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HomeMy WebLinkAbout14969-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building ...... ?.e.c. Location of Property .... 7.5.... i ...... Hav.~..Ecl ............ Ha..~.~.(t.u. 9.k ...... House No. Street Hamle~ County Tax Map No. 1000 Section ..... 1. q. 6. .... Block ......... .q .0 .... Lot ...... 1.~. ......... Subdivision ...... ~ e. e. ?. ?.~. v..~ ............... Filed Map No.. 3..2.0.~...Lot No ...... .8 ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated · .~.~.~...29 ............. ,198.6.. pursuant to which Building Permit No ..... 1.6.? .6.9.Z. .......... dated ..... ~..u .n.c.. 1. ! ............... 19.8. 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 ......... of the aforesaid building. Suffolk County Department of Health Approval ................ .~./.A. ...................... UNDERWRITERS CERTIFICATE NO ........................ J~./.A. ...................... Building Inspector Rev. 1/81 FOIR~ NO. ~ TOWH 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) 14969 Z Date ......... Permission is hereb/granted to: ..... .~..~....~..:....g~..~.~ ................. .~..~....~.~..~. .......................................... .... ~.~....~.......~.:~.,....u...t~.~.. at premises located at .....~..~......J~..~.....~. ........... ..:...'(-J..~,~'~, ............................... County Tax Map No. 1000 Section ....... L!...I~. ........ Block ....... L..~. ......... Lot No ....../....~. ............ pursuant to application dat,d ......... ..~.....~..~..~, ................... , J9..~.,--- and approv~ by the Building inspector. Fee $..~....:..~., 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 OCCUPAN BLDG. TOWN OF .SOUTHOLD Instructions 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 propertv 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 applicabteo For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of pZoperty 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 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 qccupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $15.00 3. Copy of certificate of occupancy $1.00 4 .Vacant Land C.O. $5.00 ,~:~ -..~ ~__. ~ 5. Updated C. O. $15 · 00 Date ......... .~ ~.. .............. New Building ~/ .~QId or Pre-existing Building ............ Vacant Land ............. ............ Location of Property ...... ~-[t~,, ................ ,/~. ,~,-~, ,~,,',~, ,' ,~,~¢~, ....... ,~[;~,~,~,z"~,Z".~J~, ,~,, ,~. ' House No, Street Ham/et Owner or Owners of Property County Tax Map No. 1000 Section .... I.t .LI ....... Block ..... 1.~ ...... Lot..i.. J.d....i.. Subdivision.. b.~,~,... ,~. ,~ ............. Filed Map No. ~, ?~, ,~..~....Lot No ..... ~, ....... Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval .... ~ .............. Request for Temporary Certificate ..................... Final Certificate ....................... FeeSubmitted$~...~..!fi.~. ........... Construction on above described building and permitj~neets all applicable codes and regulations, A ,. __ Applicant . . . ~,. .......... ~ ....... .~ . . . .,~ ..................... Rev, 10-10-78 FIE~D INSi~ECTION 1. FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS COMMENTS: 765-1802 BUILDING DEPT, INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [1 FOUNDATION 2ND [.] ~}LArlON []FRAMING [~'FINAL REMARKS: DATE , ~) INSPECTOR ~'~ BUIL[JING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180;3 Examined...~...,,~b'A'L~...l.t,.., 19~. ~. Approved....~..~ J.I..., 19~. {~. Permit No. ! .~.~..~..~.-~... Disapproved a/c ..................................... Received ........... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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~inspe, c, tions. . (Signature of applicant, or tuftee, if a corporation) (mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .. ~-.~.~..~j...~.~r.~...~-.: ~.~. ~,.~ ~~. ~.~...~.& ~.~ ...... (as on the tax roll or latest deed~~ NOTED If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) F~: ~' OCCUPANCY 0R ~o~,~ .u,~,.~ Builder's ~icense No .............. 765-1802 9 AM TO ~ ~ ~R 'tH5 UN~WFUL ~o~ow,.~ Plumber's License No. USE IS ......... FOR POURED CONCRETE Electrician's License No. ...... .1'1 nUU ,' ,,l.l,Ugl IT CERTIFICATE 3. INSULATION2 ROUG" FRAMING & PLUMBING Other Trade's License No. ..... urgE' OCCUPANCY *' B.F'NALcoMRETECO>ISTRUCFoR TIONC.O. MUST ALL CONST~OCTION SHALL MEET 1. Location of land on which proposed work will be done .................... ~H6 REGUIR~MENTS.OE ~HE ~..y... ~ ~ .... ~. ~ . ~. STATE, CONSTRUCTION & ENER~ .....~ ~ .................. ,. ~d/~. . ·· ...... ,.,.. ....... ..... , ............. ............. ~.~,,v,s,o...~..~c~ ................. ~,,~d ~a~ ~o. *~ ~.~ ...... ~o,... ~ .......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: -. ~/ j~ .......... ~ ............... b. Intended use and occupancy .~ .... ~.~ Nature of work (check which applicabl~): N.ew B.u, ilding .......... 'Addition ........... Alteration ........ Repair Removal Demolition ~ Other Work ~..~.~ Estimated Cost ........... .< ........ Fee .......... , to be paid on filing this application) If dwelling, number of dwelling units ............... Number of dwelling ugits on each floor ............... If garage, number of cars : ' '~ , If business, commercial or mixed occupancy, specify nature and extent of each type of use .................... · ' ' if any Front Rear J Depth D~mens~ons of existing structures, ........................................... Height ............... Number of Stories ........................... ! ............................ Dimensions of same structure with alterations, or additions: Front ,.. ' ' ' ' Rear-. .............. Depth Height Number 0f stories Dimensions of entlre new const¢~ctlon:.~Fl;_oat ~_...-P,P:.: ....... Rear ...4~,.~. f ... Depth ....,f~;. · .. Size of lot. Front ..................... ii Nil[....~..b~. ............... i Depth ...................... Zone or use district in which pf;~n~[e~,[~t~a~i .Ijl SJ [[t .. Does proposed construction viol]gPal~ ~na,~w,~ai~anae o~e-~ulatian' ~ - Will Name of Contractor · ' Addi~s~ m, Is this property located within 1.00 feet of a tidal wetland? ~ Yes ..... No .'D~... If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM o 9. 10. 11. 12. 13. 14. I5. Locate clearly and distinctly all buildings, whether existing or proposed, and. i!ndicate all set-back dimensions from property lines. Give street and block number or description according to deed, and shbw street names and.indicate whether interior or comer lot. ~ .. ~~i'. r~.'. q~55~ .................... being duly sworn, depo[es and says that he is the applicant (N'ame of indlvid~l signing contract) i above named. , , He is the ~ & ........ ~ .......................... (Contractor, agent, corporate officer, etq.) of said owner or owners, ~d is duly authorized to perform or have performed the~ said work and to m~e and file this application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the work w~l be perfo~ed in the m~ner set forth in the application filed therewith. Sworn to before me this ............ .... ....... Not aw Public, ~LA-~ '.~ ~. ~f;~ ........ County ~~ ~Q~ ; .~ .... ~I.