Loading...
HomeMy WebLinkAbout14456-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy z14770 August 6, 86 No .................. Date ................................. 19 ... Accessory storage building THIS CERTIFIES that the building ................................................ 10450 Sound Avenue Mattituck, New York Location of Property .............................. 'S't/~i ....................... h~t~/ei House No. 1 2 2 0 2 0 ~ b~ County Tax Map No. 1000 Section ............ Block ............... Lot ................. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ....D ?.c.o.m...b ?.v..9. ! ..... ,1985 pursuant to which Building Permit No. 144.56z dated De c ember 9, 1985 , 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 ......... accessory storage building The certificate is issued to ...... Geraldine Worthington ............... ?o¥,,'e;', w ................... of the aforesaid building. N/A Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO ............. N / A Rev. 1/81 I~OBM NO. ft TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 14456 Z Permission is hereby granted to: ~'~/-~a~'L'~[ t~.(~ ~,.~'~o/f--T~l ~O~ ..... ~..~~z....~.~.~ .................. .... t~.~.~ ....... .~~..~., ......... ..... ~~.~.~..,...~..M,......u~ ~ . ,o ....cn~.~:&~.~.....~a~.~.~m~.....~o.~2~....~., ........... ~, ~,,~,,e, ,~o,,a ~,..~.~.~......~.,~..~ ....... ,.: ........................................ ............................................................................................................. ~.,~.~..,...b~.,b/ Building Inspector. ~ee ~..LZ.O.....¢....~°.. Rev. 6/30/80 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND LATION FRAMING ~] FINAL REMARKS:, DATE ~'-~/0~/ iNSPECTOR.,/~~ FIELD INSPECTION ~ COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY C,ODE ADDITIONAL COMMENTS: FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1~802 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. 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 featu res. 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 $15.00 4.Vacant Land C.O. $5.00 Date ...!..~ ........... New Building . ~ ........ Old or Pre-existing Building ............ Vacant Land ............. Location of Property ..... ,[~/~--Jc.~, ..... '~Q.~..~-~.~../"~....~.1~. ........................... House No. Street Hamlet Owner or Owners of Property . .~-~.~..~.' .~. (~(~)'~..1.~,(~....~.~'.~ .-J~..-~. ~r~l .~..(~-~..-~.G./~J ............. County Tax Map No. 1000 Section [ ~ ~ Block O'~ Lot., .O..[ .~, Subdivision... '--- : .Filed Map No....~-~-iL~.., ....Lot No, ~.. ;: ......... Permit No. I.~¥.~,., of Permitl.~l.~,f?-~..~.~, ,Applicant ,~.~:,,5,¢-,~-.%; Health Dept. Approval ........................ Labor Dept. Approval ,, .~ .............. Underwriters Approval...,..,~ ........ ........ ,Planning Board Approval ...................... Bequest for Temporary Certificate ,,, .., .................. Final Certificate Fee Submitted $. ,¥.-~.. ~;.. 7..,,v. ,q..1~....q, J.. Construction on above described building and permit meets all applicable codes and regulations. Rev. 10-10-78 co e. 1'4770 Memorandum from.., BUILDING INSPECTORS OFFICE TOWN OF SOUTHOLD TOWN HALL, BOX 728, SOUTHOLD, N.Y. 11971 765-1802 / 1-T II ii C~ll:~T J j.~,.,.,4-IIx 4II 1:3L,OII /i_ ~.fII ~. oil FRONT WALL FRAMING S C/~,LE I/,I~!I; II- 0II ,) - Z-a,l' o,c END %Td I:~ I/~,Ii F>LYI. qo o D 'T I:P.I I'd I/~JI PLYIN Oo !D HE/~D f" C (j I& .4Jt GI~T~ :0 PoST ~8,T ~-OI~ O,C, [~ Ly I.'xlo 0 I$ II I I ' 1211 ×4 FILLER NJ-1 lEE t F ~E~Cp ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 8OUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined,~.~...O...,19 t.~.~t/~,~ -.~]~ Received ........... ,~9... Approve~ ~...~ .... l~e~it No ........... [ Disapproved a/c ..... ~.- ............ ~ .... ~. · (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .~.~ :. INSTRUCTIONS a. This application must be completely filled in by Wpewriter 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 Occupraicy 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 in building for necessary ' ctions. /9 _ .~ admit authorized inspectors on premises and ~~., .~:.~ ................. - (Signatd~ of applicant, or name, if a corporation) ,& (Mailing address of applicant) ,f State whether applicant is owner, lessee,~chitect, engineer, general contractor, electrician, plumber or builder. .......................................... ¢' ..... ';. ...... (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 ...... ~ ..Z~-... .......... Plumber's License No ......................... Electrician's License No...~..<:~..~4...~.--~. ......... 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 [ 4 Subdivision ....... :.,: .; ............ .............. Filed Map No .... ~ ........ Lot .. T-: .~ ......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... .~.. ,&~..~.... ~.. &~. ~[ .~.~%~... i~(~L~,~ iL~...~.--~.. ............... b. Intended use and occupancy .. ~/~0 ~L.~....L~./c.?..~..~.....----~..L,C~'7.~ --'~" ~ --X .~4/_QjO..~.' · .~. · -c~..<TT. ......... 3. Nature ~f work (check which applicable): New Building ' Addition i Alteration pair ' ..... ~ . Other Work ....... ' Re ......... Removal .............. Demqlition ............ .......... 20,0.00 ' (Description') 4. Estimated Cost.. Fee "~ (to be ~aid on filing this application) 5. If dwelling, number of dwelling units ............... Number of d~,elling units on each floor ......... If garage number of cars ',- 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7 Dimensions of existing structures, if any: Front Rear ' Depth Height Number of Stories . Dimensions of same structure with .alte. r.ations or additions: Front ............ j .... Rear .; ............... Depth .... ' .................. .H'ei~ ................ ' ...... Number of Stories' . ............... 8. Dimensions of entire new constmctio_~F~n~t, t ............... Rear ......... ...... Depth .............. Height ............... Number of Stories .~. ......................... i ........................... 9. Size of lot: Front..: ................... Reht~. ..................... Depth ................... 10. Date of Purchase ............................ .X~ame of Former Owner .! ........................... 11. Zone or use district in which premises are situated ..... .~. ............ . .....i ........................... 12. Does proposed construction violate any zoning law, ordin,a,n.~x~r regulation ..... i ............................ 13. Will lot be regraded ............................ Will ex'c~s~ fill be removed from premises: Yes NO 14. Name of Owner of premises .................... Address ................ J... Phone No ................ Name of Architect ........................... Address ................ I... Phone No ................ Name of Contractor Address Phone No ' PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, property lines. Give street and block number or description according to deed, interior or corner lot. ' - ail set-back dimensions from ~t names and indicate whether STATE OF NEW YORK, COUNTY OF ................. S.S ............ ' ..................................... being duly sworn, deposes and says that he is the applicant (Naive 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 sa'id wor} and to make and file this application; that all statements contained in this application are true to the best of his iknowle tge 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 .... ..~.)1.~%.. ............ 19 .~..~- ..,, _ .,...