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HomeMy WebLinkAbout15367-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy h Z15482 o .................. Date .. QD.~mD~X. 9 ................... 19 .~ THIS CERTIFIES that the building ~.ccg. s~.gry, ' Location of Property ....~.45.5...H.qr.r. ~.Lp. qk..a. Lafie . Mattituck · House No. Street Hamlet. County Tax Map No. ]000 Section ... $~-.5 ...... Block ...Q.~ .......... Lot .... .0~ ........... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·. S.o.g.L 3. Q 19 8.6. pursuant to which Building Permit No ~%53.67.~ . dated .... .O.~. '9. :..6 ................. 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 ig ......... Accessory building. Antone E. & Jean M. Mileska The certificate is issued to ........................................................... (ownerd~sKe~g. rx*.~:'~R~× of the aforesaid building. Suffolk County Department of Health Approval ...... N./.A ................................ UNDERWRITERS CERTIFICATE NO .............. .~./.~. ................................ Building Inspector Rev. 1/81 FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERA41T (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15367 Z County Tax Map No. 1000 Section ...... ,J.../...,~'~.. ....... Block ....... .~...~.. ........ Lot No......~.....~ ............. pursuant to application doted ...(~....~..~...~.....! ...................... , 19..~..~., and approved by the Building Inspector. Building Inspector Rev, 6/30/80 FORM NO. 6 TOWN OF 8OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY ~)~- ~, O~ Instructions A. This application must be filled in typewriter OR ink, and submitted ia=,,--~,- 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: ' 1. Certificate of occupancy $5.00 2. Certificate of ohcupancy on pre-existing dwelling $15.0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5.Updated C.O. $15.00 Date .......................... Newconstruc%ion ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ................................. . .... House No. Street Ham/et OwnerorOwnersofProperty../.~...'~/,'~.~¢fY/.;~...~. ..............?.~../~..~. . .~..~.~. .~..-,'~../.~.~, ................ //'57 BIo k ~ ~. Lot ~ ~ County Tax Map No, 1000 Section .............. c ............................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters ~pproval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $...-~ ...... ~ ................. Construction on above described building and permit meets all applicable codes and regulations. Applicant,...~...~'..c~/?....~..'~.. ,~ ............ rlmLD I.S~ m~iON FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & ?LUMBING INSULATION FERN. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 7G5-'~802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING (~~]FINAL REMARKS: DATE FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined. (2D.~.~7..°e~'A~..(0.., 19~ .~. Approved .~ .~.~...~.., 19~.~ . Permit No).~,'.~..~-I..~... Disapproved a/c ..................................... ................................ APPLICATION FOR BUILDING PERMIT Date .......... ?.: .~..~.., 19~.~. INSTRUCTIONS a. This application must be completely filled~l~n~r typewriter or in ink and submitted to the Building inspector, with 3 sets of plans, accurate plot plan to scale. Fee il~edule. b. Plot plan showing location of l~ot~a~ ]~rem,~ relationship to adjoining premises or pubhc streets Orcation.areas, and giv~g a det~led desc~ X~ ~ ~[~ drawn on the diagram which is pa~ of this appli- c. The work covered b~c~o~~ ~nced before issu~ce of Bu~d~g Permit. d. Upon approval of th~(~ti~h¢~il~ ~or will issued a Buildhg eemit to the applicant. Such pemit shall be kept on the premises ~fo~ ~ ~t the work. e. No bulldog shall be :~2~ ~a~ for any purpose whatever ~tila Ce~ificate of Occup~cy shall have been granted by the B~ HEREBY~ ~uildin APPLICATION IS [~,~ g Depmtment for the issuance of a B~lding Pemit pursuant to the Building Zone Ordinance of the T~Df ~uthold, Suffolk County, New York, ~d other applicable Laws, Oxd~ces or Regulations, for the construction o~fiild~gs, additions or alterations, or for removal or demolition, as hereh~ described. The applicant agrees to comply with all apphcable laws, ordinances, bufld~g code, housing code, and regulations, and to admit authorized inspectors on premises and ~ bulldog for necessaw inspections. ~ ~ .... ................ ~gnature of applicant, or name, if a corporation) State whether applicant is owner, lessee, agent, ~chitect, engineer, generm contractor, e~ectrician, pmmaer or ouilder. ........... .................... ....... % ....: ........... ..... -- ~ (as on the ~x roll or latest deed) . , '_. ' ' ' rize ' r ~ ~' ~- ~' ~ ~ ~ If applicant is a corporation s~gnature of duly autho d office ¥.;~11r'Y~LD NG 'OE~AR'f~NT ~T ~':-~180;.t 9 ~ TO ~ ~ ~R THE .............................................. : F*q. OWING [N~ECT (Name and title of co,orate officer) ~O[Ji~q)A'e[O~~ '~O Builder's License No...~ .............. ; qOtK~w ~RAMiN[* ~ Plumber's License No ......................... 4, ~oA~;&t [XI&~$T~D{~TtON MUST ~lectrician's License No ....................... ~[t ~, ~8~ ~,JCrtg~ davit ~T O~her Trade's License No ...................... ~A~ ~X}NST~-~OtP'~O~ ~ 1. Location of land on which proposed work will be done.. [.~ff5~. ~~~ Itouse~ Number ......................................... Street ~~~~ Hamlet ........ V / County Tax Map No. 1000 Section . .. Z/.O~ ......... Block ..... ~ ........... Lot...~'. ............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy, . ........ .~...r~Z... ~...~ ............................. b. Intended us~ and occupancy ...~~.~L-~....J2A~....~ .......................................... ' 3. Nature of work (check which applicable): New Building .......... ~ Addition . .. ....... Alteratio~ i~ · · '~ ..... Repair .............. Removal .............. Demolition ........... i.. · Other Work ..,~-f~-.. ~-... (Description) 4. Estimated Cost............$.~,~.O~O ....................... ... Fee ..................................... (to be Paid on filing this application) 5. If dwelling, number of dwelling units .... , ........... Number of dweiling umts on each floor ................ If garage number of cars ' 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... ?. 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 oflSt ' · · orles ...................... 8. Dimensions of entire new construction: Front ..... /..~/. Rear g z/~ Depth . ,~2.~. :. Height ~. ' Number of Stories / 9. Size of lot: Front .... /..~.ff.* ............. Rear ... ?.W. ~./ ............. :Depth ...--2-. ~.~ ........ ' ....... 10. Date of Purchase · ./.~'. ~. .................. Name of Former Owner . .C . .~.75.Af~. .............. 11. Zone or use district in which premises are situated ./2.e.5. . ' . 12. Does proposed construction violate any zoning/aw ordinance or re~u/ation: . .,~t~.o. ..................... 13. Will lot be regraded .... A/cd.; ...... , ........ ; ....Will excess~fill be remove! from premi~esl ' Yed' 14. Name of Owner of premises ~...'.~....~. X~..fAf.~. Address ~'~7'77.~ 7--~,~. Phone No Name of Architect Address ~ Phone No Name of Contractor Address ~ Phone No 15. Is this property located withint.00 feet of a tidal wetland? * ~es ..... No .~... · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or descnptmn according to deed, and show street names and indicate whether interior or corner lot. L. oa,~ vv ~ ,o STATE OF NEW YORK, S.S COUNTY OF ................. ................................................. being duly sworn, depc (Name of individual signing contract) a'bove named. sea and says that he is the applicant He is the ......................................................................................... (Contractor, agent, corporate officer, etc.)' of said owner or owners, and is duly authorized to perform or have performed the s~hid work and to make and file this application; that all statements contained in this application are true to the best of hN knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this .............. / .~. · ..... day of ........ .~...C,,~... ........ 19 Notary Public, ........ ~'~C-'...' · .~.~ · · . ~. g..d~County .~ c,. · ................. '~'-~ ~'7 {f (Signature of applicant) Isrm Expires Marsh 30,1 ......