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HomeMy WebLinkAbout15202-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No .Z.17.4.83. Date D?.c. em.b~r 9 19.8.6 THIS CERTIFIES that the budding Addition · 830 Ga~ens L..andin~ ' Southold Location of Property .......... House No. Street Ham/er County Tax Map No. 1000 Section 0.7.0. ..... Block .. ~.0. ........ Lot 023 Subdivision ........................ ...... . Filed Map No ........ . Lot No .............. conforms substantlally to the Appl,catmn for Building Fcrmit heretofore filed in this office dated ·...~9~.'...2.8 ........... 19 .8.6. pursuant to which Braiding ?¢rmit No .................. dated ...A. 9~.-..2..8 ................. ! 9..8.6, was issued, and confor=s to all of the requirements or' the applicable provisions of the law. The occupnncy for which this certificate is issued is ......... The certificate is issued to Al.l.e.n & .~a..r.a..13..n' Sobe.1 ............... (owner, tt'mn~x of the aforesaid building. Suffolk County Department of Health Approval ....... I~I/,A, .......................... .... UNDERWRITERS CERTIFICATE NO %I/A ............ Rev. 1/81 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) N©. 15202 Z Date ..~/d~...~......~....~ ........... , ]9.~,..(O Perm,ss,on ,s hereby gr~. ~ ~.~ ~......~.~..~ ............................. __ ~.~.....~.,.~,....!..~...~...~..~... , ................................. nt premises located at ..~...~....~........{a~..~,tl,~ ....~~ ...... ~~ ... County Tax Map No lO00 Sect,on 0.") .~... Block ..... ~..0.. ....... Lot No ..... o~.....~ . . to apphcat,on dated . . .(-~-~., .4.4~.~..~ ........ , 19 .~e, and approved by the pursuont Building Inspector. Fee $. '~.~ '/ Building Insp~tor DEC - 9 Lo, 6 FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. Thts application must be filled in Wpewmter 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 buildings, property lines, streets, and unusual natural or topographic features. -- 2. Final approval of Health Dept. of water supply and sewerage disposel-(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 responmble for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. For existing buildings (prior to Aprd 1957), Non-conforming uses, or buddings and "pre-existing" land uses: 1. Accurate survey of p~operty showing all property lines, streets, buildings and unusual natural or topographic featu res, 2. Sworn statement of owner or prewous owner as to use, occupancy and condition of buildings. 3. Date of anv 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 Cert~hcate of occupancy 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. Sis. 00 Date.., ~., . .~.~.. New C on s % r uc t · on ...... Old or Pre-existing Budding ............ Vacant Land ............. Location of Property ,. 0~, .~,,~) ........ ~, .~. ~. ,~.~.~.. ~. 4~,'Z~'~/',~~' ........ ~'~/~)Z-/zL~. ,~.., .~, ~' House No. Strut ~,, /') , J) 'Ham/et /'" Owner or Owners of Property.. ,~g,"-/..~-~.......~~.~~ ' County Tax Map No. 1000 Sect,on .... ~.~) ...... Block ..../'~9 ......... Lot. z~ .'~.. ~. ........ Subdwmlon . . ,~. ............... Filed Map No...~<. ..... Lot No....~. ....... PermltNo. ~.-~.~;~ .'~.~. Date of Perml, ~./?.~//~.Apphcant .~/¢g'~..~ ............ Health Dept Approval ..................... Labor Dept. Approval ....................... Underwmters Approval ....................... Planning Board Approval ...................... Request for Temporary Certificate ................... Final Certificate // Fee Submitted $.~¢.~. ~ .. :~ .~-~0 ........ Construction on above descr,bed budding and permit meets all_aTlpble codes and regulations. Applicant .~'/~...~2~-~¢'.,,: ............................ FOUNDATION ( ls t.) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING 3. INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: b~-C_K { 6'0" 7GS-1802 BUILDING DEPT. INSPECTION [ ] FRAMING REMARKS: FOUNDATION 1ST []ROUGH PLBG. FOUNDATION ZND []INSULATION []FINAL DATE NXF TERP VA C NXP TE t~ P N 01~8 ?0 35' ~ GAG£IV$ L~NDING ROAD DESOHIB~'D PROP~'t~TY A T SOU THOID TOWIV OF SOUTHOI-D SUFFOLK CO, iV. Y. 0,$1~ AQHK lend surveyors (]nd cons ulting engineers 515west moin street riverheed,new york 11901 (516) :569-1717 (212) 746-:5020 Mor 12,1983 Job N-° 85- 218 I000 - 70-10-2_3 Scale .1" =~0' Examlne~.o~.~..51,5{ , 19~.