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HomeMy WebLinkAbout14759-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hail Southold, N.Y. Certificate Of Occupancy No ...... .Z.l.q 5. 9.9 ..... Date ....... .J.u.n.e., .1.3 .................. 198..6. THIS CERTIFIES that the building ........ a.c..c .e.s.a.o..v 7..b.u..i .1.d.~.n.g ................... Location of Property .... 1.1. 5. ~ ............ .L .o.n. g .v .i.e.~...L .a .n.q ............. .S 9.u.~ h..o .1.d ..... House No. Street Hamlet County Tax Map No. 1000 Section .... .8.8. ..... Block ........ 5. ......Lot ...... 1.2. ......... Subdivision..?e.??.y..~..a.t.e.v.s. ............... Filed Map No. 2.9..0 J .... Lot No...~.1 .......... conforms substantially to the Application for Building Permit heretofore flied in this office dated .... g. P r.~.l.. 9. ......... , 19.8..6 pursuant to which Building Permit No ..... 1fi. 7..5.9.Z. .......... dated ...... ~ p.v.~.3:.. J .6 ............. 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 ......... .A. qc..e.s.s.q.ry, building in the rear y. ard. The certificate is issued to ................ ~I.~ T..5.N..&.. t. q3.B.~' W3.T.E. ~ .S ................... (owner,~ ~Z~t~nY~f~tX of the aforesaid building. Suffolk County Department of Health Approval ............... .~ ('? ........................ UNDERWRITERS CERTIFICATE NO ....................... .1J./.A. ....................... Building Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDIHG P£~IT (THIS PEI:~v~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 1~759 Z Permission is hereby granted to: ..... .u.~..~..~....d..,.......~..o. ............. d~,~ ..~..~~Z,.....~..:.7..,../.../...t ~.../ ............ premises Iocoted at ...../.../...~...~....~..~ .hLd.,~....~.~;;~/':~.,....~..~ ............. County Tax Map No. 1000 Section ...... ..0......~...,.~. .... Block ...... ..C~.....~... .... Lot No ..... .O....L~:.= ...... Building Inspector. approved by the Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD I~uilding 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 m~ 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, Commercia~ buildings, Industria~ 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 existing buildings (prior to Apri~ 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 $1 5.00 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5 .Updated C.O. $15.00 Date . .~..~. ~/~.. ~/..../.~..~.~. ....... New Building ~, ¢.~'~]5.~./."t/~.. · Old or Pre-existing Building ............ Vacant Land ............. '/5-5- /- ' - ~ Location of Property ............................... ; ................................... House No. Street Hamlet Owner or Owners of Pro perty . .Z'/.~.4 ~./.~./..~.~'/.Qf¢. ~..../Z(/.< .7.~-(~..J .......................... County Tax Map No. 1000 Section . .~A .~.~ Block o,~ ..... Lot...~./. '.~. ..... Subdivision ................................. Filed Map No ........... Lot No .............. · -~' '~' /-/,4//QTlt/ .J. /,,//t Permit No.../,W.. ~..~. ~. Date of Permit .~///../.,~,/.~L .Applicant 7./'/~ j- Health Dept. Approval ........ ,~.. ,~'~'~-%~, · · ......... Labor Dept. Approval ........................ Underwriters Approval ...... .~. · .~. · ........... Planning Board Approval ................... Request for Temporary Certificate ..................... Final Certificate . ~/ .... ' ' Fee Submitted $ ........ . .~..?--~.... ,~... r~..~.... Construction on above described building and permit meets all applicable codes and regulations. ~':~'~ ~/~-~)~Ck' Applicant .~/."./~(~;P...~.~., '7 ~' ' '~' ': ........................... FIELD INSPECTION 1. FOUNDATION (1st) FOUNDATIOI 2, FRAME PLUMBING 2nd) J INSULATION PER N. STATE ENERGY CODE FINAL COMMENTS ADDITIONAL COMMENTS: 3. Nature of work (check which applicable): New Building .......... Addition .'7~ ....... Alteration .......... Repair ~... Removal .~ ....... ;... Demolition .............. Other Work ............... t~;i I: '* '~ ' ' ' (Description) 4. Estimated Cost~...~'..,~.?.O.~. :.-- ......................... Fee ..... ..~.....~.~..~.'~. ..................... ~ .~ ~.