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HomeMy WebLinkAbout15095-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Date . October 30 ~ ....... 19 86 THIS CERTIFIES that the building...c[~ ~ t<..a, cl ql;L.q~,q¢. 3.0. .~lc~-AI; $¢g..q~..f.g tM- 3.y... 9680 Nassau Poin~t Road Cutchogue dwelling Location of Property ............................................................... House No. Street Hamlet County Tax Map No. 1000 Section 118 .Block 06 .Lot 09 Subdivision M/o S.ec. B. Nassau Point Filed Map No. 745 .Lot No. 88 conforms substantially to the Application for Building Permit heretofore fded in this office dated s.% z .................... ,19.. ursuant to which Building Permit No ...................... dated July 18 1986. ................................ was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy Ar w~ch t~s certificate is issued is ......... deck adoition to existing one family dyelling Gary. Valk The certificate is issued to ........................................................... (owner, of the aforesaid building. N/A Suffolk County Department of Health Approval .......................................... Rev. 1/81 FOB.~ NO. B TOWN 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) No. 15095 Z Permission is hereby granted to: ..:.z...?.~..~...~ .../..~ .......... .......................... ,o.~~ ..~. ~.,~ ..~~ ~.~ ~ ~..~..~.~.; ....... .~,z~..,~....~..~....'.u....~..... ............................................................................................... at premises located at ...~../R.~...O.......~...g~...~...-~..-.~.:...~. .......... ~~.~ .............. ..Z.~ ......... : ...... ]...~ ...................................................................................................................... County Tax Map No. 1000 Section ...... l.i..3 .......... Block ...... .~..~. ........ Lot No ......~.~. ............ pursuant to application dated ..... ..'~..~g:~....1.,O. .......................... , 19.~.., and approved by the Building Inspector. Fee $.%~..:..:~ ..... B~ilding Inspector Rev. 6/30/80 FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in WpewrRer OR ink, and submitted in duplicate 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. §. 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 peoperty 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- lion required to prepare a certificate. 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 D at e . Q .c .t.o. b,,e. r..2:4.. ~9.~ ~ ...... New Building ............. Old or Pre-existing Building............X Vacant Land ............. Location of Property .~ ~..~ .0. ?..~ .s .s?.u.. ~ .o.~. ~.~, ~q ~.~ .................... C.u..~ .c.h.o. g~..e., ......... House No. Street Ham/et Owner or Owners of Property .. ~R~.y .¥P~.[c ............................................... County Tax Map No. 1000 Section ...[l~. ........ Block .... 06. ........ Lot...0.~. .......... Subdivision :LVJ~,p. o~'..Se c .o..B. Na, s ~ e%l..~.Q ;t i3,J;. F lied Map No ..... ~[L'~, - · Lot No, .. Permit No. :1.~09~.. · Date of Permit . .?./.l~/~dApplicant ~.nvil~c~ume ri.J; .~ ~e.~,~ · [no · ~o-~. ,G.. Yello Health Dept. Approval NA, .Labor Dept Approval ~.A. PI nning Bo rd Appro al ~A Request for Temporary Certificate ..................... Final Certificate .... ~ .................. F~ Submi~ $.. ~.~QQ ...................... Con,r,ction on above de, ribed buildin~.and~e~~~es and regulations. ~. 10-1~78 765-1802 BUILDING DEPT. INSPECTION FOUNDATION ~ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [ ] FINAL DATE INSPECTOR 765-18~2 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] ~UNDATION 2ND [ ,] INSULATION [~]/~=RAMING [ ] FINAL REMARKS: ~ ~ ~ FIELD Ii~SFECTION FOUNDATION (1st) C OMi.] El; TS FOUNDATION (2nd) k.~ ___~UMBING INSULATION FERN. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: D, FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1802 Disapproved a/c ..................................... ................................ ........ (Building Inspector) APPLICATION FOR BUILDING PERMIT BLDG, DEPT. t ~..~TOWN OF $OUTHOLD Roce:Lved .......... ,19... 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 tl~is 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 regrdations, and to admit authorized inspectors on premises and in building for necessary inspections. ~o~ dz~7 ~ .,'YJ//~o.~..,~. ~ .77. ~:~.~F..../.A/.c.,....¢~ .~: '. .... (Signature of applicant, or name, if a corporation) ..... ~q.x.~ . .~.~. ~. . .~. .<~:. .Z. e~e. .-~.~.~e?x ~. . (Mailing address of applicant) //~",/"~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...... .~_7..: ././(~././.( .......................................................... (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..; ~./.~. .... /?...~..~.~.,ff.~... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .... ~ ..... (~. ....'. ....................... .~ ....... .... q~. ~ ....... . ...... /~r<~ ~...~.,?. t .~.4..- .................. .~..~. e~ .~ ~: ttouse Number Street Hamlet County Tax Map No. 1000 Section .... l ~ ......... Block .... G ............ Lot .... .~... Subdivision .~.~tP..~f...~.~.c~ i'~. ': .% .ff.~..5'.~?...~9~ ..... Filed Map No.. ?..4~..~' ........ Lot..~..~. .......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b.a' IntendedEXisting use and occupancy ............ ~.~.'(C~.~f.C.&.. ~, ? 13~ ~ .~ ~3~ltl~e~. ~! .i~...~.'~i i L .............. use and occupancy .......................... ./~ . ~i ................. 3. Nature of work (6h~ok whi:ch applicable): New Building .......... Addition . X ....... Alteration ...~ ...... Repair .............. Rem~oval .............. Demolition .............. Other Work .~2~..~.~../~.~..c. ~7.. ,. : escr on 4. Estimated Cost ..... Fee ................. ~ (to be paid on filing thb application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars .... .................................................................... 6. If business, commercial or mixsd occupancy, specify nature2nd extent of each typfi, of use 7. Dimensions of existing structures, if any Front .... ¢.~ ~" Rear .~.' ......... : ) ;->'t ....... . . ................ ........ :. Hmght .... Z~. r ...... Number of Stones ...... ~ ............................................ Dimensions of same structure ~ith alterations or additions: Front .~. ~~ Rear .................. Depth ............. :... Height ...................... ' Number of' -'Sto~es ..................... 8. Dimensions of entire new cons~'mction: Front ..... Z~ ( Rear t ........ .......... .... ......... ' : ...... /~ ............ Rear .... Z~O ............. Depth .... ~.~ .... ~ ......... 10. Date of Purchase .......... [ ................... Name of F~er Owner . ~. ~o~ ~14('~'. .......... 11. Zone or use district in which p~emises are situated .......... ?~~X ~ ....... / . 12. Does proposed construction violate any zoning law, ordinance or i'egulation: ...... 13. Will lot be regraded ........ 2.~ ....~ .......... Will excess fill be removed from premises: Yes No" 14. Nme of Owner of premises 'O.~-~ Address.. Nme of Architect ............................ Address ................... Phone No ................ Nme of Contractor f~4~P~U.ffq{~. [~, Address ~.Z~ PLOT DIAG~M Locate cle~ly ~d distinctly ~1 build~gs, whether existing or proposed, and. indicate ~1 set-back d~ensions from property ~nes. Give street and blocl number or description according to deed, ~d show street nines 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 sigqing contract) above named. Itc is the ..................... , ................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is du!y authorized to perform or have performed the said work and to make and: file this application; that all statements contgined in this application are true to the best of his knowledge and belief; ar/d that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........... [J ......&.7.day o_f .............. , .................... ~ ...... (Signature of applicant)