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HomeMy WebLinkAbout15420-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. .Z1508.5 . Date November 12, 86 THIS CERTIFIES that the building Wood burning stove. Location of Property 565 SOUND A~/E. PECONIC House No. Street Hamlet County Tax Map No. ! 000 Section 0 (57 .... Block 0 2 . .Lot 0 J. Subdivision ............................... Fi/ed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in tiffs office dated ..... Qq~:.., .1,5 ........ ,19 .8.6. pursuant to which Building Permit No. 15420Z dated .0¢.t.,~. 22 ................... 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 ......... W. ood burn. iI,lg sto.v,e. The certificate isissued to TERESA & GENNARO CAPPASSO ..................... x .................... of the aforesaid building. Suffolk County Department of Health Approval ......... UNDERWRITERS CERTIFICATE NO N/A ' Rev. 1/81 ding Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 15420 Z Permission is hereby granted to: © at premises located at .....~.-.~......~.......~' .~....~.....~~i.c~.. .................................. County Tax Map No. 1000 Section ...... ,(~...~...~.... Block ....... ,.~.....,~.. .... Lot No .......~.....J ............ pursuant to application dated ...... .(~....~......~-~,..)...~.. ............. , 19...~...~% and approved by the Building Inspector. Fee $ .......... : ............. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hail Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink. and submitted m Ilmaa~m to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate (ocation of all buildings, property lines, streets, and unusual natural or topographic features. -- 2. Final approval of Hea~th 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. Bo For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of pzt)perty showing all property mines, 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. Fees; 1. Certificate of occupancy $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 Date.../.(/./.~/.f .~. ............. NewtOnS truc ~,ion ...... Old or Pre-existing Building ............ Vacant Land ............. ................. Location of Property ...................... ~ ,, House No. Stree~ Ham/et Owner or Owners of Property ..... ~/..~:~.'..~'~'... ~ ............... County Tax Map No. 1000 Section ...~.~ .~. ....... Block ..... .¢..~. ...... Lot ..... .O.j ........ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. ~..~'.~.~..d..Z-~. Date of Permit ./.¢.~.2.../.~...Applicant... ~'.~4_M-¢~-¢~ ..... .~.....~... ..... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building a¢~t'n~..~all~ap/~le codes and regulations. Applicant,..~...~, .~..t~....~...~f,...~ ............... Rev, 10-10-78 'OUNDATION 'OUNDATION ~.. 1st) (2nd) ~OUGH FRAME & ?LUMBING ]NSULATION PER N. Y. STATE ENERGY CODE ADDITIONAL COMMENTS: 'FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved .c~.*...~F...~-~.....&..%W., 19~.¢.· Permit No./..~. ?.o~..0. ~ Disapproved a/c ..................................... ................................ ..... (Building Inspector) APPLICATION FOR BUILDING PER~IT INSTRUCTIONS Received ........... ,19... 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 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. N~ bui~ding sha~~ be ~ccupied ~r used in wh~~e ~rin ~art f~r any purp~se whatever unti~ a Certi~cate ~f ~ccupancy 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 insp,~tions. ,~' (Signature of applicant, or name, if a corporation) .... (Mailing address of applicant) State whether applicant ~ssee, agent, architect, en~neer, general contractor, electrician, plumber or builder. If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. .. 4. ..... Plumber s License No ....... - ........: ... ...... Electrtcmn s Lmense No ..... : ....... ~; 4;-~,';)~ .... Other Trade s Lmense No ......... -. ,~..:~,? ...... . ~.~ ~ 1. Location of land on which proposed ~work will be done .............. ...... .... ...... ................ ,~douse lqumber Street Hamlet County T p No. 1000 ;) ~ Oq~. ' ~-.I. ................... a?~ S,~L .................. Block._ ............ Lot Subdivision~.~.. , :. Filed Map No ............... Lot ............. ,. (Name) 2. State existing use a~d occupancy of premises and intended use and occupancy of proposed construction: a. Existing use.a~o~occupancy . ...... . ....................... b. lnt~and occupancy ........ ~..G-~-~ .... /aZ'./. ~ .~. ........................ ' .... 3. Nature of work (check which applicable): New Building ' Addition... !. Repair .............. Removal .............. Demolition ............ ;I' 4. Estimated Cost .. Fee ....... i. .... Alteration .~..' .~..~..~,'. Other Work .............. (Description) (to be phid on filing this application) on each floor 5. If dwelling, number of dwelling units ............... Number of dwelling units~ ................ If garage number of ; .' .... , cars ........................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each typ& of use ..................... 7 Di sions of isting structures if any: Front Rear Depth · ' men ex , ..'.. ............. ... ... ~... ................. .. Height ............... Number of Stories ............................. ] ............................ Dimensions of same structure with alterations or additions: Front ............. i .... Rear .................. Depth ..... ~ ................ ',h ' ' ~, t ...................... Number of Stones ...................... 8. Dimensions of entire new construq ~ ~rox~ ........ '.. ..... Rear ........ ~ ...... Depth ............... .: .............. ................... ; ........................... 9. Size of lot: Front ..... ~ ~ Y. x~ .L ~ ............. Depth . . 10. Date of Purchase . :~ .... ~ ~' -~ ......................... ~. '.~...N~me of Fo~er Owner . 4 ........................... ...... ..... .: .... ..... , .... ........ 12. Does propos~oa~uc~ yi~t¢ ~ ~aw, ordinance or regulation' .. . . 13. Will lot be reg~;~. '. '. ,.6 ~ .k~¢~ ...... Will excess fill be r;d;~i~ [r~ ~;;nl~es: ..... 14. Nme of Owner ~ ~. ,~ ..... Ad3ress ......... [...PhoneNo ................ Nme of Contracto~k ~ ~ jr] ........ 2~ress ' ~::: ~:' ']'": ' .' PLOT DI?~G~M ' ~P~OvED ~S NOT~ Locate cle~ly ~d distinctly ~l build,ss, whether existing or proposed, and, ifidicate fll set-back d~ensions from prope~y ~nes. Give street ~d block number or description according to d~nd sho~t~ a~he~er interior or corner lot. . ' t o]~ / NOTIF~ 8UI~DING O~PAflTMENT 7~54802 9 AM TO 4 ~ FOR THE STATE OF NEW YORK, COUNTY OF ................. S.S FeLt OWING! IN,.~PECTIONS: FOUNDATION YWO ~6QUIRED r;OR POO~l~ LON(.RL i~ ................................................. being duly sworn, de] ~oses and says that he is the applicant (Name of individual signing contract) above named. He is the ........................................................... , ............................. (Contractor, agent, corporate officer, et?.) of said owner or owners, and is duly authorized to perform or have performed thd said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the ~vork will be performed in the manner set forth in the application filed therewith. 5worn to before me this ................ /.~.......day of ..... ~.C~ ........... , 19. qotary Public ........ ~,~-,~d... ~:;.0~..~..k~... County ~_~:~_~.~