HomeMy WebLinkAbout14903-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No..g.1.SO62 .........
Date ..... P.q~gb~.39., ............... 19~.&
THIS CERTIFIES that the building Two car a. ccessory .ga..c.a.~e....
Location of Property . .2.55 ..... $~n.~.%h. $.t.~.~ ¢ .~ ............ L.~.q ~.1.,..i~, y ...............
House No. Street Hem/et
County Tax Map No. 1000 Section . .1.2.6. ....... Block .... 0.7, ......... Lot .... 0.0.2. ..........
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
......Ha.y 16. : ............,19..8.6pursuant to which Building Permit No...1.6.903 ................. Z
dated May .20, 19 86, 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 .........
Two car accessory garage
The certificate is issued to ....... .G?orge & Carol Kraebel
(owner, l~l~gre7o~ lre~Jx x
of the aforesaid building.
Suffolk County Department of Health Approval ..........................................
UNDERWRITERS CERTIFICATE NO ..................................................
Rev. 1/81
TOWN O~ $O~T~OL~
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 14~03 Z
Date FO 19......~.
Permission is herebt granted to:
~o ../fe~.~..~......~-~zo.......c~..... ~;,~~....~.. ~ ..............
.......... ~.~..oz.c~.z,,,,~ ......................................................................................................................
at premises located at ....1~..~,.~.,,. .................
County Tax Map No. 1000 Section ..,../..'~..i~. ...... Block ...O....7. ......... Lot No...~..O..¢~ .........
pursuant to application dated ....~. '~ ............ /..~ .............. , 19~..., and approved by the
Building Inspector.
Building Inspector
Rev. 6/30/80
FORM NO. 6
TOWN OF SOUTHOLO
BUilding Department
Town Hall
Southold, N.Y. 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
instructions
A. This application must be filled in typewriter OR ink, 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 topographic features.
2. Final 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 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 pz"operty showing all property lines, streets, buildings and unusual natural or
topographic featu res.
2. Sworn statement of owner or previous owner as to use, occupancy and condition of bu ildings.
3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa-
tion requ ired to prepare a certificate.
C. Fees:
v,r. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling
~. Copy of certificate of occupancy $1.00
4.Vacant Land C.O. $5.00
5. Updated C.O. $15.00
$15.00
Date
NewCons truct, ion Old or Pre-existing Building Vacant Land
Location of Property .........................
House No. Street Hamlet
Owner or Owners of Property ..........................................................
County Tax Map No. 1000 Section ............... Block ........... Lot ..............
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No. /~. f¢-~ Z- Date of Permit .~.L:z~Z~,~..Applicant
Health Dept Approval Labor Dept Approval
Underwriters'Approval Planning Board Approval
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $ .............................
Construction on above described building and permit meets all applicable codes and regulations.
Applicant ..... ~...~.~' .~ ..............
Rev. 10-10-78
765-X802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION ~ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING
,REMARKS:
[ ] FINAL
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING
REMARKS:
[ ] FINAL
FIELD INSPECTION~ IIDAT E COMMENTS ~ ~
FOUNDATION ~ ~ ---- ~x
FOUNDATION (2nd) --f_~/~/./~/ / :
INSULATION PER N. Y. .
STATE ENERGY .......
ADDITIONAL COMMENTS:
or SOUTHO,O
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
19
Approved./~./2.'~....~.~..., lS Permit No.../..?.~..~..-~'~
D~sapproved a/c ...... : ..................... ;/ .......
APPLICATION FOR BUILDING PERMIT
Received .... ; ...... ,19...
Date A4~Y l& t 9 .~.~
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, witl~ 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 inspections.
(Signature of applicant, or name, if a corporation)
State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, elect icia, p builder.
Nme of owner of premises ...........................................................................
(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 ..... .~.~.C. ~ ............
Plumber's License No .........................
Electrician's License No ..... ~ ~. .........
Other Trade's License No ......................
1. Location of land on which proposed work will be done ..................................................
..... ............. .......
House Number Street Hamlet
County Tax Map No. 1000 Section .................. Block ....... ! .......... Lot ...................
"' ' - ' . Filed Map No. '-~ ~ ' Lot ..........
Subdivision .......................................................
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed c~s~_ ction:
a Existin-usean~ .......... fdO~,~' ~ ~.~.Z.,~.~.-- ~j~t~r-~.~
b. Intended use and occupancy · ~'~o~¢.~' -- .y~,-~' ~'~'~..1~.. z:~,~' 7-a~O ~/~'c','-/l<z-~~
3. Nature of work (check which applicable): New Building .......... Addition ......... Alteration ..........
Repair .............. Removal ......... Demolition .
.............. ~... Other Work ...............
4. Estimated Cost .............. Fee ..................
(to b~ paid on filing this application)
5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................
If garage number of cars ~O .
6. If business, commercial or mixed occupancy, specify nature and extent of each t~ne of use .. .
7. Dimensions of existing structures, if any Front ~ g * .... Rear ~ ~' ~- 'n~,~,h ...... ;~,' ~ .....
Height I 'f ' Number of Stories i ..................... ~ ~ ..... '
Dimensions of same structure with alterations or additions: Front ~ Rear
Depth ...................... .Height ...... i~.~, ·...... ,of'St ~.~
8. Dimensions of entire new construction: Front , ..... Number~4. , or/es .............. .,. . .
............. Rear .......... Depth ...... ........
Height ...... [tq. ~ ...... Number of Stories ...... I '
9. Sizeoflot: Front ...... ~..o ............. Rear. .~.e~' ir, *u /~,~ t .........
................ ........
10. Date of Purchase .....4-./. .! .Z. ].$~ , . . ....
...................... Name of Former Owner ,.. I~. ?..~..~..~.
Z tri ti hi hp d ~
11. one or use dis cnw c remises are situate ...( " ........... i ...... ' .
12. Does proposed construction violate any zoning law, ordinance or regulation: ...N.o. ...............
13. Will lot be regraded ...... M ~ · . . ' ........
...................... Will excess fill be removed from premises: ,, ,Y_es / No
14. Name of Owner of premises .~ot~ t<.~..~.~'l~..6 Address 4q $O~,tt, l~tl,ot~, h
............................ . ..... P one No ................
Name of Architect ' Address J Phone NO
Name of Contractor .......................... Address i . 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, i~dicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and sh~w street names and indicate whether
interior or corner lot. '
~PRo P 05~ D -- , -
% Io
( amc o individual .....
above named.
being duly sworn, deposes and says that
he is the apRlicant
He is the .......................... .~.~
(Contractor', ~t ........... , ~;rporai; officer, 'e't~ ). ............................
of said owner or owners, and is duly authorized to perform or have performed the ~aid work and to make and file this
application; that all statements contained in this application are true to the best of hig 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
. ........ ........
.
Notary Public,~/f, ..... ~.'. ............... County ~ ~ ~
(Signature of applicant)
h
i. i
~API:~R~VED J~ NOTED....~ ~L
N~NG DEPART~NT AT
7~5-1802 9 AM TO 4 PM FOR T~
FOLLOWING IN~ECTIONS:
,~. FOUNDATION - ~O
FOR POURED CONC~E
2. RODGH- F~ING & PLUMBIN6
3. INSU~TION
4. FINAL - CON'ST~UCTION ~UST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N, Y.
~ATE CONSTRUCTION & ENERGY '
CODES. NOT RESPONSIBLE
DESIGN OR CONSTRUCTION
,I
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