HomeMy WebLinkAbout15236-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. zl5548 Date March 31, 1987
THIS CERTIFIES that the building ..... Ac. c..e.s.s.q r. y ................................
Location 1600 BAYSHORE ROAD GREENPORT
of Property ...............................................................
House No. Street Hamlet
County Tax Map No. 1000 Section 53 . .Block 04 .Lot 31
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore f'fled in this office dated
..... .A.u.g ....I .9 .... ! .9.8.6.. pursuant to which Building Permit No...1.5. 2. .3.6.Z. ............
dated ...S.e. ? .t.... 5. .,..1.9. 8..6 .......... was issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is .........
..... .&c.?..~.~.o.r y...b3.~. ~..a 3.~.~: ....................................................
PAUL M. & MAUREEN CLANCY
The certificate is issued to ..................... /o~,n'e'r,'~'I~tt~'y~Y;) ......................
of the aforesaid building.
Suffolk County Department of Health Approval ........... N./..A ............................
UNDERWRITERS CERTIFICATE NO .................. N./..A ...............
PLUMBERS CERTIFICATION DATED: N/A
Rev. 1/81
FO~t~g NO. It
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
15236
Z
Permission ts hereby granted to'
......
.J...~.~.....~....~..~ ..... ~ .............
· ..~~....~........~.:..V.., ..... u...~,..~: .... _,
ot premises located c~, .. ~...LP. .......... [..~. ' ..... ~ .~-~.....~... ........ .~...~~ .....
pursuc~n, ,o opphc~mtlon doted k~4~,,,~v ../ ~, ..
Building Insp~tor
, 19<~. ~, and approved by the
Fee $~.° .'/-~...
Building Inspector
Rev &/30/80
FORM NO. 6
TOWN OF SOUTHOLD
BuildingTown Department Hall
Southold,765-N'Y'180211971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A
Thru application must be filled ~n typewriter OR ~nk, and submitted m mmmmmm to the Building Inspec-
tor w~th the following; for new buildmgs or new use:
1. Final survey of property with accurate location of all buildmgs, property lines, streets, and unusual
natural or topographm features,
2. Final approval of Health Dept of water supply and sewerage dmposal-(S-9 form or equal).
3, Approval of electrical installation from Board of F~re Underwmters.
4 Commercial buildings, Industrial buddmgs, Multiple Remdences and similar buildmgs and installa-
tions, a certificate of Code comphance from the Architect or Engmeer responsible for the building.
5. Submit Planning Board approval of completed rote plan requirements where applicable,
For existing buildings (prior to April 1957}, Non-conformmg uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of p~Coperty showing all property lines, streets, buildmgs and unusual natural or
topographic features.
2. Sworn statement of owner or prewous owner as to use, occupancy and condition of buildmgs.
3. Date of any housmg code or safety mspection of buildings or premises, or other pertinent informa-
tion required to prepare a certif~cate.
Fees:
1. Certlflcate of occupancy New Dwelling $25.00, Accessory,SI0.00 Business $50.00
2. Cert~fmate of-occupancy on pre-existmg dwelhng $ 50.00
5.Updated C.O. $ 50.00 Date ....
NewConstructzon ...... Old or Pre-exmtmg Building .... Vacant Land ............
Location of Property.. ?,, ,~,~?~.'?,~.. ,~, · .~, ?.'~.. ~ ............ ~~~'
Owner or Owners of Prope~ ...... C... --.;..~~.. .~ ........
County Tax Map No. 1000 Section ............... Block .............. Lot ................
Subd~wmon ............................. Fded Map No .......... Lot No .............
Permit No./.,~,~...~.?,. Date of Permit .~/,~.JE{~..Appllcant .~.j...,Z.;.
Health Dept Approval ..................... Labor Dept. Approval .......................
Underwriters Approval Plannmg Board Approval
Request for Temporary Certificate ................... Final Certificate .......................
Fee Submitted $ .... ,/¢¥?, . .'~,. ..............
Construction on above described bulldmg and p~ble codes and regulations.
Applicant . . .(,.~,;/ . . ..z,~.~.,. ................
FOUNDATION (1st)
FOUNDATION (2nd)
ROUGH FRAME &
FLUMBING
INSULATION FERN. Y
STATE ENERGY
CODE
FINAL
~DDITIO~AL COMMENTS:
TOWN OF $OUTHOLD
OFFICE OF BUILDING INSPECTOR
P,O, BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL. 765-1802
To Whom ~hls May Concern,
We are unable to complete your Certificate of Occupancy because
of the following reasons.
)An application for Certificate of Occupancy is not on file.
)No Underwriters Certificate on file.
/~The check is (*a~h~=~/not on file.)
)No Health Department Approval on file.
)No final inspection has been made.
Please contact our office on this matter.
Thank you for your cooperation.
Building Permit # .~ ~ ~, ~ ~ Z
)No Plumber Solder Certificate on file.
(all permits involving plumbing being issued after
April 1, 1984)
L
APPROVED AS NOTED
.'..,.;d?ANCY OR
L~SE iS UNLAWFUL
~ ,~.,,,..o., "..~ OCCUPANCY
~ .O(~S~ ~UC r~ON S~LL
m[,/, ~f~ OH CC ~STEU~ON ERRORS.
