HomeMy WebLinkAbout15222-zFORM NO, 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Buildin§ Inspector
Town Hall
Southold, N Y
Certificate Of Occupancy
No Z-15260 Date February 9,, I987
THIS CERTIFIES that the bmldmg Enclose existzng deck to year round room.
I005 Clearview & 75 Breitstadt Court Southold, N.Y.
Location of Property Hous~ ~o ......... Street
.......................... hamiel
County Tax Map No 1000 Section 0 70 . .Block 0 9 .Lot 2 3
Subdlwsxon M./o. Smithfield Park . .FdedMapNo 4770 LotNo 10
conforms substantially to the Application for Bmldlng Permit heretofore filed in fins office dated
August I3, I986 . pursuant to wlnch Bmldmg Permit No. 15222Z
dated . A u.g u, s t. 2..9, ....I 986... , was issued, and conforms to all o f the requirement s
of the applicable provlmons of the law The occupancy for Much tlus certificate is issued is .......
ENCLOSE EXISTING DECK TO YEAR ROUND ROOM ON ONE FAMILY DWELLING.
RICHARD S. PILLES
The certificate m msued to ......... ?o'wn'e),/~'[)~ ............
of the aforesmd bmldmg.
N/A
Suffolk County Department of Health Approval ..........................
PENDING
UNDER%VRITERS CERTIFICATE NO ...................................
PLUMBERS CERTIFICATION DATED:
N/A
Rav 1/81
· 0~ NO. ~
TOWN ON $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
15222
BUILDING P EPJAIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Z Dote ~.,,.'~'~..~........~......~ ............ , 19.2.~
Permission ~s hereby granted to' ~ ~
· '"'~ ....... ~' ,'"~'" ..... tt ~ .... t~ ............. ;" '. .........................................
at premmses located tot ..L.o..?...~'__~?..~ ~Lv ' .."] ~. ~T.'~..~.....~......~'
County Tax Map No 1000 Sect,o~(~.'~.~, Block ....(~..~ ........ Lot No ....~..,~...
pursuon, to opphcot,on dot~ ~~ [~ . , l~ ~., ond oppmv~ by the
Budding Inspector
Fee $.'~. ,,.;..~"~
Building Inspector
Rev 6./30/80
r'IELD INSI~ECTION COMMENTS
FOUNDATION (1st)
FOUNDATION
2.
(2nd)
ROUGH FRAME &
PLUMBING
INSULATION 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
Z Z 1981
Instructions
Bo
This application must be filled in typewriter OR ink, and submitted m ~ to the Building Inspec-
tor with the following, for new buddings 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 disposal-(S-9 form or equal)
3. Approval of electmcal installatton from Board of Fire Underwriters.
4. Commercial buddings, Industrml buddings, Multiple Remdences and similar buildings and installa-
tions, a cert~hcate of Code comphance from the Architect or Engineer responsible for the building,
5. Submit Planmng Board approval of completed rote plan requirements where applicable.
For existing buddings (prior to April 1957), Non-conforming uses, or buildings and "pre-exmting"
land uses'
1, Accurate survey of p~operty showing all property lines, streets, buildings and unusual natural or
topographic features.
2. Sworn statement of owner or previous owner as to use, occupancy and condition of buddings
3 Date of any houmng code or safety inspect~on of buildings or premises, or other pertinent informa-
tion required to prepare a certificate.
C. Fees:
1. Cert]flcate of occupancy $25.00 -- BUSINESS $50.00
2. Certificate of occupancy on pre-exmtmg dwelling $ 50.00
3. Copy of cert~flcate of occupancy $ 5.00, over 5 years $10.00
4.Vacant Land C.O. $ 20.00 ~..~..
5.Updated C.O. $ 50.00 Date ..... /~'~
NewConstrucl;lon .... Old or Pre-ex~stmg Building .......... Vacant Land .............
Locatton of Property .... ~.b.~ .... .~ .........................................
House No. Street Ham/et
Owner or Owners of Property . ,../~L,~., ?, ~/~¢,~'. ..............................
County Tax Map No. 1000 Section .... 7,(~. .... Block .... ? ......... Lot ...~?.,~ .........