{o Approve .... ~. '~., 19 Disapproved a/c ........... ..... (Building Inspector) APPLICATION FOR BUILDING PERMIT TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL Tfik.. 7~5-180~ Rece3. ved ........... ,19.. Date .......... , 19.. INSTRUCTIONS a. Tkis apphcahon must be completely filled m by typewriter or in ink and submitted to the Building Inspector, w~th sets of plans, accurate plot plan to scale Fee accordmg to schedule b Plot plan showmg locatmn of lot and of buddings on premises, relationship to adjomlng premises or pubhc street or areas, and giving a detailed descnphon of layout of property must be drawn on the diagram which ~s part of tins appli cation. c. The work covered by tins apphcat~on may not be commenced before issuance of Bmldmg Permit. d. Upon approval of tins apphcatlon, the Building Inspector will issued a Budding Permit to the applicant. Such perm~ shall be kept on the premises available for inspection throughout the work e. No bmldmg shall be occupied or used in whole or in part for any purpose whatever untal a Certfficate of Occupanc- shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Bufldmg Department for the issuance of a Bmldmg Permit pursuant to th Bml&ng Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of buildings, add~taons o/w~erat~ons, or fo.~'jemoval or demolition, as hereto descnbed The apphcant agrees to comply with all apphcable laws/ordu~ances, bufldm(g,6ode, housing code, and regulations, and t, admit authorized mspectors on premises and m bufldmg//or/d'/efessaryAnspectl~as. ,~ rO ~ " {.~Sig~ture of applmant, or name, if a corporation) . .,./,A/-, . // .... (Marling address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises ~ ~.0-/' , . .~-: .... (as on the tax rolI or la~l/deecl)jr'-''- 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 .... Location of land on which proposed work wall be done ~..--~.. ~ ,4~ ,t~'~..~J.-F ~---. -~...-~'.,~. / ~:'/.,~ . ..... House Number Street Hamlet County Tax Map No 1000 Section ~/9~3 . Block ./'~) ..... Lot. Z~9. ~.cfl ....... Subdivision · ' 7 .. Filed Map No .Jcl .... Lot. ,~ (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction a. Existing use and occupancy t~O.,,~t~. ............. b. Intended use and occupancy . . ,.Og-q2cr/~ ......................... Repmr ... ~Removal ......... Demolition er (Description) 4 Estimated Cost ..... ~.~z~d~ ~) ........ Fee ......................... " (to be prod on fihng th~s apphcatmn) 5 If dwelling, number of dwelling units ......... Number of dwelling units on each floor .... If garage, number of cars .................................................. 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 ......... Height ........ Number of Stones .................................. DLmenslons of same structure with alterations or additions Front ........... Rear .............. Depth ............... Height ............... Number of Stones ................ - 8. Dlmenmons of entire new construction Front ..... Rear .......... Depth ..... Height ............ Number of Stones ...................................... 9 Size of lot Front .......... Rear ................ Depth .............. 10. Date of Purchase ................. Name of Fe,,'-rner Owner ..................... 11. Zone or use dlstnct in wln,.h premises are mtuated ............................... 12. Does proposed construction violate any zoning law, ordinance or regulation ........................ 13 Will lot be regraded ................ Will excess fill be removed from premises: Yes ~ 14. Name of Owner of premises .... Address ........... Phone No ......... Name of Architect .......................... Address ............... Phone No ............. Name of Contractor .................... Address ............... Phone No .......... 15. Is this property located wzthxn 300 feet of a tidal wetland? *Yes ..... No ..... *If yes, Southold Town Trustees Permzt maybe required. PLOT DIAGRAM Locate clearly and distinctly all buddings, whether existing or proposed, and indicate all set-back dunenslons fro property lmes. Give street and block number or descnptmn according to deed, and show street names and indicate wheth interior or corner lot STATE OF NEW YORK, S S COUNTY OF . . . .... a~me of l' .~'' t~' ': ......... being duly sworn, deposes and says that he is the apphca ndlvldual mgnmg contract) above named He is the ... (Contractor, agent, corporate officer, etc ) of said owner or owners, and is duly author~ed to perform or have performed the said work and to make and file ti apphcation, that all statements contained m this apphcatmn are true to the best of hm knowledge and belief, and that t work will be performed in the manner set forth m the apphcatmn filed therewith. Sworn to before me this - 19~.~ ........ ~. ..... day of ~ ............ ~.~_~_ I~ (S~gnature of apphca,