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"