Loading...
HomeMy WebLinkAbout15134-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...z 1/~723 Date July 29, 86 THIS CERTIFIES that the build~g deck addition 165 Short Lane East Marion, New York Location of Property Hou~ No. Street Hamlet County Tax Map No. I000 Section 053 ...Block 02 .Lot 02 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated July 2.3, .86. 15134z ..................... 19 . pursuant to which Building Permit No ...................... · aateO: '...~.u. Ly...2.4., ................. 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 ......... deck addition The certii'icate is issued to ... L..~.~.d.~...&. ~.?..e ?.h..~..c.h.o.~.n..s .~?.~.n. ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...... .N/.~ ................................ UNDERWRITERS CERTIFICATE NO .............. .~./.3: ................................ Building Inspector ffoR~r NO. J TOWN OF $OUTHOLD 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) N9 15134 Z Permission is hereby granted/~J~: __ ................................................ County Tax Map No. 1000 Section ..... .(]~)....~....~:J ..... Block ...... Q.....-~.. ..... Lot No ......~..~ ...... pursuant to application dated ........ ~....~-..~ ................... , Jg,.~...~,, and approved 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 OCCUPANCY 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--(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 required 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 $15.00 // 4.Vacant Land C.O. $5.00 5.Updated C.O. $15.00 Date ................... NewConstruction ...... Id or Pre-existing Building ............ Vacant Land ............. Location of Property . .~. · .~.. ~,~tO..,~, .¥-..../..~, .f?..~....~/~./~q~%~..... ~.~ .r-../.~..,~. ........... House No. Street Ham/et Owner or Owners of Property . .'~J-~!~.~.?. ~'~.. F~ .~'..~¥.. ~'..~D. ~.~-~...~.~ .~. O.~'.~ff). ~. ~.~..~2. .... CountyTax Map No. 1000Section ....(~..~..~. ..... Bl~k r © ~ Lot ..... .~..?-~-~.. Subdivision ................................. Filed Map No ........... Lot No .............. Permit No..z/~. ~ ~.~.Z-. Date of Permit--7./..Z.y/~.~/¢..Applicant....~...L/~. '~. ~... 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 p,~.~t meets all applicable codes and regulations. Applicant . . . . .~ .~zP,~... ~...~....(~..-"~f..~/~.~ ............ Rev. 10-10-78 FIELD INSFECTiON FOUI__~DA__TI_~ON -- (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Received ........... ,19... Approved...~. .~..~..., 19~(~. Permit No. ]..~./..~.~..'~. Disapproved a/c ..................................... (Building Inspector~. :: , .. . APPLICATION FOR BUILDING PERMIT / a. T~s application must be completely fi~ed ~ by ~pewriter or in i~~itted m ~e Bui 'g pe , ' sets of plans, accurate plot plan to scale. Fee according to schedule. /~~ b. Plot plan show~g location of lot and of build~gs on premise~p~ ~ ~[ng premises or pubic streets or areas, and giv~g a det~led description of layout of property mut~w~~~Ite ~hich is pa~ of this appli- cation. ~/~l~~ ~ e. The work covered by t~s application may not be commen~e~~ d. Upon approval of this application, the Building Inspector ~s~d'~g ~ ~apphc~t. Such pe~it sh~l be kept on the premises available for ~spection ~rou~out the w' ~~ e. No build~g shall be occupied or used in whole or in p~t for a~~h} ~ ~ificate of Occup~cy shall have been granted by ~e Building Inspector. -~1.__~ APPLICATION IS HEREBY MADE to the Building Dep~tment for the issuan~ ~ ~ld~ pu~uant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, ~d ct; er app~cabl~ws, Ord~ces or Regulations, for the construction of build~gs, additions or alterations, or for removal or demolition, as here~ described. The applicant agrees to comply with all app~cable laws, ordinances, burden code, hous~g code, and reg~ations, and to admit authorized ~spectors on premises ~d ~ build~g for necessa~ insp~ct~gns. - (Signature of applicant, or name, if a corporation) ... ~.~ .TT..x.~.~. c:0.~...