HomeMy WebLinkAbout15247-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
Date September 9, 19 86
THIS CERTIFIES that the building d e c k a d d 1 t 1 o n
Location of Property 2740.91.6. .N.o?.t.h. ~.oad. ............ S.c..ut.b.c. 1..d ...............
House No, Street Ham/et
County Tax Map No. 1000 Section . .05..5 .. .Block 02 .Lot 1 . 2
Subdivision ......................... Fded Map No ........ Lot No .............
conforms substantially to the Application for Building Permtt heretofore fried in tlus office dated
.S.e. [3 t.e.m b. e .~. 8. ~ ..... 19 .86. pursuant to wtuch Budding Permit No 15247 Z
September 9, 86
dated .................. 19 .., was issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for winch tins certificate is issued is .......
... d.e.c.k, a.d.d.J:.t.l.o.n...to .ex..J. st.l. n6. o.n.e.f.am, ml.y..6.w.e.11.1, n.g ...............
Thecert~ficate~s]ssuedto Randazzo Buo_ld~.ng Co.
(owner, ~ xmol[tlg]x X
of the aforesaid building
Suffolk County Department of Health Approval .... N/A
UNDERWRITERS CERTIFICATE NO N / A
Building Inspector
Rev 1/81
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PER'AlT
(THIS PERAAIT /v~UST BE KEPT ON THE PREMISES UNTIL FULL
CO/V~PLETION OF THE WORK AUTHORIZED)
N? ~5247 Z
Permission ~s hereby granted,t~,.
.../..~..'L...~.~ ............~;C.3~ ..'~.~_ ..........
~...~...~...~...,~ ..,~,,.... ~....~ .. .....................
o, prem.ses located at ...~..~..~..~. ........ ~-...~.......~..~ .~.,......~,~~zL~ ............
County Tax Map No 1000 Sect,on . ..0.~.,~'. . Block .... ..C:~....,.~,. ..... Lot No .... L.~.~ ........
Budding Inspector
Building Inspector
Rev'. 6/30/80
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
765- 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instruct[ohs
Thru apphcat~on must be filled ~n typewriter OR ink, and submitted ! ~ to the Building Inspec-
tor with the followmg; for new buildings or new use'
1. F~nal survey of property w~th accurate location of all bullrings, property lines, streets, and unusual
natural or topographic features.
2. Fmal approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal).
3. Approval of electrical installation from Board of F~re Underwriters.
4. Commercial buddings, Industrial buddings, Multiple Residences and similar buildings and installa-
tions, a certificate of Code compliance from the Architect or Engineer responsible for the buildmg.
5. Submit Planmng Board approval of completed site plan requirements where apphcable.
For existmg bullrings (prior to April 1957), Non-conform,ng uses, or buddings and "pre-existmg"
land uses:
1. Accurate survey of pz~operty showing all property lines, streets, buddings and unusual natural or
topographic featu res.
2. Sworn statement of owner or previous owner as to use, occupancy and condition of buddings.
3. Date of any housmg code or safety ~nspect;on of buildings or premises, or other pertment informa-
tion required to prepare a certificate.
C, Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existmg dwelling $15.00
3. Copy of certificate of occupancy $1.00
4.Vacant Land C.O. $5.00
5.Updated C.O. $15.00 Date ..$p~.t.,.9.,..1.9~.6 .........
NewC ons bruc t ion Old or Pre-exlstmg Building Vacant Land
2740 Old North Road ~outhold, N.Y.
Location of Property .......................................................
House No. Street Harnle~
Randazzo Buztdzng Co. Inc
Owner or Owners of Property
055 02 1 .2
County Tax Map No. 1000 Section ............... Block ............... ~.ot ........... .....
Subdiwmon ............................... Fded Map No ........... Lot No .............
Permit No ........... Date of Permit .......... Applicant ......................
Health Dept. Approval ........................ Labor Dept Approval ........................
Underwmters Approval ........................ Planmng Board Approval ......................
Request for Temporary Cert~fmate ................... F~nal Certificate ........... .~ ...........
Fee Submitted $ ~ 5 · 0 0
Construction on above descmbed budding and permit meets all apphcable codes and regulations.
Apphcant ..................................................
