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HomeMy WebLinkAbout15405-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Date .......... D.ece. mb..er 9. .............. .... 19..8.6 THIS CERTIFIES that tbe buildingWoo.d.s.tove ' 405 Pine Neck Rd. ' Southold Location of Property ............................................... House No. Street Hamle~ q County Tax Map No. 1000 Section 0 7 ...... Block 0 6 .... Lot Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated O. ct. 16 19.8.6p to hioh Building Permit No 15405Z ................ , . ursuant w .................. dated .Q~ ~3 ,..%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 is ......... .e.x, i q t $[,n.g .f i.r.e, p 1 .a~ ...... SoliD..lurk .~O.v.e.. SO.s.i.d.¢ ......... e.: .............. . ......... The certificate is issued to ........... D. ONA.L.D. & .JOAN.. ...... .V, ON..E.I.F.F. .............................. {owner, of the aforesaid building· Suffolk County Department of Health Approval ....... .N/.A. ............................... UNDERWRITERS CERTIFICATE NO ............... .N/.A. ............................... l~t~g I~spector ............ Rev. 1/81 FOB. M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING pEIJJ~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 1540~ Z Permission is hereby granted to: .... ...... u..~:..c~.~ .......... ~ ............. .... .c=..~,,.....,g...:.~.:.....t./..~..&~ .......... ............................. lJZ~J .......... ~ ............ ': ....... ~2'". .......... C~; ....... '. .... County Tax Mop No. 1000 Section ~ -j ~ Block ~ .~.. Lot No. ~ I ~, pursuant ,o application doted ..... (~..~...~....~. .................... , 19..~..~..., and approved by the Building inspector. Building Inspector Rev. 6/30/80 FORM NO, 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- I802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted m Jam~Ja to the 8uildlng 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 dlsposal-(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 a~d instalta- 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 pZOperty showing all property lines, streets, buildings and unusual natura~ 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 oc_cupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. Updated C.O. $15.00 $15.00 Data .... ............ acan and ............. New C on s % r u c t i on ...... Old or Pre-existing Building Location of Property .... House No. St:reel: Ham/er Owner or Owners of Property ,. .~. 4%~'/. .......................... County Tax Map No. 1000 Section C) 7© Block ., Lot ....... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. /'.~..~ .z(z.°..5~.. Date of Permit G. .Applicant . .'~;/. q, ./g ....... Health Dept Approval Labor Dept Approval ' Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ..... .P~... ............. Fee Submitted $ .~. 7 .. ....................... Construction on above described building and permit meets all applicable codes and regulations. e,. 0.,0.Ta 765-X802 BUILDING DEPT. INSPECTION FOUNDATION IST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING ~NAL ~REMARK · L FIELD INSI'ECTION FOUNDATION (lst) C OM,,~E,J'I S FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE ADDITIONAL COMMENTS: FINAL FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL COUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined .~.~. ~. ! .('.., 195.~. Approved ~..~...o~..... !~.., 19~..(,,. Permit No..}..~.9.°.~.~ .~z.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERi~/IIT .Aeceived ........... ,19... Iio ~[,z.o._ [Jo-e_. Date .................. , 19... INSTRUCTIONS a. Tkis 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 ~ 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, an¢ regulation~s, and to admit authorized inspectom on premises and in building for necessary inspections, f/_~..~/~. (Signature of applicant, or nal/ie, if a corporaff~'fi) ..... ?.. (mlilifi~ address of'a~iiclni)' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or I . ............... ~,~4z//. ~. ......................................... .. · ~, ........................... Name of owner of premises .... ~..~.~ iq/.</. .rfP....~f~'z'~/0...~.~.. ~-7~...~.~. · .~. · ........................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No......~.. ~ ......... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ..... ~./.4Z¢..../~.~...c, .~/... ~.o..dA, C/ ............... ............................................................... ................ House Number Street Hamlet County Tax Map No. 1000 Section ... Q../~.~ .......... 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 ..... ~f~..<~.~--. ....................................................... b. Intended use and occupancy ............... ~. · .. ~..~r~.. . .. 3. Nature of work (check which applicable): New Building ....... Addition . .... ~ ........ Alteration .......... Repair .............. Removal .............. Demolition ............... Other Work. d~.. 4. Estimated Cost . ..~./.~.o.O. ............................. Fee .......... i .......................... (to be ipaid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars ............................................ i ............................ 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 ight f St He ............... Number o ories ............................ i ............................ Dimensions of same structure with alterations or additions: Front ~ Rear Depth ...................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front Rear ....................... l ....... Depth ............... Height Number of Stories 9. Size oflot: Front ...................... Rear ...................... iDepth...................... 10. Date of Purchase ............................. Name of Former Owner .i ............................ 1 1. Zone or use district in which premises are situated 12 Do pr posed ti iolateany oni gl ordi eg lati · es o construc onv z n aw, nance or r u on: .... i ............................ 13. Will lot be regraded ............................ Will excess fill be remove~ from premises: Yes No 14 Nam fp i Add ~ N · e of Owner o rem ses .................... tess ............... ~ ....Phone o ................ Name of Architect Address ' Phone No Name of Contractor Address Phone No 15. Is this property located withinl.00 feet of a tidal wetland? * .Yes ..... 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 description according to deed, and sho~ street names and indicate whe, ther interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF ................. ................................................. being duly sworn, depo?es and says (Name of individual signing contract) ~ above named. ~ that he is the applicant He is the ............................................................. ! ........................... (Contractor, agent, corporate officer, etc.)i of said owner or owners, and is duly authorized to perform or have performed the s dd work and to make and file this application; that all statements contained in this application are true to the best of hi, 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 NOTJ~ofNewYo~k "/ /~/// (Signature of a~J~a'~t) . Ne. 47d7878; Suffolk County.,¢ ,~ J~tm Expires Msrch