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HomeMy WebLinkAbout15325-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Z15169 J..a n.. 6 198.7 No .................. Date ............................. ,. . THIS CERTIFIES that tbebuilding ....A. ccess.o.r.y barn--install plumbing · Location of Property ....4 4.9~3.(~ ~M&2.I~ .Ig0/~ ....... $0]J.ZttO~D .......................... ~ouse mo. Street Hamle~ County Tax Map No. 1000 Section 075 . ·Block ,0.6 ...... Lot 7. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated 15325z .... .S.e.p .t :..2.2. ........19 .8.6. pursuant to which Building Permit No ...................... dated ....S .e p.t.....2.4 ................ 19 .8 .6., 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 ......... · ,.T.q p.ut g.l.u.m, bing. in .an. e.xisting accessory barn. . The certificate is issued to ...% l M O.T. RY. C.O.F. E $ % ........................................ (owner, l~,~g~eYoX iO~I~X X of the aforesaid building. Suffolk County Department of Health Approval ........... ~ {~ ............................ UNDERWRITERS CERTIFICATE NO .................... ~./A .......................... PLUMBERS CERTIFICATION I/5/87 Rev. 1/81 / Blfllding Inspector FOB~ NO, ~ TC~VN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUll. DinG PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Z Permission is hereby granted to: ..~.~.~.~ ........ ~.~.~.: ...................... , ,..~. ....~.....~...~.,....u~.~.! ....... ta ....~.~.,~**..:,~**~' .... ~..~..~* ~ ..... 0-~...~ ......... '~'"'"~'~'"~"~' ~"'"< :': ........ ','""~ ........ ~"~"~ ........... i ..... et premises located et ............................. .v-v-.~,.e-4~:~'~ ........................................................... County Tax Map No. 1000 Section ....... ,,C~,..'~.......~,.'~..... Block ....... ~.b. ..... Lot No......~J...'.J ............. pursuant ,o application .dated ,,....~...~..~......'~....~. ....... , 19,~..~.., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. $ TOWN OF SOUTHOLD Building Departmant Town Hall $outhold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY NOV I 01986 Instructions A. This application must be filled in typewriter OR ink, and submitted ~ I~aammaaa 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, =~reets, 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 iprior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~oparty showing all property lines, streets, buildings and unusual natural or topographic features. 2.Sworn statement of owner or previous owner as to use, occupancv 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: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $15.00 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 ....... 5.Updated C.O. $15,.00 Dat, e . ~)~ %., ..... i 'i"ii"i ...... NewC°ns truc t'i°n ...... Old or Pre-existing Building ......... Vaca a ........ .4 ~.4.q. ~.,q. '- ¢.7H "/. D. Location of Property ... .0..~.., ~.~. I./..L?.. ,~ O House No, Street Ham/et Owner or Owners of Property ........... ; ................................... Co~nty~ax Map No. ~000Sect~on .... 7.~ ....... B,oc, ... ~ .......... tot....~.:.l ..... .~!~.~.T Subdivision ................................. Filed Map No ........... Lot No .............. Permit ,o./.5 ~..?. Zf Date of Permit .......... App,ica~t .................................. Health Dept, Approval ........................ Labor Dept, Approva~ ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certific~ate ..................... Final Certificate Fee Submitted $ " Construction on above described building and/P~'m,~...ee~.~EI p.~. I.~/able codes and regulations, Applicant, ,~~~~; 10.10-78 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date //~'~/~ 7 Building Permit No. Owner ~p~ease r~rint~ Plumber /l'/O ~"~/J ~ ~-';'T (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. ~__~,--~plumber '~s ,~igna~ure ) Sworn to before me this day of ~ , Notary Public, ~/~ County Notary Public NOT, HF.J.EN ~,RY PUBlIC, State of I~ew '/ora No. 470787~ Suffolk Count~ Term Exp FIELD ~NSPE~CTION COMMENTS FOUNDATION FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~*OUTHOLD, N.Y. 11971 TEL.: 765-1803 Approve~t~....~2~......'~.~.., 197.~. Permit No. [.~-'..~..~ .~'...~ J .......................... BLDG. TOWF~ OF SOUTHOLD Received ........... ,19... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date ............. 1 ... 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 buildhl~l on prl~mises, rg~ationship to adjoining premises or public streets or areas, and giving a detailed description of layout c~e$~st ~l~'~wn on the diagram which is part of this appli- cation. -t~k ~.