HomeMy WebLinkAbout15048-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate 0t: Occupancy
No .... 7~14613.5 ........ Date ........... .g. ttly..2.2 ............ ,19.8.6
THIS CERTIFIES that the building ... deck addition
745 North Oakwood Road Laurel
Location of Property ...........................................
House No. Street ...............
County Tax Map No. 1000 Section 1 2 7 .Block 7. ....Lot 1 2
Subdivision . M/-o-~Laurel Park .Filed Map No. :2. ).~.'. .Lot No. 34
conforms substantially to the Application for Building Permit heretofore filed in this office dated
....~.u,n.e...2.2 ........... 19 .8.6. pursuant to which Building Permit No ..... J .5.0.4.8..Z ..........
dated ,...........................June 28 19 .8.6. , was issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for wkich this certificate is issued is .........
Deck addition to existi, ng one-family dwelling.
The certificate is issued to HENRY E. & THERESA KUHN
..................... ....................
of the aforesaid building.
Suffolk County Department of Health Approval Iq / A
lq/A
UNDERWRITERS CERTIFICATE NO ..................................................
Building Inspector
R~v. 1181
F~RM' NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDIHG PER~IT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N°. 15048
Z
Permission is hereby granted to:
..~~.....~ ................................
~. '. ';..[~'~[...~:..~..: ....... ~.5.".;....,....i..i ....
,,,,.~~....~...~,....~.~..~....z~:<,.,~. ......
~.. ..~..~~.~....~....¥~~~__.~ .............................
a~pt remises located at ..~...~/...~.~--..~....~....~~.....~'- ...~.........~ .............
County Tax Map No. lO00 Section .../.....'~..,']. .......... Block ...... ,~),,.~, ....... Lot No ....... /,.,.,'~,,. .........
pursuant to ¢~pplication dated ....... ...~...~...~,~ ................ , 19~..~R., and approved by
the
Building Inspector.
Rev. 6/30/80
FORM NO. 6
TOWN OF $OUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
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 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.
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 requ ired to prepare a certificate.
Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling
3. Copy of certificate of occupancy $1.00
4oVacant Land C.O. $5.00
5 o Updated C.O. $15.00
$15.00
Date ...... q :.~..~. ;. · .~. ........
NewConstruction ...... Old or?re-existing Building ............ Vacant Land ..~ ..........
Location of Property. ,~.~, .~.. ,~.0,, ,~,, ,0.~ .c~, .o..~.. ~ .................... ,~./? ,0, .r~.~, ,i~, .......
House No, Street Hamlet
Owner or Owners of Property l.~.~.v}. ,~.~ .~,: ~.~.o. ~..~..'~..'~. ~.~..~..5~..~..u.~.~. .......................
County Tax Map No. 1000 Section I ~,-~ Block 7 Lot. ~f '~
Subdivision. ~../~.E.~! ,1~,?,o.~.., ,~, ?,J~.',-[,E,~. ......... Filed Map No..~ot No... ~ .~ ........
Permit No ........... Date of Permit .......... 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 c~des and regulations.
~--~,'A~, ~pp dcant . ./,,4-'f~...~7 ...... ~2..,~-~'~..... ~ .......................
Rev. 10-10-78
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. ! 1971
TEL. 765-I 802
To Whom This May Concern,
Please complete the enclosed application for
Certificate of Occupancy and enclose a check for
$5.00 (the fee for the C.O.) and I will be able to
complete the Certificate of Occupancy.
Thank you so much for your cooperation in this
matter.
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[] FOUNDATION 2ND [ / ~L~ATION
[]FRAMING [~]"FINAL
REMARKS:.
FIELD tNSi'ECTION
FOUNDATION (1st)
FOUNDATION (2nd)
COMMEN TS
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
CODE
ADDITIONA'L COMMENTS
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N.Y. 11971
TEL.: 765-1802
Examined ...~....A~'A~a.....~..~ .... 19 ~.~.
Approved ... ~..~.~...., 19~.~. Permit No./. . .5~..q..~..~e..
Disapproved a/c .....................................
Received ........... ,19...
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date .
INSTRUCTIONS
a. This 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 ,qode, and regulations, and to
admit authorized inspectors on premises and in building for necessary i/n~pections. ~.~ ~ -~
· .....................
