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HomeMy WebLinkAbout14048-zFORM MO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No ~-17425 Date OCTOBER 19~ 1988 THIS CERTIFIES that the building Location of Property 50605 MAIN ROAD House No. County Tax Map No. 1000 Section 70 Subdivision ADDITION SOUTHOLD~ NEW YORK Street Hamlet Block 1 Lot 8 Filed Map No. Lot No. conforms substantially to the AppLication for Building Permit heretofore filed in this office dated JUNE 17, 1985 pursuant to which Building Permit No. 14048-Z dated JUNE 17~ 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 TRELLIS ADDITION & FENCE TO EXISTING ONE FAMILY DWELLING The certificate is issued to J. DOUGLAS PEIX (owner, of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 Building Inspector lrOB~ NO. 2 TO~N OF SOUTHOLD BUILDING DEFAI~,TMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 14048 Z Permission is hereby granted to: ..... ~..~..~.~_.......~..~......~.... ...................... ....~.~.~.....?.~..:.....u...~.~.~ ..... . ....... ................... at premises located at ...~.......(R..~..~ ....... .~.(~c~..,.f~r.. ........ ~_~~....C~[_~ .................... County Tax Mop No. 1000 Section ..... ..~...-[..~ ........ Block ....... .~ ............. Lot No ....... ..~.. .............. pursuant to application doted ...... ,.,,~.,.~,~,....~..~. ..................... , 19.~.....~.., and approved by the Building Inspector. Buirrdlng Insl>ector 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 OB ink. and submitted ,,, ~ 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 b~ildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code complianbe 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 property showing alt 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: Additions $25.00 POOLS $25.00 ALTERATION $25.00 1. Certificate of occupancy New Dwelling $25.(10, Accessory ~$10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ ]00.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $]0.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date .../..~.;.--..!J.~.,~,f~ ..... NewC°nstz"uc%i°n .... ~ ~%c~4~_c>f_%Ol~d-°rPre'exjstingBuilding- ~-. ..... ....... VacantLand i. ............ Location of Property ,~~7~-, ....... ~ ................ ~-~ House No. Street Ham/et Owner or Owners of Property ..._~ ..;..~..c;~.W-~ ¢.~ .L~.~.~ ..... .~ .~.~. ................. County TaX Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No.~..~'.~..-/~.~.~. Date of Permit ~. ~/.7./!..~.~A. pplicant..~../~..~..J~.~~ ....... 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~mj~Fneet.~l ap.l~able codes and regulations. Applicant ./.~.~..~ ./~-~.~ ...... ~...-~. ............ Rev. 10-10-78 FIELD INSPECTION COMMENTS F 0 U__N D A._T I O__N .-- FOUNDATION (2nd) -~ROUGH FRAME & INSULATION PLUMBING FERN. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined · [x.o,-,~l..~.. ., 19..~. Approved ...~,~-{//~..I .7., 19~..'~.Permit No ............ Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date . .17..3p.n.e ........... 19 .8.5. INSTRUCTIONS sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, or areas, and giving a detailed description of layout of property cation. c. The work covered by this application may no d. Upon approval o f this application, the shall be kept on the premises available for ins e. No building shall be occupied or used i shall have been granted by the Building Inspector.~ APPLICATION IS HEREBY MADE to the Building Zone Ordinance of the Town c Regulations, for the eonstrucfion of buildings, The applicant agrees to comply with all Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 to adjoining premises or public streets on the diagram which is part of this appli- ; Permit. applicant. Such permit until a Certificate of Occupancy of a Building Permit pursuant to the other applicable Laws, Ordinances or emovai or demolition, as herein described. code, housing code, and regulations, and to admit authorized inspectors on premises and in i )ecti/~r/,,~,~, ..... · ........... i'd .... (Signature o~l~plica/nt, or name, if a corporat'o ) ~(/~'~ 208 Fifth Avenue, New York, N.Y. 10010 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................................. AS Name of owner of premises .J...D.o.u. glas .P. qi.x..