~'O~~ , e~-. ~ .... c. The work covered by thisapplicafionn ,~t~be~L'~lll~'bl!~gl!l~'~lt'orelssuanceofBuildmgPermit. d. Upon approval of this application, ~n~J~i~ i'ssued a Building Permit to the applicant. Such permit shall be kept on the premises available fei ~N~c'tlqkf~'~[g~L~ ~vork. e. No building shall be occupied,,.(l~'~ i~w'hi~oz~h'~ ~ny purpose whatever until a Certificate of Occupancy shail have been granted by the Buil~[t~,~c~ '~.~q[,~,,~ ~,~ - ,,~ ~ ~n,'m~- - ' APPLICATION IS HEREBY MA'~i~ ~ _I])~l/~ent (or the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town~.~~6unty, New York, and other applicable Laws, Ordinances or Regulations, for the construction of bu~'~d~OF_a, lteration_s, or for~.~enevxal dez.~oli~,~s herein described. The applicant agrees to comply .with all a]~i~e~ ordinances,.builgiff~"l:ode, 1~ ~r;~;/,4gl~, ~ regulations, and to admit authorized inspectors on premises and in ~ing for necessary i~ ~ [SigrP, tture of~lSli tJn~n'e',}; ;co};;;a'tion') .... tmazJ_zng -aoor~ss or appJ_zcann) State whether applicant is owner, lessee, agent, architect, engineer, general contractac,.81e_~trici~,p,~ p~n~ltago~ Jl~lder. Nme of owner of premises ...~ ./~. ¢. ~.. G¢.~ ........... ~g~.~. ~ ~. *O' 4. ~.mR. THE... (as on the tax roll orF~ If applicant is a co~oration, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... 3, INSULA rtO~) 4-, FINAL C¢)~$TFIUL'T~ON MUST ALL CO~aSTRUCDON SHALL MEET THE RfiQUtRE~t:NT50~ ~ N.Y ~D~ NOT ~NS~ ~ DDS~GN OR CC-NS~UCT~ON ER~RS, Other Trade's License No ...................... (~ 1. Location of land o~,~2ch prc-oosed work will be done. ~..~.O. .... ~../~./../t?.....~_..c~..x.x] ................. ....... .... ............ ................................................ House Number Street ~J 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...~./~.~...~. ....... ./~..6(..~. ~. · .~L. .................................... 3. Nature of work (check which applicable): New Budding .......... Ad&t~on .......... Alteration :,~.. ] .... Repair ..........-r- ~%., ... Removal .............. Demolition .............. Other 4. Est~ated Cost ...... ~ .......................... Fee ...................................... ~ (to be paid on filing this application) 5. If dwelling, number of dwellin~ units ~. ~. .......... Number of dwelling units on each floor... ~ .......... ' ' If garage, number of cars .... ;~ ~ ~ ~ ................................. , .............. 6. If business, commercial or mixed oc~pancy, specify nature and extent of each type of use ..................... 7. D~ensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ D~ensions of same structure ~ith alterations or additions: Front ................. Rear .................. Dep~ .................. ~... HeiSt ...................... Number of Stories ...................... 8. D~ensions.o~ntire new construction: Front ............... Rear ............... Depth ............... Height ../.~ .......... Number of Sto~es ........................................................ 9. Size of lot: Front...,~.~. B ~.~... Rear ...................... Depth ..... , ................ 1:1. 'Zone' or use &smct ~n which premmes are mtuated ..................................................... 12. Does proposed construction wolate any zoning law, or&nance or.regulation: ................................ 13. Will lot be regraded ....... ~ .................... Will excess fill be removed from premises: Yes No 14. Nme of Owner of premises~.~ P.T~ff¢.~[.. Address ................... Phone No ................ N~e of Architect ......... ~ ...... '. ........ L.. Address ................... Phone No .............. Nme of Contractor ........ ' .................. Address ................... Phone No..~ ............ 15. Is this property located withini,00' feet of a tidal wetland? * Yes ..... Nof~... be · If yes, Southold To~ T~ustees Pemit may required. ", ~ ~J. ~ ~r Locate cle~ly ~d distinctly ~1 bufld~)~f(?j.,~oposed, ~d. indicate ~1 set-back d~ensions from prope~y ~nes. Give street ~d block number or~Ji~rdf~eed ~d show street n~es ~d indicate whether ,o STATE OF NEW. oYORK, i o o COUNTY OF ~ ...... j ..... ~ .//f~7.. Q.~.~.~.~ .....(~.~Q .2~ .,~. fif ................. being duly sworn, deposes and says that he is the applicant (Name of individual siglning contract) above named. He is the ....................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dt~ly authorized to perform or have performed the said work and to make and file this application; that all statements conltained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manher set forth in the application filed therewith. Sworn to before me this ...... ........ day ....,i Note. Pub,it. .............