TE
Guaranteed to Southold Sawng$ Bank
Securdy Dtle & Guaranty Ca
Paul8 Maurean Clancy
PA T T SECCAFICO
PROFESSIONAl rAND SURVEYOR
109 tOOP DRIVE
SAYVILLE, NY 11782
(51G)567-4775 NY~ l-lC NO 049287
D,~TE 1/22/88
SCALE 1"--20
Approved
Disapproved a/c
FORM NO 1
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
EOUTHOLD, N.Y. 11971
TEL.. 765-1803
, 19~G Permit No
(Bulldzng Inspector)
APPLICATION FOR BUILDING PERMIT
Date
INSTRUCTIONS
a This application must be completely filled m by typewriter or in ink and submztted to the Building Inspector, w~tl
sets of plans, accurate plot plan to scale. Fee according to schedule·
b. Plot plan showing location of lot and of bmldmgs on premises, relationship to adjoining premises or pubhc sim.
or areas, and giving a detmled description of layout of property must be drawn on the diagram which is part of this
cation.
c The work covered by tins apphcatzon may not be commenced before zssuance of Budding Permit.
d Upon approval of this application, the Building Inspector will issued a Budding Permit to the apphcant Such perr
shall be kept on the premises available for mspectlon throughout the work
e. No buildmg shall be occupied or used m whole or in part for any purpose whatever until a Certificate of Occupan
shall have been granted by the Budding Inspector
APPLICATION IS HEREBY MADE to the Bufldmg Department for the issuance of a Bmldmg Permit pursuant to
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 demolition, as hereto descnb,
The apphcant agrees to comply with all applicable laws, ordinances, buildmg code, housing code, and regulations, and
admat authorized inspectors on premzses and m bmldmg for necessary~ ~ ~
,,."-' ~' -(b'tk, r~ture of applicant, or name, ~f ~c~ '
,,*,,.- ,,o'.z>. . ....
.........................
State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or build,
Same of owner of prem,ses P~" /~/, ~.. ~q'~ ./~' ~,~----~1/.
(as on the tax roll or latest deed)
If apphcant ~s a corporation, signature of duly authorized officer
(Name and title of corporate officer)
Builder's License No
Plumber's L~cense No
Electnman's License No ..
Other Trade's License No.
Locanon of land on which proposed work will be done
House Number Street
County Tax Map No 1000 Section
Hamlet
Block.. ~/... Lot.
2
Subdlvis~on ..... Filed Map No ... Lot
(Name)
State ex~shng use and occupancy of premises and intended use and occupancy of proposed construction
a Existing use and occupancy ~.~'..~/~T/~/. ~t~-~V.~. ..........
b Intended use and occupancy
3. Nature of work (check which applicable) New Budding .... Addition . .. Alteratio~ . . .
Repmr ... Removal .... Demolition . .. Other Work .
~ o (Description)
4, Estimated Cost ~ ~9~ ' ~/) Fee ~e ~6...~, g~' ~/
(to be paid on filing this application)
5, If dwelling, number of dwelhng umts Number of dwelhng umts on each floor ........
If garage number of cars ---
6 If business, commerclalormlxedoccupancy, specffy na~ure and extent of each.type of use .. .
7 Dimensions of exlstmg structures, if any. Front. ~' ~. . . Rear ~.~'. ~..... Depth . .
Height ~ ~ ..... Number of Stones. / ..................................
Dnnenslons of same structure with alterations or additions Front .......... Rear ...........
Depth ........ Height .... Number of Stones .......
8. Dlmenslonso£e, ntlrenewconstructlon'Front /~'~ .. Rear /.{'..~ ..... Depth
Height .~'O . . Number of Stones /
9. Sizeoflot. Fr;nt' ...~.,~,O .~,~. Rear.. ~.,~.' 'i.' i'ii
10 Date of Purchase .~. '7..( ~.- ~..~. . . .~ame o~f. FormerD!vnei . .~.., 4~..~',~r~ ......
11 Zone or use dlstnct in which premises are situated.. ~ .~ .~$..'~..g~/~/.~'. .......................
12. Does proposed construction violate any zoning law, ordinance or regulation
13. Will lot be regraded ..... ~b~ .~.,. - ..... Will excess fill be removed from premises: Yes No
14 NameofOwnerofpremlses/~./.~. g"~. "~.... Address .~./~..~ ........ Phone No. .~?>.
Name of Architect ~' Address . Phone No.
Name of Contractor .. . .'7. ........ Address .......... Phone No .......
*Yes ..... No ~'.
15. Is thzs property located wzthinl00 feet of a tidal wetland?
* If yes, Southold Town Trustees Permit may be required.
PlOT DIAGRAM
Locate clearly and distinctly all bufldmgs, whether existing or proposed, and. indicate all set-back dnnenslons from
property hnes. Give street and block number or descnptlon according to deed, and show street names and mdicate whether
interior or comer lot.
STATE OF NEW YORK, S.S
COUNTY OF ........
(Name of individual signmg contract)
above named
being duly sworn, deposes and says that he is the applicant
He is the .......
(Contractor, agent, corporate officer, etc.)
~ owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
application, that all statements contamed m this application are true to the best of his knowledge and behef; and that the
work wdl be performed in the manner set forth m the application filed therewith.
Sworn to before me this
......... / 7 .... day of....~----~..
Notary Pubhc, .~..~- ~a<..~ .
County(~~..