(Signatfire of applicant, or name, 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 4 ~lk~a~ I.~ 61t&d ~l~/~f~l~,gR WU[JO
(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... ~:~<F2M2eZ~:. ............
Plumber's License No .........................
Electrician's License No .......................
~Juzc~ Trade's License No ......................
1. Location ofland on which proposed work will be done~ .~..t4.~...~/.O..(b.~....~..~.q.k~..O'>..~i'. .....................
..... 2.q.C ............. ......... ......... .............
House Number Street Hamlet
County Tax Map No. 1000 Section .... [ ~..~. ......... Block ...~. .............. Lot... !..~. · ...........
Subdivision ..... .~.~..L).~.. '.~-./7 . .~.Q.fL.t.~. ............... Filed Map No...Z.I..l~. ........ Lot ....3.'.~ ........
(Name)
2. State existing use and occupancy of premises,.and intended use and occupancy of proposed construction:
a. Existing use and occupancy
b. Intended use and occupancy .........................
3. Nature ofw~3~l~{~c~!w~t~to~!ae]3p~,ca~) New Building ' Addition..... ,b~. .... Alteration ..........
Repar ...~[ ~: ....... Remm, al .i'.,b!..~ ......... Demolition .
, i~}i ~jjj ~ ~j~ !.,,~ , · ............ Other Work ...............
4. Estimated C0sf ............ J.~ ..................... Fee (Description)
i ' (to be paid on filing this application)
If dwelhng, hum bet of dwelling uVits ............... Number of dwelling units on each floor ................
If garage, number of cars ...... : ...................................... ; ................ .: .........
6. If business, commercial or mixed bccupancy, specify nature and extant of eaeh type of use .....................
7. Dimensions of existing structures,! if any: Front ............... Rear ....... ~ ...... Depth ... ! ...........
Height , .............. Number of Stories ........................................................
Dimensibns'of same structure with alterations or additions: Front ................. Rear ..................
Depth ..................... !. Height ...................... Number of Stories ......................
,8. Dimensions of entire new construction: Front .......... . ..... Rear ............... Depth ...............
.eight ...............
9. Size of lot: Front ..... ,~ .'..~'. ~ ........ Rear $k2~./ n~nth ~o'o~/~
10. Date o£ Purchase .q.[.g~ ! . . ...... Name~ of ................. Former Owner l~'gfl. ~¢~c.H~' ......... mt, o ...............
11. Zone or use district in which preroises are situated .....................................................
12. Does proposed construction viola~e any zoning law, ordinance or regulation: ....~.o... .........................
13. Will lot be regraded ....... ~. · ·: ..................... Will excess fill be removed from premises: Yes No
14. Name of Owner of premisesk/~/0, e.~ ~/l?pT!~.g~../(g~ ff.o.B.~ddress~..~o,.~..~' (~..]]mtkaax~L. Phone No ~./.6..q..q.~..6~./.q ....
Name of Architect ........... ~ ............... Address ................... Phone No ................
Nmne of:Contractor .......... ; ............... Address .... : .............. Phone No ................
15. Is this property located within 300 feet of a tidal wetland? *Yes ..... No ..~...
· If yes, Southoid Town Trustees Permit maybe required.
i PLOT DIAGRAM
Locate clearly and distinctly all bhildings, whether existing or proposed, and~ indicate all set-back dimensions from
property lines. Give street and block m tmber or description according to deed, and show street names and indicate whether
interior or corner lot.
v°
3TATE OF NEW~,YORIC
~OUNTY OF. ~.q .......
............................. , .................. being duly sworn, deposes and says that he is the applicant
(Name of individual signin~ contract)
tbove named.
te is the
(Contractor, agent, corporate officer, etc.)
)f said owner'or owners, and is duly ~uthorized to perform or have performed the said work and to make and file this
tpplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the
york will be performed in the manner spt forth in the application filed therewith.
;worn to be_fgre me this
....... · .~." .... ._. ....... day of..i..~..9~-5.. ............. 197~..
~otary Public, ?. · '.
NOTARY PUBLIC, Store ~ New yor' / /
No. 30~46~3137 ( / ........................
, ~ :~lllfl.~d In N~U C~nty~ O r'/~--~ (Signature of applicant)