Subdivision ..... Str~l'.~Qt~.~l~...I~)~¢..~_~ .. F,led Map No..z¢/.7.?.47..Lot No .../.~) ......
Permit No ........... Date of Permit · ~/~....Apphcant ...............................
Health Dept Approval .................. Labor Dept. Approval ........................
Underwmters Approval .................... Planmng Board Approval ......................
Request for Temporary Certificate ................ Final Certificate ......................
Fee Submitted $ ...................
Construction on above descmbed budding and permit meets all apphcable codes and regulations.
^ppl,ea.t ..... ..................
Rev 10-1078
¢0 % 1sAgO
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL. 765-1802
CERTIFICATION
Date
Building Permit No.
Owner
Plumber
(please print)
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
(plumber's slgnature)
Sworn to before me this
day of ,
19
Notary Public, County
Notary Public
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
765- 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This apphcat~on must be filled m typewriter OR ~nk, and submitted m ~ 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 topographm features.
2. F mai approval of Health 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 buddings, Multiple Residences and s~milar buddings and installa-
........ ;'-~ - C~"~'~:~m~-'~ ¢'~.'He~"~mmnli~n~-R {r~rn-the Ar~ch~tect or-Engmeer.responmb!e.,fpr t~h~e~_b.~ujldmg.
CHESTER ORLOWSKI
CUTC:HOGUE. NEW YORK 11935
8073
Location of Property I ~
.~P.~, ~,.. ~'.~. r .
House No. ~treet Hamlet
Owner or Owners of ProperW . .. .- ......................... . .
CounW Tax Map No. 1000 Section ..C3. 2.0. ........ Block..(~..~. ......... Lot.. 2,...~ .........
N . ~[~..t~¢~.~...Lot N ..............
Subdmslo,..~~-~~..,....~'~..~- .... Fded Map o
Permit No. /r ~.~ate of Permit ~. ~r~plican, ~ ~.: ........
Health Dept. Approval . .~.'.~. ~ ................ Labor Dept. Approval ........................
Underwriters Approval t.~..~ .................. Planning Board Approval ......................
Request for Temporary Certificate ............... .... ..Final Certificate ...~ ............... . . .
Fee Submitted $...--~".,. ~ .................. . .
· ' d p ppi '
Construction on above described building an ermit meets all a ~cable codes and regulations.
Applicant .~.~ ....................
Rev 10-10-78
h
F
//
I-.
q
OF OCCUPANCY
3 IN,c,d~.-~ tgi
ALL COf~TRdCT~ON SHALL ~EET
THE REQUIP~EN~S ~ TH~ N.Y
COD~ ~OT ~NS~E FOR
'~6GIGN 0~: CC ~STRUCTION ~RORS
BUILDING DEPT.
INSPECTION
[ ] FRAMING
REMARKS:
[ ] FOUNDATION 1ST [ ]ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[ ]FINAL
'FORM NO 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL.. 765-1803
Dzsapproved a/c
(Budding Inspector)
APPLICATION FOP, BUILDING PERMIT
INSTRUCTIONS
a. Ttus application must be completely filled m by typewriter or in ink and submltted to the Budding Inspector, wltl
sets of plans, accurate plot plan to scale Fee according to schedule
b. Plot plan showing location of lot and of buddings on premises, relationship to adjoining premises or pubhc stre
or areas, and giving a detailed descnptmn of layout of property must be drawn on the diagram which is part of this
cabon.
c. The work covered by tins apphcatlon may not be commenced before issuance of Building Permit
d. Upon approval of tlus apphcatlon, the Bmldmg Inspector will issued a Bmldmg Permit to the apphcant Such pen
shall be kept on the premxses available for inspection throughout the work·
e. No bufldmg shall be occupxed or used m whole or m part for any purpose whatever until a Certificate of Occupa~
shall have been granted by the Bmlding Inspector
APPLICATION IS HEREBY MADE to the Bulldmg Department for the xssuance of a Bmlding Permit pursuant to t
Bmldmg Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances
Regulations, for the construction of buddings, additions or alterations, or for removal or demohtion, as hereto describ.
