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HomeMy WebLinkAbout15204-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N Y. Certificate Of Occupancy THIS CERTIFIES that the budding DORMER.. ADDITION.. .. ...TO. EXISTING.. .. .. ONE... FAMILY... ...DWELLING. .. Locatlon of Property .. 71.9.5. M.ain B.ayv. i..e.w..R, oad Southold, New York House No Street Ham/et County Tax Map No 1000 Section 07 8 .Block 0 7 .Lot 4 3 Subd~vimon .. ...... FHed Map No ...... Lot No ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated August I1, I986 15204 Z ...... pursuant to winch Building Permit No ................. dated..,Au g.u s. t ..28 ,. 1 ..986 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for wluch flus cemflcate is msued is .. DORMER ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate ss issued to. PATRI.. . CK of the aforesaid braiding. Suffolk County Department of Health Approval & BLASE STIGLIANI .... ?ow.e;, ~;~t9xx ...... UNDERWRITERS CERTIFICATE NO .... N/A N822147 PLUMBERS CERTIFICATION DATED: N/A Building Inspector Rev 1/81 FO]~,M NO. · TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDIHG PERi, IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15204 Z Permission Is hereby granted to Counl~ Tax Map No 1000 Sect,on .... (~'-)..~.., , Block ...... ..~.....'] ...... Lot No....,1~,...~ ........ J pursuont to opphcation dated .~ ~'--~~...I I ...... , 19~., ond approved by the Building Inspector ~..~~.;; ................ Building Inspector Rev 6/30/80 A FORM NO 6 TOWN OF SOU'I'HOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUP~ Instructions Thts apphcat~on must be filled in typewriter OR ~nk, and submitted in duphcate to the Braiding Inspec- tor w~th the following, for new buddings or new use I. Final survey of property w~th accurate location of all buddings, property lines, streets, and unusual natural or topograph lc featu res 2. Final approval of Health Dept of water supply and sewerage d~sposal-(S-9 form or equal). 3. Approval of electrical installation from Board of F~re Underwriters. 4. Commermal buddings, Industrial buddings, Multiple Residences and s~mdar buddings and mstalla- t~ons, a cert~fmate of Code comphance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed s~te plan reqmrements where applicable· B. For ex~stLng buddings (prior to Aprd 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property hnes, streets, buddings and unusual natural or topographm features. 2.Sworn statement of owner or previous owner as to use, occupancy and condition of braidings. 3. Date of any housing code or safety inspection of braidings or premises, or other pertinent informa- t~on required to prepare a cerbflcate. C. Fees: 1 Certificate of occupancy $5.00 2. Cert~fmate of occupancy on pre-ex~sting dwelhng or land use $5.00 3 Copy of certificate of occupancy $1.00 , Date....~. ~. ,~. ( 1...: .... .7... NewBuildmg ........ Old orPre-exist~ngBu~dmg . /~ ...... Vacant Land ........... Location of ProperW/~o:~ .~N.:~7...~. M~-../~ '~ (,1/ ~St~t · _ .... 'A"; .... Owner or Owners of Property ~,~,' ~./t~ ~r~ ~.>/~ ~ ~-'~[ ,~/[ t~Pl f · . .......... ......... County Tax Map No. 1000 Section ../. - .... Block ............ Lot .. Subdlws~on ..... Fde~t Map No. . . Lot No ........ /~'¢~' ' ',x~. Date of Perm,t ~ ¢C~ , · Health Dept Approval ............ Labor Dept. Approval ..................... Underwriters Approval .......... .... Planmng Board Approval ..................... Request for Temporary Certificate ............. Final Certificate ...................... Fee Submitted $ .... i,~w. ~'~. ........... Construction on above described building and permit meets all apphcable codes and regulations. Appl,cant .... ...................... Rev 10-10-78 iP c.3 o!'7 Memorandum from .... BUILDING INSPECTOR'S OFFICE TOWN OF SOUTHOLD TOWN HALL, SOUTHOLD, N Y 11971 765-1802 August 5, 1987 I am returning your application for a C.O. for Stzgllan~. In January our new fees ~ent into effect. Please see the enclosed applzcation. The amount due is $25.00. Please send us a new check so we can do the C.O. for you. Thanks. FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: Examme~ Approveo~ Disapproved FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL.: 765-1802 , ig~b Permit No ). A. pphcatlon No .. