Loading...
HomeMy WebLinkAbout15176-zFORM NO 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Bmldin§ Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No . .z [ 5. .~ s.5 ...... Date February 18, 1987 THIS CERTIFIES that the building Addition Locat~on of Property 2720 KENNY'S ROAD SOUTHOLD House No Street Hamlet County Tax Map No 1000 Sechon 059 .Block 02 . .Lot 17 Subdivision ................... Filed Map No .... Lot No ........... conforms substantially to the Apphcahon for Building Permit heretofore fried in this office dated ... j. ul. 7.2.?:. 19..8.6. , . pursuant to which Bmlding Permit No t5176Z dated . A.u.~u..s t 6 ,.. 19.8.6.. . . , was issued, and conforms to all of the requirements of the applicable provm~ons of the law Ti~e occupancy for which tlus certificate ~s issued is ..... Add. it. zon..to exz.s.t~ng one family dwelling. The certificate m issued to RAYMOND AND DOROTHEA MELHADO (owner,]~,b~n~) of the aforesmd bmldzng Suffolk County Department of Health Approval . N /A UNDERWRITERS CERTIFICATE NO ............... N..7.9.2.6. 3..3...2 ./.6 / 8.7. ....... PLUMBERS CERTIFICATION DATED: N/A Rev 1/81 / ~)gdln g Inspector · Olt.~ NO. Il TOWN OF $OUTHOLD BUILDING D£PARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 15176 Z Perrn~ssTon ,s hereby granted to ........................................................... at premises located at ..~r,~..~.w~J ....... /.~.~ ........ . .~....~ ~J County Tax Mop No 1000 Sect,on__ OW . Block . ..~....~:.. ......... Lot No .... J."'] ..... pursuant to application doted L~ d,,~~' ~-~ .., J9 ~..(D,, and approved by the Bu,ldlng Inspector Building Inspector Rev 6Y30./80 DUNDATION ( ? st ) ~-~ OUNDATION (2nd) OUGH FRAME & PLUMBING NSULATION PER N. Y. ~ STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FORM NO 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. Thru application must be filled ~n 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 buddings, property hnes, s'treets, 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 electmcal installation from Board of Fire Underwriters. 4. Commercial buddings, Industrml buildings, Multiple Residences and similar buddings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed rote plan requirements where applicable. B. For existing buddings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operty showing all property hnes, streets, buildings and unusual natural or topograph m featu res. 2. Sworn statement of owner or prewous owner as to use, occupancy and condition of buddings. 3. Date of any housing code or safety ~nspectlon of buildings or premises, or other pertinent ~nforma- tmn required to prepare a certificate. Fees: 1. Cert~ficate of occupancy $25.00 -- BUSINESS $50.00 2 Cert~fmate of occupancy on pre-exist~ng dwelhng $ 50.00 3 Copy of cert~hcate of occupancy $ 5.00, over 5 years $ 10.00 4.wo nt o.o. 2o.oo !l 5.updated C.O. $ 50.00 Date .q~..'-. ..~. ............ NewConst~'uctzon ...... Old or Pre-exmtmg Budding ............ Vacant Land ........... Location of Property, ~., 7 Hou~ No. N~let Owner or Owners of Proper~ .. ~.~ ~. ~ .D~r~.<%. ~eJ~V ................. Coun~ Tax Map No. 1000Sectlon ..~.~ ....... Block ...~ ........ Lot.../..~ ........ Subd~wmon ........................... Fded Map No ........ Lot No ............. Permit No. , Date of Permit . .Apphcant ............. Health Dept. Approval ...................... Labor Dept. Approval ........................ Underwriters Approval Planning Board Approval .... Request for Temporary Certificate ............... Final Certificate ....................... Fee Submitted $ .................... Construction on above descmbed budding and p~m~t meets all apphcable codes and regulations Apphcant .~ ......................... TOWN OF SOUTtIOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 To Whom This May Concern, We are unable to complete your Certificate of Occupancy because ,of the following reasons. _/ /_u// An application for Certificate of Occupancy is not on file. /--/- No Underwriters Certificate on file. /_~ The check is(outdated/not on file.) /~/ No Health Dept. Approval on file. /Z/ No final lnspectlon has been made. Please contact our office on this matter. Thank you for your cooperation. Building Permit # Building Dept. / 7Az ***/Z/ No Plumber Solder Certificate on file. ( all permits involving plumbing being issued after April 1,1984 ) / l(~lUIIllllllilllllllllllillilltllllll~ lll[lllllilllllflllllllllf[lllllllllfll IIIIfllllllllliltlllilllllltlllllflltlll 'lllltlllllJlltJlltlllllJllJlllJllllli IIIItlltllllllllllllllilllllli|lJfiJl~ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: DATE /~/~'7'""/~ INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [~IJNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION []FRAMING []FINAL REMARKS: DATE INSPECTOR FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL P, OUTHOLD, N.Y 11971 TEL.: 765-1803 Examine~(~ ~..