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HomeMy WebLinkAbout16180-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall $outhold, N,Y. Certificate Of Occupancy No. Z15920 Date July 7, 1987 THIS CERTIFIES that tile building ...F.e..n .c.e ........................................ Location of Property 1555 Bayv iew Ave. Greenport County Tax Map No. 1000 Section 5 2 .Block 5 .Lot I I. I Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated · .. fl.u. 1. rt..6. ,...I .9.8. 7. ...... pursuant to which Building Permit No.. ! .6 .I.8.Q z. ............. dated ....J.u. 1. y..7.,.. ! .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 ......... .... F.e.n..e.i.n.g., .a.r.o.u..n.d..a.n...i.n.g.r..o .u.n.d...p .o.o.1...a.s..r.e..q.u.i.r.e..d..b.y...c,ode. LEWIS L. EDSON The certificate is issued to ..................... /o'~n~), '/'K~j~'~i~Tr~){~f ]i]~ k .................. 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 TOWN O~ $0~40L~ BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ,. t~. ~ ~ - .~ ~..~ .. ~-..~-...~,-. ............................................. ...... ,o ~ p~.~ ~a ~ ...l..~.~ ...... ~ ......... Cou.~ Tox M~p No. I000 S~ctio. ...... ~.~.~ .... Bilk ...... ~.~ .... Lot No ..... ~..~..~..~). ...... Building Inspector. approved by the 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 A. This application must be filled in typewriter OR ink, and submitted ~ ~ 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 natura~ 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 ~ines. streets, buildings and unusua! natural or topographic featu res. 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 certificate of occupancy $ 5.00, over 5 years $10.0,0 4. Vacant Land C.O. $ 20.00 .~~ 5.Updated C.O. $ 50.00 Date .... ~.. ......... NewConstruction ...... Old or Pre-existing Building ............ Vacant Land ............. ...... Location of Property ./..~.-~.-~..~. ............... .~.,~.'.~./'.4~.....,~.: .' .~... . .~..~.: .~.~.~.. z~.~.~/ House No. Street Nam/et Owner or Owners of Property ....~.'-~..~...~.47.~../..../~..~..~,.` ¢'..~7..../-~., .... ............ · ..... County Tax Map No. 1000 Section ....x~-..~- ..... Block ...... ~."~.. .... Lot..'~... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. 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 p lations. Apphcant ...~f.A.-'~ . .~/ .... ~-~....~-~-~ .......... r~o~-E-LOT. INO'5. SHOVCN P'.EFIE~]'©"fd~,P OF ~ ' ~~ ENCLOSE POOLTO CODE ~0 0 0 ~ / t'~ ~ ~N CdMPLETION 0 UNDATION ( 1 st) UNDATION (2nd) UGH FRAME & PLUMBING SULATION PER N. Y. STATE ENERGY CODE FINAL - ADDITiONaL COMMENTS: 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 TO: Examined ..'q. .... Approved,..~..~..']..., 19'~ .'7. Pen-nit No, J.(O.[ .~..O.'~,.. ...~. [~~~ ..... TOW~-OF SOUTHU~U (Building Inspector) APPLICATION FOR BUILDING PERMIT Date...~...-..(o.~ ....... 19~..~ INSTRUCTIONS a. This application must be completely filled 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 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 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 authorized inspectors on premises and in building for necessary inspections. (Signaturo, gY applicant, or nmhe, ' p ' ) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. o..c> .............................................................. Name of owner of premises ........ ~ .J.~ .~ .vT~ . . . .~..~.q,.a.t..~...)~ ..................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) . ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No ...... :~2~' Z~ .............. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. ltouse Number Street ,-3 Hamlet County Tax Map No. 1000 Section ........ ~.. ,2D~. .... Block .... .~. ........... Lot../.~.."7.. ]../ ......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ~d.~.l~.-~.. $-% a. Existing use and occupancy ............ ~ .-5'exo.t. · .~. o..3~,e o. c.~e.~ .......................... b. Intended use and occupancy .......... o. ..~.-n. .. ~,xx~..~.~. ~v.o_~_ ............. !3. Nature of work (check which applicable): New Building ..... ' ..... Addition ...~ ....... Alteration .......... Repair .............. Removal .............. Demolition ............ '.. Other Work...~-.~c-O_~. ..... (Descrip. tion) 4. Estimated Cost .... · .°~.~.C)...'..<~...~. ................... Fee .... .q~..~..: .O.. ~ ....................... ' (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling unitsron each floor ................ If garage, number of cars ............................................. ~ ........................... ~. 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 Stories ............................. ! ........................... Dimensions of same structure with alterations or additions: Front ............. .... Rear .................. Depth ...................... Height ...................... Number of Sitories ...................... 8. Dimensions of entire new construction: Front .......... ..... Rear ............... Depth ............... Height ............... Number of Stories ............................. ........................... 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner .. i ........................... 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ....~.;~. ......................... 13. Will lot be regraded ............................ Will'excess fill be removed from premises: Yes No 14. Name of Owner of premises .~-~$ o. ~ .......... Address ................ i.. Phone No ................ Name of Architect ........................... Address ................ . .~. Phone No ................ Name of Contractor~,~ ~,.~?~ .~ ~.c.~.~X~r,~.~ AddressBq)~b ~'~'zff. ~,.L~c~ 1~. Phone No..'3. too~-7..~.~..q.<~. 15. Is this property iocateh:t--Jaithin 30~-)feet of a tidal wetland? ~Yes; ..... No ..... ~If yes, Southold Town Trustees Permit maybe required. PLO-T DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from ~roperty l/nes. 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 .~OUNTY OF ................. ................................................. being duly sworn, dep(~s and says that he is the applicant (Name of individual signing contract) ,. ' ove named. ~ i~ is the~ (Contractor, agent, corporate officer, etc.) ~f said owner or owners, and is duly authorized to perform or have performed the sa:id;w~ork and to make and file this pplication; that all ~tatements contained in this application are true to the best of his l~owl~dge'v and 1Jelie~'; and.-that the ~ork will be performed in the manner set forth in the application filed therewith. ;worn to before me this ........... ~:..; ........ day of ._... ~ ............ 19 ?.'7 ~, ~0tary Public, .~... Y. ~..t..~..~J/..~.. N01~q,~..~_Y~ ~ _ ' (Signature of applicant) ~ Ir..xplres MIsCn ~ J,,~ /