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HomeMy WebLinkAbout14773-zFORM NO. 4 TO~VN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.Z14369 Date April 29 1986 THIS CERTIFIES that the building ....... .D.c.c..k..a.d. cl..5_.t.i.o..n ......................... Location of Property 3780 BAYVIEW RD. SOUTHOLD h3;s~ hio] ....................... 's't/e$i ....................... h$~iei County Tax Map No. 1000 Section .... .0.7.8. .... Block 03 .Lot 52.1 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... Apr;[.1..~ ......... , 198.6. . pursuant to which Building Permit No...1.4.7.7 ~ ............. dated .. g.p.r..i .1..2.2. ................ 198.6. ., 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 ......... .... De c.k..a~id.J_.t i~)n..to, e~cia g£~g. 9n.e.. fg~i. 3, y..d.w.e..1.1.i.n.~: ..................... The certificate is issued to ..... J.Q .E .L..4 . .J .U.D.Y...W.H.I.T.T..I .N.G.T..0 .N ........................... (owner, ~]¢~Y..~ of the aforesaid building. Suffolk County Department of Health Approval N / A UNDERWRITERS CERTIFICATE NO. N/A Building Inspector Rev. 1/81 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 14773 Permission is hereby'granted to: 'i~~" ~..v.. ,..,..~.~..~. ............. .~-~.~~.,...~....¥~~....: ............ ;. ....... = ....... =....:..~. ..................... at premises located at ...'~..~..~ ................ ....~.~. ............................................................................... pursuant ,o application dated ..~....,~...~.. ....................... , 19..~...~..., and approved Dy the Building Inspector. 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 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 featu res. 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 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 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. Updated C.O. $15.00 New Building ............. Old or Pre-existing Building ~..'. ........ Vacant Land ............. Location of Property ...~.~ .~.kO ......... .~/[ .~,~, J-rq. ......... D.. .~... ¥/ ~ House No. Street Owner or Owners of Property .~©.~1..0.~ .~.~..'-/...~ ~ L~Jr-). ~..©~ County Tax Map No. lO00Section ...).(~x'. ....... Block .... ~ ........ Lot.........,..,~'c~,/... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. 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~r~mit mee~s all ap~ca~b ode~and regulations. Rev. 10-10-78 FIELD INSFECTION COMMENTS FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & FLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS'. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N,Y, 11971 \ TEL.: 765-1803 Examined..~..~..Z.:. .... 19 .~.~. Approved .~,~..~..~ .... , 19~.~. Permit No...q .'7'1 .~:~. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detai~scription o~,.1,ayput of property must be drawn on the diagram which is part of this appli- cation. ~'J i ~ '~' ~* i ~,~ · · c. The work covered b~ this al>plicatiog may not be commenced before issuance of Building Permit. d. Upon approval of fh~s~i]-a~io~,,fi~{i~,in~jp~"~r will issued a Building Permit to the applicant. Such permit · shall be kept on the premis~§ ~'Y, tfl~ffi't~fd~'hh~16~'cff$l~ffhqSt~gl~oh¢ the work, ' e. No building shall b~,~ o{~0i~.~ ~j~jI~t~_h~or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by t&elB~ild~r~]pg$~r~] ~ APPLICATION IS Hl~i~)~t_~ t~,ilding Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance o¥/h~ol~hl~f~o~t~]d, 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 .applican.t agr. ees to comply wit.h all app. licab!e !aws, ordinances .buildin. g cot~e, h,ousin, g code and~ r~egul~tio?, and to admit authorized inspectors on premises and m buildmg for necessary inspections, d" ~ ~ ~- h''~ ''' i~;~ applicant, or name, if a corporation) . (Mailitfg address of applicant) / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builden (as on the tax roll 6r 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 .................................................. .... ....... 63 ...... ...................... House Number Street County Tax Map No. 1000 Section .... ~ .~J. ......... Block ..... ~.~ .......... Lot....~ .q~.:/ ........ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........... ' 5 "'72cer' ' '.,~-vrJ-& ................................ b. Intended use and occupancy ................................................ 3. Nature of work (check which applicable): New Building ' Addition ~. ...... Alteration .......... Repair .............. Removal .............. Demolition ............ ~.. Other Work ............... .~. : (Description) 4. Estimated Cost .. .~ .............................. Fee ........ !. (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 ' 6. If business, commercial or mixed occupancy specify ~)ature and extent of each type of use ................... 7. D~mens~ons of ex~st~ng structures ~f any. Front .~2~g ........... Rear .~.(~ ..... ...... Depth .L~..., ..... Height .............. Number of Stories ,Q:~ ........... Dimensions of same structure with alterations or additions: Front ............. J .... Rear .................. Depth Height Number of Stories 8. Dimensions of entire new construction: Front ............... Rear .......... Depth ............... Height Number of Stories 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10 Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated 12 Does proposed construction violate any zoning law ordinance or regulation: 13. Will lot be regraded ..... ~.h(-) .o. .................. Will excess fill be removedl from premises: Yes No 14. Name of Owner of premises .................... Address ............... i Phone No ...... Nam f A hit Add ' Phone No e o rc eot ........................... tess ................ : ................... Name of Contractor .......................... Address ................ i. · · Phone No..., ............. 15. Is this property located withinl.00 feet of a tidal wetland? * Yes ..... No ~... · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, ind!icate all set-back dimensions fi'om property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. OCCUPANCY OR USE IS UNLAW L .,,!ITHOUT CERTIRCATE OCCUPANCY APPROVED AS NOTED '" ,,..¥,.Y" S,C. NOTIFY BUILDING DEPARTMENT T 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: I FOUNDATION TWO REQUIRED FOR POURED CONCRETE 2 ROUGHT FRAMING & PLUMBING' 3. INSULA ON 4.. FINAl. CONSTRUCTION MUST BE,COMPLETE FOR C.O, ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y ,~I'ATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR ~ESIGN OR CONSTRUCTION ERRORS. STATE OF NEW YORK, S.S COUNTY OF ................. ................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named, i He is the .............................................................. ! ........................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the sald 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 . ' ( .~. ' 'da of. " ' · ..... ,197..~ , ,