~.. ~,., 19~~o. ipprove~J~..t~?7...~..., 19'~{~, Permit No. ~.~'.J.'7 .~..~. (Budding Inspector) APPLICATION FOR BUILDING PERMIT BLDG TOV, N OF ~.'e ' Received ........... ,19. Date ...... ,19, INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Budding Inspector, wil sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showmg location of lot and of buddings on premises, relationship to adjoining premises or public str, or areas, and giving a dettuled descnphon of layout of property must be drawn on the diagram winch is part of tins aF cation. c. The work covered by this application may not be commenced before issuance of Budding Permit. d. Upon approval of this application, the Building Inspector will issued a Bufldmg Permit to the apphcant Such per shall be kept on the premises available for mspectmn throughout the work e. No budding shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupa 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 Bmldmg Zone Ordmance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinance Regulations, for the construction of bufldtngs, addltaons or alteratmns, or for removal or demolition, as hereto descril The applicant agrees to comply with all apphcable laws, ordinances, budding code, housing code, and regulatsons, an, admit authortzed mspectors on premises and in buildmg for necessary tnspectlons. (Mailing address of applicant) State whether applicant is_owner, lessee, agent, arcintect, engineer, general contractor, electrician, plumber or buff, Name of owner of premises /~%)t rB. 0nc~. ./~e_ ~?q.~ o .............................. (as on the tax roll or latest deed) If apphcant is a corporatmn, signature of duly authorized officer (Name and t~tle of corporate officer) Buflder's License No. fl I~--,~.. FT~[ .... Plumber's License No / 0~//~ . lectrician's L,ce ,e No Other Trade's License No I Locatmn of land on winch proposed work will be done ............ .. .... House Number Street Hamlet County Tax Map No 1000Section ~. Block ..~. ...... Lot../7 Subdivision ........... Fded Map No .. Lot (Name) 2 State exmtmg use and occupancy of premmes and intended use and occupancy of proposed constructmn a Existlng use and occupancy ,,~i.~ .~l~ r~{~nC~... b. Intended use and occupancy . ~ ~ +~a .~ i")~5 '~' ' ' 3Nature of work (check which apphcab[e) New Budding .. , Addition ./,".. Alterat,on Repmr ....... Removal ........ Demolition .......... Other Work ..... 4. Estimated Cost .................. Fee ......................... ' (to be prod on fihng th~s apphcahon) 5. If dwelhng, number of dwelhng umts.. [ ..... Number of dwelhng umts on each floor ........ If garage, number of c~s ...... 6. If busmess, commercmI or m~xed occupancy, specffKnature and extent of each. type of use 7. D~mensmnsofe~snngstmctures, ffany Front . .~ .... Rear ~X ..... '~e~ih q~..'' ''~ Height · . I{ ...... Number of Stones ..... ~ ....................... D~ensmns of same structure w~th alteratmns or add~tmns Front ~ ....... Rear ~f .......... Depth .. ~ .... He~t [~ ...... Number of Stones.. [ ............... - 8. D~ens~ons of entire new construction. Front ... &g ...... Rear . .~[ ....... Depth ]~ ......... Height . . ~. ...... Number of Stones . .( .................. 9 S~zeoflot FrOnt . lt.~ ...... Rear .~],~ .... '.'~.'Depth ..]~'[~.~.~[~.. I0 Date of Purchase .. ]O[t~l~4 .......... ~ameofFomerOwner ~ O~iTg ............ 11 Zone or use d~stnct ~n winch p[em~ses are s~tuated. ~$(~pp~M ............................. 12. Does proposed construction violate any zomng law, ordnance or regulahom.. 0 ~ ..................... 13. W~I lot be re~aded .... ~ ......... Will excess fill belemoved from premises' Yes N 14. N~e of Owner of premises ~. ~g[~ Address K~q~. ~ ...... Phone No 7~7~$.~&... Nme of ~ch~tect .~.t0a~ .~.~ ...... Address ~ ~ ~.~?. ~... Phone No. 7~ .~(&5 .... Nme of Contractor 15. Is thzs property located within 300 feet of a tidal wetland9 *Yes ..... *If yes, Southold Town Trustees Permit maybe required. PLOT DIAGP. AM Locate clearly and d~stlnctly all buddmgs, whether existing or proposed, and. mdlcate all set-back dnnenslons rrm property hnes. Give street and block number or descnptlon according to deed, and show street names and mdmate whethe ,F '-('l~me of md~vldual signmg contract) (// above named bemg duly sworn, deposes and says that he is the apphcan He is the ............. · ~.--"~---"~ ................................ , agent, corporate officer, etc ) of said owner or owners, and xs duly anthonze t~-T6~perform or have performed the sa~d work and to make and file application, that all statements contamed m this application are true to the best of his knowledge and belief, and that th~ work wdI be performed in the manner set forth m the application filed therewith. Sworn to before me this ...... .day of . Notaj:~Pubhc,, : .,e.~7¢'~ ...~.. ~County ~ 52_-8125850, SUffOLK Ten~ ~r~ (~r 31.