The URL can be used to link to this page

Home My WebLink About15147-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall $outhold, N.Y. Certificate Of Occupancy No. Z-15174 Date January 7, 1987 THIS CERTIFIESthatthe building Two dormer addition to existing one family dwelling 195 Midway, Southold, New York Location of Property ~/3~s~ X/o[ ........................................................ Street Hamlet County Tax Map No. 1000 Section 88 .... Block 04 .Lot 20 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated J.u.~y..2.8.,..1.9.8.6 ......... , ,. pnrsuant to which Building Permit No...I.5.1.4.7.z .............. dated............................July 28, 1986 .,wasissued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... TWO DORMER ADDITION TO EXISTING ONE FAMILY DWELLING. ROLAND V. PHILLIPS & DOROTHY A. PHILLIPS The certificate is issued to ..................... [ohJn'o;',~,~ ...................... of the aforesaid building. N/A Suffolk County Department of Health Approval .......................................... N/A UNDERWRITERS CERTIFICATE NO .................................................. PLUMBERS CERTIFICATION DATED: N/A Rev. 1/81 FORM NO, ~ TO~N OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTNOLD, N. Y. BUILDING PERJ~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 151~? Z ot prem'ses located at . I c/..~.. ~ ............. ~ County Tax Map No. 1000 Section .... .~.~ ....... Block ...... .~....~. ........ Lot No.....,~.....0.. ............. Building Inspector. .J Fee $..~.... ............... Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department. Town Hall . $outhold. N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted aa ~ 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. B. For existi~g buildings '(prior to April lgB7), No~-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of pzToperty 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- lion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $15 o 00 3. Copy of certificate of occupancy $I.00 ~'.~./. / /?__~¢~... 4.Vacant Land C.O. $5.00 dc, / 5. Upda~ed C.O. $15.00 Date ..................... New C on s t r.h c t i on ...... Old or Pre-existing Building ............ Vacant Land ............. ocat,on of .... ,Vo. .,,%. .qM. ,i '¼'" ........ ' '¼ ....... Owner or Owners of Property ....Y.-: ......... ~.~-,....../..: .................. County 'Fax Map No. 1000 Section ... ........ Block ..."~.' .......... Lot ................ · ' ' Filed Map No Lot No Subdlws~on ....................................... ...., ................ PermitNo /~..5'/.~.~..~... Date 0, Permit ~/.~/.~. AppPcant .~... ~. ~../~.~.r..~.,.[~.. ~. ............ Health De;t ~p;rov21 ./[ .~.'~., ii.'ii;' ikabo; Dept 'A;provll i~' .~. i i .........~/" '/'~ ; i Planning B;ard Approv;,' ' i~:~ ............ U nderwriters Approval... ,,,,.. -.... ........................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $...~ .d? ....................... c)/h/~ aJ0~e codes and regulations. Construction on above described building an me..e~s all Applicant ......................... Rev, 10.10-78 C0 ~5 i31q? .~ FIELD I~S, ~ON FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION AST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING FINAL REMARKS: DATE INSPECTOR TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL.: 765-1802 Examined .~ .~..~...., 19~.~. · Approved .~..~..., 1~.~.. Permit No./..~../.~.?..~.. Disapproved a/c ..................................... ................................ .............. (Building Inspector) APPLICATION FOR BUILDING PERMIT JUL 2 B 1986 l~ece±ved ........... ,19.,, INSTRUCTIONS a. Tins 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 tins application may~ not be commenced before issuance of Building Permit. d. Upon approval of this application, the Budding Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspectidR~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 BuildinlV)epartment for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of S0uthold, Suffl~lk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions ~r alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances~-.b~ilding code, 3mt3sing code, and regulations, and to admit authorized inspectors on premises and in building for necess ect' ~.~~~ (Signature of ~name, if a corporation) /. (Mailing address of appli6afit) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of pre 'e . ......................................................................... (as on the tax roi1 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 ...................... 1. Location of land on which proposed work will be done~ ...... .. · · House Number Street Hamlet 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 .... . .'~...k4..~.~..~./..AC/..~. ................................................. b. Intended use and occupancy ...... ~..~ .... ~..... ~ ............................ 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition, .. t ....... I ....Other Work.. ~.~. i ......... 4. Estimated Cost ..J .~.OO Fee .... i ' - [to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor...;... .... :...: If garage, number of cars ........................................... i ............... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ....... ]iii:iiii i]iii 7. Dimensions of existing structures, ifany: Front ............... Rear...............: Depth . ....... Height ............... Number of Stories .......................... ; .... "' Dimensions'of same structure with alterations or additions: Front ........... , ...... Rear ................. Depth ...................... Height ...................... Number df Stories ..................... '--8. Dimensions of entire new construction: Front .......... ' ..... Rear ....... ........ Depth ..... ......... Height ............... Number of Stories ........................... ................... ......... 9. Size of lot: Front ...................... Rear ...................... i Depth ..................... 10. Date of Purchase ............................. Name of Former Owner i .................... ......... 1 1. Zone or use district in which premises are situated ........................ ............................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ...i ............................. 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address .............. i .....Phone No ................ Name of Architect ........................... Address .............. ..... Phone No ................ Name of Contractor .......................... Address .... : ......... , .....Phone No ................ 15. Is this property located within 300 feet of a tidal wetland? *Yes ..... No ..... *If yes, Southold Town Trustees Permit maybe required. PLOT DIAGRAM Locate clearly and distinctly all 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 shdw street names and indicate whether interior or corner lot. ~ STATE OF NEW YORK, S.S COUNTY OF ....... ,~.. ....~..~.d....~..~/..~....~.,....~. '4.. $ ¢'d_.../(.-~................ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the .... .~.~.~. ~..f~..~.~. ?.~..~ ................................. '. .... ! ............................. (Contractor, agent, corporate officer, etcI) of said owner or owners, and is duly 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 manner set forth in the application filed therewith. Sworn to before me this ...... , ............. df. ....... day of... NotaryPublic .... ~--M--~..~.~. . County //~ ..~ ,/,~, .. ................