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HomeMy WebLinkAbout14071-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of tile Buildi0g Inspector Town Hall Southold, N.Y. Certificate Of Occupancy zl.46.45 Date July. 1.5; 19 86 THIS CERTIFIES that the building~. . ~ .Lg!~.g.e. ,b,u. 5:..1.d.i.n.g, .~.s..a. ppiS. 9 ,d' .~.q~. ......... Lo ..... ,. 12585 North Rcl. & 4250 Cry. Rd. #48, Mattituck~ N.Y. cation o[ vroperty i000 County Tax Map No, Section 141 ...Block .Lot '. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated Ma.rch. 12/ 198.5. plwsuant to which Building Permit No 14071Z dated .. ?.u.n. ?..2.0. ,. ................ 19.8..~, was issued, and conforms to all of tile requirements of the applicable provisions of the law. The occnpancy for which this certificate is issued is ......... Storage., buildJ . n The certificate is issued to George L. Penny~ Inc. of the aforesakl building. Sufiblk County Department of Health Approval ~/.~. UNDERWRITERS CERTIFICATE NO ....................... ~I/A ............. '...: ...... Building Inspector Rev. 1/81 l~OEit~ NO. ~ 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) NB 14071 Z Permission is hereby granted to: C~ /~t ^ ...... ......... · ~....~....~ ..... ~ ............ ...~ ......................... .;~.~ ........................................... ~. ........................ .~ ........... , ............ ., ......... ~.. at premises located at ........... ..~....~.....~..~.........~......~........~.~......~...~...~.........~...~ County Tax Map No. 1000 Section ...... ~'.....~./. ......... Block ....... .~. .......... Lot No. ~..~..~'7'~ pursuant ,o application dated ......... ..~......~....~. ..................... , 19.~..~.."~, and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hell ~ Southold, N.Y. 11971 765- 1802 APPL~CAlqON FOR CERT)F~CATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted m ~mmm~a 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. 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 $15,00 3, Copy of certificate of occupancy $1,00 4.Vacant Land C.O. $5.00 5 .Updated C.O. $15.00 New Building .,%.'~.o.~. ~'.. . .., .. Old or Pre-existing Building · . Location of Property J.~, ,~: ~.~',., ,A),o. ,e~,', ,~.~.'..~, ?/.~..~,"~., , ...~.~.: House No, Street Owner or Owners of Property . .G ..................... .~. ......... County Tax Map No. 1000 Section ..... ./.~./. ..... Block ..... ~ .$ .... Date...' .~ ,~/~'~. ·...~.. ............ Vacant Land ............. Nam/et Subdivision ................................. Filed Map No ......... Permit No. J.~. ,O.-2). ,~,. Date of Permit ,G/~o,),<~ ~..Applicant..~..E~.o, ,~, ,~. ,~- Health Dept. Approval ........................ Labor Dept, Approval ,. Underwriters Approval ............ Planning Board Approval Request for Temporary Certificate ..................... Final Certificate ...................... Fee Submitted $..~'.,..Z~'.O. ..................... Construction on above described building an;Lp~rmit meets a[I.a(ppl~mable codes and.~regulations. Applicant...% ~ t ..~.". ~.~.~ .Lot No .............. ? 1 ELF~S{~ECT I ON FOUNDATION FOUNDATION (2nd) 2. ROUGH FRAME & ?LUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL COMMENTS ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N,Y, 11971 TEL,: 765-1803 Examined. % .ht~,~.....2~. 9.., 19 .~.~.~2' ~ -[ App, r6ved .?. , .~..~3-A~.....~:o..., 19 ~.~. Permit No.~.~. ,~. 0..~)..