Loading...
HomeMy WebLinkAbout14890-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ..... ~ ] .45.~ ...... Date ............ 4U~a~..1.7. ............. 19 .~ THIs CERTIFIES that the building ...... a3-.t.er~g:L~n ..................... ' Location of Property ..... 7,B.Q 0 ............ S o.tzn d ¥ ~_.e.~q. g .v.e .............. S 9 u I;/xq ~. d ..... County Tax Map No. 1000 Section .... 59 ...... Block ......... 9. .....Lot ...... 32. ........ Subdivision ............. ~X ................. Filed Map No ..... g...Lot No ....... X ...... conforms substantially to the Application for Building Permit heretofore fried in this office dated ·. ~i~.. 13 ............ ,19 B.6. pursuant to which Building Permit No ..... .~ .4.8. 99 g .......... dated ........ I~ ~ ¥.. 1. q ............. 19 ~3.6., 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 ......... .../t.~e r~.e.~.~u ...................................................... ~ .......... The certificate is issue d to ................. ~I Z.C.H g ~ L.. ~.,. FL.~ ~J fi ....................... (owner, ~]~ of the aforesaid building. Suffolk County Department of Health Approval ................ iq//~ ....................... UNDERWRITERS CERTIFICATE NO ........................ ~/. ~t ....................... Building Inspector Rev. 1/81 ~Oll~[ NO. :1 TOWH OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, bi. Y. BUILDING PERMIT CT'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK ^UTHORIZED) N.o 145~0 Z Date Permission to: is hereby, granted ........ ........ ....... .... ~..a~.~.~,,,-,,,~,,.* ,,~... ....... ~...//..~7/.. ~o .,...co.~.~.T..~..c~.~...~~....~..~.~...~~oz~ .............. County Tax Mop No. 1000 Section ....~...~ ..... Block ...,.C~.,.~. .......... Lot No...0,5 pursuant to application doted ....... ....~..~ ........... ./.....~. ............... , 19~....., and approved by the Building 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 OCCUP~ Instructions A. This application must be filled in typewriter OR ink, and submitted m Immmamma 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 topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal-iS-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable, B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" 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 buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $1 5.00 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 ~. / .~, //~..~.~. 5.Updated C.O. $15.00 Date .. (Z/;..~%~. .............. New Building ............. Old or Pre-exi~ing Building .... ~ .... Vacant Land ............. Location of Property ..7~ ........ ~~..2~.~., ....................... Owner or Owners of Property . .~¢~G~f. ...................................... County Tax Map No. 1000 Section .... ~.~ ....... Block ...... ? ........ Lot ..... 2~. ...... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./..~.~.f.0... DatoofPormit .'~//.~//~.~..Applicant../~i~,.~/. f...~,/~.~.~. ......... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certifi,c~te ..................... Final Certificate ..... X~ ................. Fee Submitted $, .CZ. ......................... Constrpction on above described building and_p_erini~ r6eets, cl, l~plic~/eodes and regulations. ~, ~, ~q~q I Apphcant ./~,~. r ..... ~ ..................... INSPECTT~ON ~ ~ COMMENTS FIELD ~ FOUNDATION~g) FOUNDATION (2nd) ........ ROUGH FRAME PLUMBING I~S~L~TIO~ ~E8 S. Y. ~ ADDITIONAL COMMENTS: 765-~,802 BUILDING DEPT. INSPECTION FOUNDATION FOUNDATION 2ND FRAMING REMARKS: ROUGH PLBG. [~SULATION FINAL DATE ~.__~~' ,NSPECT~ 7GS-1802 BUILDING DEPT. INSPECTION  ]/FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION ~/~' FRAMING [ ] FINAL JO© ' .9 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved Permit No. Disapproved a/c .... . .-:w. ........ ~ ....... ...~ ......... APPLICATION FOR BUILDING PERIVIIT BLDG. DEPT· TOWN OF SOUTHOLD Received ........... ,19... Date :Y'- ! 5 l~.