§ .Wm....g, .Cr~t~fvrd ..... D'A'TP. ~//7/~' B'P'~ '] q~)' 1~'~ ~25' ' · ' (as on the tax roll or la2e' ~t~teed) J' FEE: _'"2_C :..'-5.. ...... BY: If applicant is a corporation, signature of duiy authorized officer. NOTIFY B! JILD!NG DEPARTMENT AT 765-~80~ 9 AM TO 4 PM FOR THE .............................................. FOLLOWING IN?ECTIONS: (Name and title of corporate officer) 1, FOUNDATION - TWO REQUIRED · _~ Ch FO~ P UR.:D CONCRETE Builder's ~icense No .................. ,/'~' 2. ROUGH - FRAMING & PLUMBING 3. INSUI AT!.qN ['lumber's Liceuse No ......................... 4. FINAL - C©]N'SmRUCFION MUST BE C"V,~m "TF [:OR C.O. Electrician's LicenseNo ......... " .............. ALL CONSTRUCTION SHALL MEET THE REOtHpr:MENTS OF THE N.Y. Other Trade's License No ...................... STATE C©NSTRUCTION & ENERGY ,CODES, NOT RESPONSIBLE FOR 1. Location of land on which proposed work will be done ................. I~E~SlON OR '~ONSTRUGTIOI~I '~R~O~.' ' ' 50605 Maj, n (State) Road Southold }louse Number Street Hamlet County Tax Map No. I000 Section 070 1 (Pcl,) 8 ........... Block Lot Subdivision ................................ Filed Map No ............... Lot ........... 2. State existing use and occupancy of premises and intended use and occnpancy of proposed construction: a. Existing use and occupancy .... p. ri¥.ate .bq¢s.~ .................................................... b. Intended use and occupancy . · · .s .a~. [n.o...ch..a.ng~) ..................... 3. Nature of work (check which applicable): · ' ' ' .g'...... ..... New Building .......... Addition .... Alteration ..... Repair ............ Removal ............ Demolition ............. Other Work...T.r.e.1.1 .i.s ...... ' ~ (Description) 4. EstimatedCost .~ 7~0 .. .................... Fee .7.~'~..~. ~ ............ (to be paid on filing this application) 5. lf,dwelhng, number of dwelling umts.. 1 ........... Number of dwelling 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 . r ................... 7. Dimensions of existing structure~, if any: Front.. ~ 8 ! .......... Rear glg.' ........... Depth .6.0.' ........... Num:ber of Stories ~tr 1/~ ' Height . .25 ! ............................................................. structure wi.th alterations or additions: Front .28' Rear 28.' Dimensions of same .............................. ' 1{2 Depth... {).0 '. .............. i.. Height ...... 2 $ ' Number of Stories 1 - 8 Dimensions of entire new construction: Front - Rear - Depth - Height - Numlber of Stories - 9. Size of, lot: Front 67 46' ' . i. Rear...6.5...2.5.' ............. Depth, '~'e¥'~bn'e ........... i ........... 66.30.~ ........... 10. Date of Purchase 2 danuar~ 198.5 Name of Former Owner . .s .t .e p .n .e p 11 Zone oruse .... ' ' are situated · district in which premises ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: . no 13. Will lot be regraded . no... ,..i,. ................. Will excess fill be removed from premises:r212~ Y~ 988~1o ...... o. ~oouglas vezx --- 208 Sth Ave. NYC ' 14. ~mme 0I owner oI premises Wm' i. R' · Crawferd ..... Auaress ...... ,.. Phone No. rg4,~.l..?,q.g. ~4.7.~.. Name of Architect Pelx. [. Crgwford ............ Address ................... Phone No .............. Name of Contractor " ,,i Address " " " Phone No 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 show street names and indicate whether interior or corner lot. ~ ' ' ,, ,,,' ,,, j,~---q ~e~e.~ ,~ r-~ ~ ' ' Ik J STATE OF NEW YORK, S.S COUNTY OF ................. .................................................. being duly sworn, deposes and says that he is the applicant (Name of individual sign: ng contract) above named. He is the .......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul~ 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 mannei set forth in the application filed therewith. Sworn to before me this HELEN K ~E ¥OE, NOI^RY PUBLIC, State d Ne~" No 4707878, Stdlolk latin Exp*res March 30. ..... , 19~.$~- con? /(Signature of applicant)