HomeMy WebLinkAbout15107-zFORM NO, 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N,Y.
Certificate Of Occupancy
No. z14784 Date August 12, 19 86
THIS CERTIFIES that the building ...~'.c.r.e.e..n.e.d..~..n..afl. 0..~.t?.n. ......................
LocationofProperty 7800 Soundview Avenue Southold, N.Y.
House No. Street Ham/et
County Tax Map No. 1000 Section ...059 ...... Block ..... 09 ........ Lot.. 3.g ............
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
J u 1 y 1 6, .., 19 .8.6. pursuant to which Building Permit No. q 5 q 0 7 z
July 19 , 86
dated ............................ 19 .... 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 .........
screened in addition to an exLsting one family dwelling
The certificate is issued to .......... ~ ~- ch.g e Z. Y... F 3.y.r;8 ..............................
(owner, ~t[eYoX ~.YtYt~lgx x
of the aforesaid building.
Suffolk County Department of Health Approval ........... N.../.A ............................
N/A
UNDERWRITERS CERTIFICATE NO ..................................................
Rev. 1/81
'ini3iit;i ............
TOWN O~
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDiHG PERi, IT
fi.HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
15107
Z
Permission is hereby gronted to:
...........
..............
to ...... ..~'......,~.. ..,~,,n ........... ~ .......
County Tax Map No. 1000 Section ......0....~..'~..~ ....... Block ...... .(~...CJ ........ Lot No ..... .~1...-~-... ..........
pursuant to application doted .... ..~..~...1....~.. ......................... , 19..~...~..., ond opproved by the
Building Inspector,
Fee $...~....'..~ ....
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 ¢~:i¢ ~ ~,Fj
Instructions ~,)/~ ~- ~
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 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-IS-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 required to prepare a certificate.
C. Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling $15.0 0
3. Copy of certificate of occupancy $1.00
5.Updated C.O. $15.00 Date '.. ./ .........
NewConstruc%ion ...... Old or Prezexisting Building ./.. ........ Vacan3: Land .............
Location of Property ....... ~4 ........................
House No, Ham/et
Owner or Owners of Property .............................................
County Tax Map No, 1000 Section . .~..~.¢. ........ Block .... I~..~. ........ Lot ....'~.. · .¢~. ........
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No ........... Date of Permit ..... Applicant . .~ f-..~.~.... '. ~ ............
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $. ~,. 0 P .......................
Construction on above described building and ,~//~iZTa~, ,p~Z,~,e~c_odes and regulations.
Applicant .... gr.-.-..';v...//. ,' V~', ~.~,~, . .......................
Rev. 10-10-7S
FIELD INS?ECTION
FOUNDATION (1st)
FOUNDATION
2.
(2nd)
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
CODE
ti~ATE !t
ADDITIONAL COMMENTS:
765-1802
BUILDING DEPT.
INSPECTION
[ ] FRAMING
REMARKS:
[ ] FOUNDATION 1ST []ROUGH PLBG.
[ ] FOUNDATION ;ZND []INSULATION
[]FINAL
DATE ,,
INSPECTOR ~-~ ~'~/~'
'FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
t
Disapproved a/c .....................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
Received ........... ,19...
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 code, and regulations, and to
admit authorized inspectors on premises and in building for necessary in~st~cti~J~s../~ -~ ////~///f~-~-/~'//.~/
..... 4 ~: ~. '?~. ~f4 ~/n ,?. ................
(Signature of applicant, o~ 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 ...~..~..~.:.~...~. · ......................................................
(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 ..........................
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No ......................
Location of land on which proposed work will be done~ .7..8.0.0..S.o..o~..u.&..e~...~.tr.*,: ............................
7800 $ourutu. i.~ P, ue.., $oulh. o.t.d, IL~...
House Number Street Hamlet
County Tax Map No. I000 Section ....... .~. ~. ....... Block..... ~. ........... Lot... &~ ...........
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name)
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
....... ~.. , ~ t~%~" ~ b' .'~ ...........
3. Nature .... ~ ' ' '
of work (check winclt'.appllcable) New Building ... Addition .......... Alteration ..........
Repaii' Ren/bval Demolition " Other Work
4. Esfi~ed Cost ... ~.~.0.0...0.0.~ ........................... Fee ......... -
,; ? ,~ ,.,':::., ,,,,,,~~, (to be paid on filing this application)
5.- If ~welllifg,' nc/tuber Of dwelling!units ..... q~.e ....... Number of dwelling units on each floor ................
If garage, number of cars . . .q ~r~. ..................................................................
6. If business, commercial or mixed occupancy, specify nat~J;}and extent of each ty~pe of use .. [ ........ ~ .........
7. I)imensions,~f/existing structures, if any: Front...-J~{~ ......... Rear .. ?.J.[ ..... Depth. ~.7 ...
Height .. / ............ Number of Stories.. 00~ .....................................
Dimensions?,,f sam~ structure With alterations or additions: Front . .f..,(/.~..~... Rea~
De th ~/ ~r rt~q -' , H ' --e · ' .......
P .......... ~...~... ~.. e~ght .. $~ ................ Number of Stones ... ~..~.~..~ . . .
Dimensions of entire new construction: Front ~ Rear Depth
Height ............... N ,tuber of Stones .....................
9. Size of lot:Fr~nt..,0~_~:/..~.~.~b,~, ....... Rear .... /.~..~f..ii.iiiiii.i ~);~h'..i~.'~?.'..II........... ...........
10. Date of Purchase ....... ~!..~.a! ................ Name of Former Owner ...~..e~...~...~.. ...............
11 Zone or use district in ....
· which premises are s~tuated .....................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: n~ .
13. Will lot be regraded ..... 0-0_.,.I ;. · .; .,;...,;.., ........ Will ex~c~s,,s,,fil~,be relnqved from nr, emises: ,,,~, Y,e*,, No
14. Name of Owner of premises ttC, J,f;~..e~. r.o t.,t~v~... Address (ooo
Name Of Architect ....... q..~qr.~. ............... Address ........... Phone No
Name o1' Contractor ...... ,a.e~. ............... Address .... : .............. Phone No ................
15. Is th±s property located w±th±n 300 feet of a t±dal wetland? ~Yes ..... No . &o..
~f yes~ Southold Town Trulstees ?erm±t maybe requ±red.
; PLOT DIAGRAM
Locate clearly and distinctly ali! buildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
STATE OF NEW~~YORK, S
COUNTY
........ .c~-~.z.~.fT..~l .~-.. '~/~. f..~..Al..~. ........ being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named. :
He is the ...................... ! ....................................................
~ (Contractor, agent, corporate officer, etc.)
of said owner or owners, and is dui>, authorized to perform or have performed the said work and to make and file this
application; that all statements contained in this application are true to the best of his knowledge and belief; and that the
work will be performed in the manneriset forth in the application filed therewith.
Sworn to before me this
...... .......... day of.. ~ ........... 19 .~?.
ferm ex~lree, DeeMtt~r 31, 1~ , "~