~ INSTRUCTIONS a. Tins application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the BuildiNg Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary insp~/t~ n~3 ....... 1.~..~-~..~e:..1. '...~.4~:..~a~.. .............. (Signature ~o,f appl~ant, or njfime, if a corporation) ..... d. . o. ........ .. · '' ~.raai~ing a~t~l~ o£ applican~c) ....... State w,hether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · ~..C3. ~,qeW' .............................................. ......]~//~. ~ "~'~'~'£)'~r-~/ ...................................... Name of owner of premises '--{'C'~'l[~'-'' '--('a} 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 License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .......................... · ....................... .............. ...... ....... ........................ House Number Street Hamlet County Tax Map No. 1000 Section .... .-rS.- ./. ......... Block ..... 7.. ........... Lot...~-?..q~".. .......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State ex/sting use and occupancy of premises and iBtended use and occupancy of proposed construction: a. Exmtmg use and occupancy ........ ................................................... b. Intended use and occupancy . . .~,.~.J/¢./.~k/../. ....... ~ ................................... 3. Nature of wxor/k (check which applicable): New Building .......... Addition .. ! ........ Alteration . Repair . ../2% ......... Removal .............. Demolition ........... i' · · Other Work ............... /~/ _ : ~,,,,, ' (Description) 4. Estimated Cosf.~. ~.~, .(]-6~...: ..~.. ...................... Fee..t~..~..."ff. ..................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............. Number of dwelling uni s on each floor.../ ............. If garage, number of cars ...... [. ........................ ~ ....... 6. If business, commercial or mixed occupancy, specifynature and extent of each tv~e of use .................... 7. Dimension.s of,existing structures, if any: Front .... 7?. ........ Rear ... f./~.i ....... Depth...fl..d)... ...... Height . f. 3'.~..~. .'f. ..... Number of Stories ....... O.(q..e. ................ ! ........................... Dimensions of sera'structure with alterations or addit!ons: Front ..... ~C',,q:..A~Y. f. .... Rear . . .,.?,qZ.~! ~. ...... Depth..~..tiq..Z~ f. Height f./'?~?.q ....... Number of]Stories ..... ~)./7..~. ........ 8. HeightDimensi°ns..2./5k~ .~. of entire new construction:Number of StoriesFr°nt .. ~/~.~j~ .~ .... Rear .... ..C./?.~/.~.. .... . Depth .. X'.~..e. ..... 9. Size oflot: Front .... /.0.0..:,. ............ Rear...i~ii~iiiiill ~_~il~ i~ib~.'ir~ii.};'.i ...... 10. Date of Purchase .. D..e. ~;,. ~.,~/ff.. ~ ......... Name of FormerOwner . i~.-. ?ee.e. .~.~. ~ 11. Zone or use district in which premises are situated ......................... , .................... : ........ 12. Does proposed construction violate any zoning law, ordinance or regulation: ....~)..Q ....................... 13. Will lot be regraded .... ~d. Q...~ .... .~ ............ Will excess fill be removed from premises: ~ No 14. Name of Owner of premises ..~.../.(...ff~/~,/~,~ Address .~.~.0...ffo~xf.v./.~/~.PhoneSo Name of Architect ........................... Address ............... : .... Phone No ................ Nmne of Contractor .......................... Address ............... ! .... Phone No ............... 15. Is this property located withinl.00 feet of a tidal wetland? * Yes ..... No .~.,. · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF .... : ............ .............. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ............................................................. i ........................... (Contractor, agent, corporate officer, of said owner or owners, and is duly authorized to perform or have performed the sitid work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this .............. /.~. ........ day of ....... .)'kl~ ......... 19~?J~' "~ ~-- . .'., Notaw Pubtic ...... ~..~.~&~ ..... Court ~ .......... ................. ~ g ~ ~ ~ ! ~i~da[~re °f app!icat) T~ Ex~r~ M~h ~, 1~