The URL can be used to link to this page

Home My WebLink About15070-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Zl6382 Date November 10~ 1.987 THIS CERTIFIES that the building A d d i t i o n Location of Property 1145 HENRY'S LANE PECONIC House No. Street Hamlet County Tax Map No. 1000 Section .0..7.4 ........ Block 0 I .Lot . .Q .0.3 ..... Subdivision. Peconic Homes ............ Filed Map No. 4181 .LotNo. l0 conforms substantially to the Application for Building Permit heretofore filed in this office dated July 7, 1986 pursuant to which Building Permit No. 15070Z dated . .J .u.l.y...9 :.. I. 9. .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 ......... Deck addit±on to existing dwelling amended for roof over deck. The certificateisissuedto JOSEPH & CAROL LYNN BETTY ..................... ?oYn'e; ..................... of the aforesaid building. Suffolk County Department of Health Approval ..... .N./.A. ................................. UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED: N/A Building Inspector Rev. 1/81 FOI~.M NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDIHG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 15070 Z Permission is hereby gronted to: ..... ........................ ...II~..~....~L-/~.cd..,~.L..~~..... ..~.~_,a~.~.c.,...t~.:~ ........ t.;.~..~...~ ~o ..... .<2:0. e,~..:~.T~ .~..~'IT....... ~ .~ .~......Z.~.T~.. ~. ~..~..~.....~'Y~.... ~ ................. .... ~ ..t.~u..~....*~.......~..~,~..~.~r,,,.o.~.~, .................. , ......................................................... o, prem,,e, I,~ote, ot ..... 11.~.~. .... ~Z'.'J.t~-~.F~.~ ............ ~ ..................................... County Tax Mop No. 1000 Section ...~.....~.....,'~...... Block ....(~..l .......... Lot No..~'...~..~:~ ....... 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 OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted I~ to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate ~ocation 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 applicabte. 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: Additions $25.00 1. Certificate of occupancy New Dwelling, $25.C~0, Accessory'i$|0.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50 -. 00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 5.Updated C.O. $ 50.00 Date ............ NewConstruc6ion ...... Old or Pre~existing Building ... X. ..... Vacant Land ............. ,-ocat on'of Property ........... ...... House No. Owner or Owners of Property. ~. ~.~ Subdivision ~'~.~'.~, .//~'., ./'..~'~,..~, ~..~ ~.4. ...... Filed Map No. ,~'.4.. ~....Lot No..,~.~'>'? ........ Permit No./..~.~../~4',,~, Date of Permit/?6~/C/~/~.~.Applicant ~/~.~.~..~/~'.~Z~. ......... Health Dept. Approval ........................ Labor Dept. Approval ........................ Unde~riters Approval ................... Blanning Board Approval ..................... ..~ Request for Temporary Certificate ..................... Final Certificate ... ¢.. ........... Fee Subm'itted $ .................... Construction on above dbscrJbed building and permit ~eets~~s and regu,ations. Rev. 10-10-78 FIELD ~INSP~CTION COMMEN'IS .... ~.,, ~f FOUNDATION 2. ROUGH FRAME & PLUMBING INSULATION PER STATE ENERGY q?DE FINAL (2nd) N. Yo ADDITIONAL COMMENTS: ~ ~ , 7GS-tS02 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION REMARKS: DATE-////~//~//'~ 7 INSPECTOR~ 765-~,802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION APPROVED AS NO'~.D ~, ----.~----..~-,,e'.a~,~x~-~= ~ · . 0~ ~ - ~ ~0 4 ~.,~ ~"~ 765-1802 ~ I~, ' ~oLLOWING iNSPECTIONS: 1.FouNDATiON ' 5WO R~QUIR~D ~OR pOURED coNCRET~ ~. ROUGH - FRAMING & pLUMBIN~ 3. iNSUlAtiON 4.FINAL" CONSTRUCTION MUS~ BE coMPLETE FOR C. O. ALL coNSTRUCTiON sHALL MEET ~HE REQUIREMEntS OF THE N.Y. ~ATE coNSTRUCtION & ENERGY coDES NOT RESPONSIBLE FOR D~SiG~ O~ CONSTRUCTION ERRORS. Examined. ~,4~.~.....~'... Approved .~J"Cc.C~.'A~.....~'... 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 BLDG. DEPT. TOWN OF $OUTHOLO Received ........... ,19... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Dat,ek ./~. · ~ ....... 