The apphcant agrees to comply with all apphcable laws, ordinances, budding code, housing code, and regulatmns, and
admlt authorized mspectors on premises and m bufldmg for necessary~..~,~,
(S~gnature of apphcant, or name, if a corporation)
(Maxhng address of apphcant)
State whether apphcant is owner, lessee, agent, arclutect, engineer, general contractor, electrician, plumber or budd(
Name of owner of premises ~:>'~ '~'., e.~..
(as on the tax roll or latest deed)
If apphcant is a corporahon, s~gnature of duly authorized officer
(Name and t~tle of corporate officer)
Builder's Lxcense No. ~,~ (~ q...~1.,~.. ,
Plumber's L~cense No /'f'~ ~t' ~
Electrician's L~cense No ~' '~ ~f ,~, ........
Other Trade's License No ..
1. Locatlonoflandonwhlchproposed, workwdlbedonerl.~..~r)O'.~f.'.(~ '.~.. .~t~..) .......
. .....
House Number Street
County Tax Map No 1000 Section -0- -~. .... Block t~
Subdlvlslon ~.~-J~,~t~ [Dom~ Flied Map No
Y (Name)
Hamlet ~.~ ~
· Lot. /.o..~.z'~ ..
"'/7 7 o Lot /o ......
2
State ex,sting use and occupancy of premises and intended use and occupancy of proposed construction
,:#"~ : _~ ,,.t~ .~ ~*tit~, ' ........
b. Intended use and occupancy ~.~..~... J~.' FI,-{w/''~ '" .
3 Nature of work (check wluch applicable). New Building .... ' .... Addition )~ Alteration
Repa2r .......... Removal ............ Demohtlon .............. Other Work ............
~r ~ ~ (Description)
4. Estmaated Cost /.~. ~ .................... Fee . .~..o.,..'~. ........................
(to be paid on filing this apphcation)
5. If dwelling, number of dwelling units... ~ ..... Number of dwelhng units on each floor .............
If garage number of cars ---
6 If business, commercial or mLxed occupancy, specify nature and extent of each type of use ...~ ....... v ......
? Dnmensions of existing structures, if any: Front .... .2P.o. .... Rear .,. ,5-.a ..... Depth.. ~. ~' ....
Height .. ~ 2. ! ...... Number of Stones .. ~x..~':'~. ......................................
Dunens~ons of same structure with altera~ons or additions Front ...~'.t~ ........... Rear ~%'7..~ ..........
Depth ... ~' ~. ! ........ Height .. ~Z-.~ ~ ........ Number of Stones ..................
8. Danenslons of entire new construction Front.. . ~ ....... Rear .. ~ ........ Depth . ;- ..
9 S~zeoflot. Front . /~1~./..~ ~, ..... Rear .[.5/~. ............... Depth ./.-~'.q./. ............
11 Zone or use d~stnct ~n which premises are situated..[~ . .. .~. ...........................
12. Does proposed construction violate any zoning law, ordinance or regulation ...I-~-. -
13 Will lot be regraded . . .kl~., ~ . ., ~ .... ...... Will excess f'fll be removed from premises Yes Q
14. Name of Owner of premlses/(,,~[.o,~ ..... /'~t~-.. . Address . ~-~.t 1~:~.'.. Phone No ............
Name of Architect ...... Address .............. Phone No ...........
Name of Contractor i~1~ i i~~.'.' . Address ~-~t .~.~t .... Phone No ............
PLOT DIAGRAM
Locate clearly and distinctly idl buddmgs, whether exlstmg or proposed, and. indicate all set-back dnnensions fro
property lines. Give street and block number or descnptaon according to deed, and show street names and indicate wheth
intenor or corner lot
STATE OF NEW YORK, S S
~e'~~~m~g co~'t~acti
above named
·. being duly sworn, deposes and says that he is the applica]
He is the ...............................................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly anthonzed to perform or have performed the said work and to make and file ~
apphcatmn; that all statements contained m th~s apphcatton are true to the best of his knowledge and belief, and that tl
work will be performed In the manner set forth m the application filed therewith.
Sworn to before me this
.... .... ............