~.,, y...././.24 .?. ........... (Mailing address of applicant) (Name and title of corporate officer) - Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... State whether applicant is_owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ../.-., ;9 ~..a.~. ~ .~0 ~ ~ .e .'~ . - · .~ % ~ ~. ~ ~ .%.~ , .~ .................... (as on the tax roll or latest deed) If applicant is a co~oration, signature of duly authorized officer. ~OVEO A8 ~TEO 765-1802 9 g~ TO 4 ~ ~ THE ~LOW~NG INSPEC~ONS: ~ ~U~DA~ION ~O REQUIRED 2 ROUGH FRA~ING & PLUMBING ~. INSULATION Other Trade's License No ...................... 4. FINAL CONSTRUCTION MUST . ..~ ~/ ~ C~MPLE~E FOR C.C. ~. [o~ation oriana o. wHi~ p~opo~a wo~ win ~ acne. /~..~'h O MEET .... THE ~01P~M~NTS'OF ~E N'.~ ....... . ~... s T .~. ~.~,. a~ .~. ~,. ~. ~ co,s,~uc,~o, · ............................ CO0~L~gT ~s~t'ffiR ........ House Number Street ~N~ ~NS~ON ~RORS. County Tax Map No. 1000 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 .~..~/.~.*.4 .~.~<. ho ~'t ~ b. Intended use and occupancy ............ : ......~ .................... 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... Alteration ..... ' ..... Repair ........... '... Rerr oval . .' ............ Demo~ ..... · ...... Other Work .......... 4. Estif~:~.~. ~...: .......................... Fee . ..~... :...'~. " (Description) ' ' (to be paid on filing this application) 5. If dwelling, number 6f dwellin units ............... Number of dwelling units on each floor ........ ~ ....... If garage number of cars 6. If business, commercial or mixdd occupancy, specify nature and extent of each type of use . ' .... 7. Dimensions of existing structur s, if any: Front ............... Rear ............. Depth ..... Height ............... Number of Stories ........................................................ Dimensions'of same structure ~ith alterations or additions: Front ................. Rear .................. Depth ................... ~.. Height ...................... Number of Stories ...................... Dimensions of entire new construction: Front .......... . ..... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Sizeoflot: Fr6'nt .......... i ........... . Rear ...................... Depth ...................... 10. Date 6fPurchase .......... i .................. Name of Former Owner ............................. 1 1; Zone or use district in which premises are situated ..................................................... 12. Does proposed construction vioiate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ........ i ................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .. i ................. Address ................... Phone No ................ Name of Architect ......... i, ................. Address ................... Phone No ................ Name of Contractor ~ · ......... ................. Address ............. Phone No. 15. Is this property ' .................. located ~within 300 feet of a tidal wetland.9 *Yes ..... No ...../~/ be uired. If yes, Southold Town T.r~s[~e~ Pqrmit may pe requl, r { - ¢->'~, ' ~-.~ PLOT DIAG~M Locate cle~ly ~d,~stt~ ~ ff~'~s, ~hether existing or proposed, and. indicate ~1 set-back d~ensions from property ~nes. Give ~a,hl~e{ 0f desc~ption accord~g to interior or corner lot.,~,~k~43~ j~' '% },% %~X~%~. %(',,:' ~ deed, ~d show street nines and indicate whether STATE OF NEW YORK, COUNTY OF ................. .......... , ....................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above namedi . He is the ....................... i .................................................................. , (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly! authorized to perform or have performed the said work and to mhke 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 manner iset forth in the application filed therewith. Sworn to before me this ............ ....... dayof.i.... ........... i9.f! f) Notary Public .... ~-'~..- ~.-.i. ,~, ,ff~,..///~: ..County ~~RI(' DE ~tg StirS'of New Y~rk (Signature of applicant)