1~1~ 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 9 Certificate of Occupancy shall have been granted .by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the is Building Zone Ordinance of the Town of Southold, Suffolk County, New Ym Regulations, for the construction of buildings, additions or alterations, or for The applicant agrees to comply with alt applicable laws, ordinances, building admit authorized inspectors on premisesI and in building for necessary inspectior · State whether applicant is qwner, lessee, agent, architect, engineer, general ;uance of a Building Permit pursuant to the ~, and other applicable Laws, Ordinances or removal or demolition, as lierein described. e, housing code, and regulations, and to ¢/,d .... Mailing address of applicant) _/~,7-~ :ontractor, electrician, plumber or builder. Name of owner of premises .~ .~..~./J'..]~., .~.-.~-.~..~.~:. ~.~.,.4~.,,y.~< .~, &"~. ~..~. ............................ (as on the tax roll or ,latest deed If applicant is a corporation, 4ignature of duly authorized officer. (Name and title oflcorporate officer) Builder's License No...~.~:~...~.i .............. Plumber's License No ......................... Electrician's License No ....................... '~, " Other Trade's License No ...................... Location of land on which proposed work will be done....~&9,..~'~ __ , House Number Street Hamlet County Tax Map No. 1000 Section .... ~. d~.. ......... Block ..... ./. .......... Lot...~..k2~ ............. (Name) State existing use and occupancy of premises and intended use and occupancy ofpropos?d qoostruction: 3. iN,ature of~w.orl/{~t/eck w}(i~l{ apphcable): New Building .......... Addatlon .... Alteratmn ......... *Rel~a~r ............ ,{k~emoval .............. Demolmon ....... Other Work ....... .... ~ :/ %:: f ~ ~" ~: ~' (to be paid on filing this applicatio:') 5. If ~elling,'nh~FaY ~f'~lllng ~nits .... ~ ......... Number of dwelling units on each floor...: ............ If garage, number of cars ..... j ............................................. .. ..................... 6. If budness, commercial or mixed occupancy, spec~y nature ~fl extent of each type of use ..................... 7. D~ensions of existing st~ctur~s, if any: Front ............... Rear .............. Depth ............... Height . .............. Number of Stories ..................... . ................................... D~ensions of same st~cture with alterations or additions: Front .............. ,.. Rear .................. Depth ........... ........... HeiSt ........... ~ ......... Number of Stories ............... 8. Dimensions of entire new const~ctlon: Front . .. Rear ............... Depth . ~ .~. 10. Date of Purchase ..... /~.~ ................ N~o of Fo~er Owner ~~~/~ ::: 11. Zone or use district in which pr~mises are situated.. ~ ................................................. 12. Does propOsed.c~truction violate any zoning law, o~inance or regulafion: ~ ............. 13. W~I lot be tegraded . ~..,~ ......... ~ ......... Will excess ill,be r~moved from premises: Yes ~ N~e of Architect ~ ' Address Phone No N~o of Contractor ........ ~ ................. Address ................... Phone No ................ PLOT DIAG~M Locate cle~ly ~d dist~ctl~ ~ bufld~, whether ex/sting or proposed, ~fl. indicate E1 set-back ~ensions from prope~y lines. Give street and bloc~ number, or description accord~g to deed, ~d show street n~es and indicate whether ~ interior or corner lot. STA'rE OF NE~,YO..RK .......~~ ~signing contr~c~~ .................. being duly sworn, deposes and says that he is the applicant above named. He is the .................. : ........................................................ ~' (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is d¢ly authorized to perform or have perfomed the said work and to m~e ~d file this application; that ~1 statements coht~ed ~ this application are true to the best of his knowledge and belief; and that the work will be perfomed in the m~ner set forth in the application filed therewith. Sworn to befo~ me this .............. ......... day Of .... ~x~ ............ Nota~ Public .... ~...~ .~.;. ~ ~gm~ ' ..... ~?.:./A.~ .................... : . T~ t~¢~h a0,1~ ~ f nature of'applic~t)