~ ~" ~' ~' (to be paid on filing this a~pplication) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars ........................................................................ 6. If business, commercial or mixed occupancy, specify na. tu, re and extent of each ty_pe of use ......... ./, .......... . 7. Dimensions of existing structures, if any: Front .... ~. ~.'. ....... Rear .. ~..~J~ ........ Depth..~ .......... :. Height ... ,~ ~.*. ....... Number of Stories .... /. ................................................... Dimensions of same structure with alterations or additions: Front ................. Rear ................... Depth ...................... Height-.~;; ................... Number of Stories ....................... Dimensions of entire new construction: Front ...'~.°.* ......... Rear .../.q.~ ......... Depth . Height .... { .Of. ....... Number of Stories .../. ..................................................... 9. Size of lot: Front .... /.~.~ ./ ............. Rear ..... ~./.'~ .............. Depth I.~..~f., ....... ./..~.'.~ ....... 10. Date of Purchase .~.~. ~ 8/8 f~ ....... Name ofFormer. O,wner .[/?'.~.~./.~I~.6..K.~. [3../i.l.~/~.; ...... · '""/'" ' .... ' .... :' '' E- tP N'F. AL A6:tr[fCuI-T~i'~AI. 11. Zone or use district ~n whtch premises are mtuated..,~../~.. ~'.. i[... [ ........... ' ........... !. ]-. .......... 12. Does proposed construction violate any zoning law, ordinance or regulation: ../~..o ................... ; ....... 13. Will lot be regraded .... ~/0 ..................... Will exc~ss_fill be removed from premises: 14. Name of Owner of premmes/.~ ............. .- .....Address /, ....... .~:ax.N }~ ....ne . Name of Architect ........................... Address ................... Phone Ne ................ Name of Contractor .......................... Address ................... Phone Nc. .' ............. . PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposefi, and, indicate all set-back "iimensions from property lines. Give street and block number or description according to deed, and show street names and interior or corner lot. ¸8. dicate whether STATE OF NEW YORK, S. S COUNTY OF ................. ..... ......... . ................................................ -hei~g~du~n.~p~es-and ~sa~s~t~he4s -~he applicant (Name of individual signing contract) above named. ~ He is the .............................................. % .......................................... (Contractor, agent, corporate officer, etc.) ' of said owner or owners, and is duly authorized to perform or have performed the said wo, rk 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 ...................... day of .............. 19 Notary Public, ...~...~.:...~..Z:.~...~... County 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~*OUTHOLD, N.Y. 11971 TEL.: 765-1803 Disapproved a/c ................ ! ..................... (Building Inspector) · APPLICATION FOR BUILDING PERMIT Received ........... ,19... Date ................... 19... INSTRUCTIONS )letely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 a. Tins application must be com' sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plof plan showing location o~ 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 occupie~ 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 inspections. (Signature ol(/applicant, or name, if a corporatio ) A. (Mailing address of applicant) State whether applicant is owner, ilessee, agent, architect, engineer, ge~teral contractor, electrician, plumber or builder. · O al'm ............................................................................. PiA ¢ 14/A ................... 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 pro] iosed work will be done ................. House Number Street Hamlet dounty Tax Map No. 1000 Section . Subdivision..~.~ .1~ ~.~...~.r ~ J? ~ .............. Filed Map No. ~ ~ ~ ......... Lot.. ~. ( .......... (Name) State existing use and occupan&y of premises and intended use and occupancy of proposed construction: a. Ex sting use and occupancy; ............................................................ ..... b. Intended use and occupancyj ...................... ..