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date .., a Tbas application must be completely filled m by typewriter or in ink and submitted to the Building Inspector, with sets of plans, accurate pIot plan to scale Fee according to schedule b Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or pubhc strec or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this app catmn. 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 Budding Permit to the applicant Such pern shall be kept on the premtses available for inspection throughout the work e No bmldnlg shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupam shall have been §ranted by the Building Inspector APPLICATION IS HEREBY MADE to the Bmldmg Department for the issuance of a Building Permit pursuant to tl Bmldmg Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances, Regulations, for the construchon of bmldmgs, additions or alterations, or for removal or demohtlon, as hereto describe The applicant agraes to comply with all appbcable laws, ordinances, bmldmg code, housm§ code, and regulations, and admit authorized Inspectors on premises and in building for necessary mspechons //~. (Signature of applicant, or name, if a corporatmn) (Marling address of apphcfda'flt) State whether applicant is owner, lessee, agent, architect, engineer,, e~neral contract_t~, electnman, plumber or budde Name of owner o f premises ?/d/C/EL"/ d-~ J'~--~ ~/vA~>~ . (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 L~cense No Other Trade's License No Location of land on which plop,osed work will be done A/~ ~. ~_/~ House Number Street Hamlet County TaxMapNo 1000 Sechon /~ . Subdivision Filed Map No Lot (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction a Exmt~ng use and occupancy J'¢ '* b. Intended use and occupancy . . ? r _,~, ~.~.¢t. ~*~'~" ~?~ ~''' ' . 3. Nature of work (check which apphcable) New Budding . Addition ..... Alteration ...... Repair . ~. Removal ...... Demolition ....... Other Work ......  ' /. (Description) 4. Estnnated Cost . cJ-0 t .~?'-o.: .o.~. .......... Fee. Or~-..~, .f.~. .................... (to be paid on filing this application) 5 If dwelling, number of dwelling units .... / .... Number of dwelling units on each floor .......... If garage, number of cars ......... t/~ 6 If business, commercial or mixed occupancy, specify nature and extent of each type of use ........ 7. Dtmenslons of existing structures, if any. Front .. Rear ...... Depth ..... Height ..... Number of Stones .............................. Dimensions of same structure with alterations or additions Front ..... Rear .... Depth .... Height .... Number of Stones ................. 8 Dimensions of entire new construction Front .. Rear ....... Depth .. Height ..... Number of Stones .................................. 9. Size of lot Front .......... Rear ..... Depth ........ 10, Date of Purchase ......................... Name of Former Owner ........................... 1 1. Zone or use district in winch premises are situated 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 .......... PLOT DIAGRAM Locate clearly and distinctly all bufldmgs, whether exlstmg or proposed, and~ indicate all set-back dunenslons fron property lines G~ve street and block number or descnptlon according to deed, and show street names and indicate whethe interior or corner lot STATE OF NEW YORK, S S COUNTY OF .. (Name of individual slgmng contract) above named .... bemg duly sworn, deposes and says that he is the apphca. He is the ................................. (Contractor, agent, corporate officer, etc.) of smd owner or owners, and is duly authorized to perform or have performed the said work and to make and file tl application, that all statements contained m this apphcatmn are true to the best of his knowledge and behef, and that tl work will be performed in the manner set forth in the apphcatlon filed therewith. Sworn to before me tlus APPROVED AS NOTED "~OTIFY BUILDING DEPARTMENT A ?~5 1802 9 AM TO ~1. ph,a FOR TH FOLLOWING INSPECTIONS: FOU,~D~'qO~ -rv¢O q~QUIRED ~0~ ,~UREU ~t[' ~UL~t~:''" ( "~ O~ ~HE N Y FTAT~ jO~.gri~l~:t!ON & ENERGY COOE5 ~t~l aa~)NSlbLE FOR OCCUPANCY OR USE iS UNLAWFUL WITHOUT CERTIRCATI- OF OCCUPANCY J7 '5"