Rev. 10-10 78
9
FIELD INSPECTION COMME~TS
FOUNDATION (1st)
FOUNDATION (2nd)
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS:
D~sapproved a/c
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.' 765-180:3
, 19]g~ Permit No
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
, !ii
! TOW~ OF SOUT~OLD
Recezved ........... ,19·
Date .¢/g ............ , 19~
a Tins apphcataon must be completely filled in by typewnter or m ink and subrmtted to the Bufldmg Inspector, wit
sets of plans, accurate plot plan to scale Fee according to schedule
b. Plot plan showing locatton of lot and of buddmgs on premtses, relationsinp to adjmmng premises or public str~
or areas, and giving a detaried descnptmn of layout of property must be drawn on rite dmgram winch m part of this ap
cation.
c. The work covered by tins apphcat~on may not be commenced before msuance of Budding Permit
d Upon approval of thru apphcat~on, the Building Inspector will tssued a Buridmg Penmt to the applicant Such pe~
shall be kept on the premises avadable for mspechon throughout the work.
e. No buildmg shall be occupied or used m whole or ~n part for any purpose whatever until a Certificate of Occupm
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MA~DE to ~e Buridmg Department for the issuance of a Bmldmg Permit pursuant to
Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinance-
Regulations, for the construction of buddings, additions or alterahons, or for removal or demolition, as hereto describ
The apphcant agrees to comply .w~th all apphcable laws, ordmances, budding code, housing co~t~, and r,¢gulations, and
admlt auth°nzed respect°rs °n premzses and m buridmg f°r necessary mspectl°nsl/¢
(S~gnature of apphcant, or name, ~f a ~Srporatmn)
.. z .~.?... ~.~. ~....z, .& .<¢_...4).,A.., ...........
.
· (m~ailing ada~ess 8f'il~l~].±cant5 .....
State whether apphcant ¢. ownerJlessee, agent, architect, engineer, generm contractor, elecmcmn, plumber or burid
Name of owner of premtses ~. ~ '~AI't2 ...................
(as on the tax roll or latest deed)
If app. hcant ~s a corporatmn, s~gnature ofOuly au¢onzed officer
(Name and title of corporate~f' ricer)
Budder's L~cense No
Plumber's L~cense No
Electrician's License No
Other Trade s L~cense No. ..
Location of land on which proposed work will be done .~~ .~'~-~..
..
ouse N tuber Street Hamlet
County Tax Map No 1000Sectlou q2}~'~ .... Block .. . {~-- .... Lot ...[ '~'~
Subdlvls~on (Name) Fried Map No Lot
State emstlng use and occupancy of premmes and intended use and occupancy of proposed construction.
a. Exmtmg use and occupancy ~ 1~. ~.~~,~,,-. ~ ...............
b. Intended use and occupancy ~ t~0,..~4~ex, ~...~ __ . [~~,?.~~.. ~C~ ...............
o
4. st ate Cose ..............
5. If flwellmg, number of dwelhng units .........
Nature of work (check which apphcable)' New Budding ......... Additmn ....... Alteratl°~X ~,~ r.2,' ' '
Repmr . . Removal .......... Demolition .......... Other Work... ,~.-.4~,~..
(Description)
(to be paid on filing this application)
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. D~mens]ons 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. Dimensions of entire new construchon' Front ......... Rear ............. Depth ..........
Height ......... Number of Stones .........................................
9. Size of lot Front ...... Rear ................ Depth .........
10. Date of Purchase .............. Name of Former Owner ......................
11 Zone or use &strict ~n which premises are situated .......................................
12. Does proposed constructmn violate any zomng law, ordinance or regulahon' . .........................
13. Wz!l lot be regraded .................. Will excess f'fll 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 withint00 feet of a tidal wetland? * Yes ..... No .....
· If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distmctly all bmldmgs, whether ex~sting or proposed, and. mdmate all set-back dxmenmons fro
property hnes Give street and block number or descnphon accordmg to deed, and show street names and ]ndmate wheth
interior or corner lot.
STATE OF NEW ~R~ II,~ o e
.... kJ~! U. ~x-J~' 6~ .~-.c')/"~.. .......... being duly sworn, deposes and says that he is the apphcm
(Name of individual signing contract)
above named
Heisthe .................................
~C~t~gent, co,orate officer, etc )
of smd owner or ownem, ~d ~s duly authon~u i~erfom or have perfo~ed the mad work and to m~e ~d file ~
apphcatmn, that ~1 statements contmed m thzs apphcahon are tree to the best ofh~s ~owledge and behef, and that ti
work will be perfo~ed m the m~ner set for~ m the apphcatmn filed therewzth.
Sworn to before me thzs
...... ~ ..... day of~g ~E ¢~( .... 19~
. ........