NOrt~ 8glLD,HC-' '~66 1802 -q (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED llder'sLlcense No. , S' 3 gr/4 Plumber's License No Electrician's License No Other Trade's License No Location of land on winch proposed work will be done House Number t County Tax Map No I000 Section 2 Subdivision Filed Map No Lot (Nan~e) State existing use and occupancy of premises and intended use and occupancy of proposed construction a. Existing use and occupancy ~1 O . . . . . ..,,. : : b Intended use and occupancy ~ d O. /--- ~ h ~-- CZ~ ........ 3 Nature of work (check which applicable) New Budding . .. Addition ' . .... Altera~op~ ., Repaxr ..... Removal , .. Demohtion ........... Other Work ~ (D~cffpli'6n) 4 Estimated Cost . ~. ~ ~' ~ Fee..~'~. ~'''' ~ (to be paid on filing this apphcatlon) 5 If dwelling, number of dwelling umts ........ Number of dwelhng uruts 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 structures, if any Front .......... Rear ....~. ..... Depth. Height ........ Number of Stones ................................. --.rr" '" D~mensmns of same structure w~th alterations or additions Front ~r3 ~r- ~ Rear ......... Depth .............. Height ............. r,-,,Number, o,~aof ~t~one s .................. · 8. Dimensions of entire new construction' Front ........... Rear ............. Depth ........ Height ....... Number of Stones ....................................... 9. Size of lot Front ........ Rear .......... Depth ..................... 10. Date of Purchase ........ Name of Former Owner 11. Zone or use district in which premises am situated. .. 12. Does proposed construction vmlate any zoning law, ordinance or regulation 13. Will lot be regraded . ./..~ ....... Will exCess fi bJ~.~..q~em, oved from premises. Yes N 14. Name of Owner of premlses ~t~-v~.~.~.' .Address .~dl.~:~ )7:~.':. Phone No .......... Name of Architect ....... ---- ....... Address . . 'T'. ........ Phone No .......... Name of Contractor .~. ~ Address ~,~4_~. ~,.~. Phone No.'25.~. :.6 9.?.g.. 15. Is this property located within 300 feet of a tidal wetland? *Yes ..... No ~.. *If yes, Southold Town Trustee~ Permit may be required. ~ ~ PLOT DIAGRAM Locate clearly and distinctly all buildn~gs,.w, ethjr ~xistmg or proposed, and mdlcate all set-back dnuenslons frm property hnes. Give street and block number c~ descnpt{on acc6rdmg to deed,'and show street names and mdmate wheth, mtenor or corner lot. STATE OF NEW YORK, S.S (Name of ~nd~wdual s~ng contract) above named He ~s the . ~ ....... (Contractor, agent, corporate officer, etc.) of smd owner or ownem, ~d ~s duly authorized to perform or have perfo~ed the smd work and to m~e and file ti apphcatmn, that all statements contmned m thru apphcat~on are true to the best of h~s ~owledge and behef; and that t~ work wdl be perfo~ed ~n the m~ner set forth m the apphcatmn filed therewith. Sworn to before me thru ..... .... . ~ 4~ ~ ~ (S~gnature of appbcm