~, i Di~appro~te.d a/c .................. ~ .' ........... ~ .... .... .. APPLICATION FOR BUILDING PERMIT Received ........... ,19... INSTRUCTIONS · a. This application must be completely filled in by typewriter erin 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 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. .. r ro - , · (Signature of applicant, or name, if a corporation) :..X'.7 .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder, Name of owner of premises .G.~'..~. · .~..~--.).~....~r .,....~....~.....g?..~....~ .t~ ~ ........................ (as on the tax roI~ or latest deed) If applicant is a corp~tion, signature of duly au~orized officer. . 0 '~(~q~an~e an'rt~title of corporate otfficer) 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...~.. 0. ..~ ...... Pt~...-~. · .................. .... ......................................... House Number Hamlet County Tax Map No. I000 Section ..-.;..~.. [.;., .~ ,.~. .... .) Block ..... .~. .......... Lot..,.tl~ ~' '~' ............. Subdivision... ~ ........................... (Name) 2. State existing use and occupancy of premise~ and intended use and occupancy of proposed constructiop: a. Existing use and occupancy ~-~ .~,.O..r~./"~.fl.~.-~. ./~.~. t..~.'.~..l:.?.'t.(.,t..J(~..t4. T.ff'~t..~l.~'',[. b. Intended use ,nd occupancy ~...~, .~...~¥~ 3.; Nat¢re · ,k (check whicli aF New Buildit; .... Jtion ..... ' kF e Repair .............. Remr~~ .... ::~olition ........ Othe~ ' (Description) 4. Estimated Cast . . .R .......................... Fee ..................................... ' ~' (to b~ paid on filing this application) 5. If dwelling, number of dwelling units .............. Number of dwelling units on each floor .......... f , I garage number of cars .. ~ ......................................... If ' ' " ' ' 6. business, commercial or m~xed occupancy, speedy nature ~d extent of each type of use ~9.~ ~ ~. ~- ...... 7. Dimensions of existing stmcthres, if any Front,. ~. ~ .... : Rear ~ O Depth . .~ ~ .... Height . ~ .~ .......... Number of Stories ..... ~ ............................................... Dimensions of sam~tmctur~ with alterations or ad4itions: Front ~ .~,0 .......... Rear .. ,~O. ~ ....... Depth ..... ~. ~ ............ Hel~t . .~,//. ~.... ~ .......... Number of Stones ..................... 8. Dimensions of entire new cofistmction: Front ~,~ ........ Rear . . ,~ ~; .' . Dehth ,~.~.' ...... Height , . .~ .~ ......... NMmber of Stories ..... ] ................................................ 9 Size of lot: Front i Rear Depth 10 Date of Purchase Name of Fomer Owner 11. Zone or use district in which Ipremises are situated. ~ ~ ~.~ 12. Doe~s proposed c0nstructio~ ~iolate any Zoning !aW ordinance or regulation: . 13. Will lot be regraded .... ~'9 ....... ~... '...'.. ,~il[exeess fill be removed from premises: Yes 14. Nme of Owner of premises~. ~.0.,. ~,..~e~ ~.~. ~ ................... Phone No. Nme of Architect ............. '.. Address ................. Phone No ............ N~e of Contractor ........................ Address ................ '.,. Phone No ............... PLOT'DIAG~M Locate cle~ly ~d distinctly E1 budders, whether existing or proposed, ~d, indicate ~1 set-back~d~ensiOns fro~ property .lines. Give street and blogk number or description according to deed, ~d show street names ~d indicate whethe~ interior or corner lot. STATE OF NEW YORK; COUNTY OF .......... S.S , . (Name of individual signing cent/act) · being duly sworn, deposes and says ~hat he is the applicant CATHERINE: M. BURNS: NOTARY PUBLIC, State of New ~nrk No. 4693093, Sullolk Bounty ~omrnlssio~ Expires March 30~ ..... ... County~--, ? ' ' 0 ',h ~ ~'-'~' ~(Signaturc of?pplicanC above named. Heis th~.. ,P..~..e~..t .-hf>:~.,'..: .,..9..V: . . . .~. ,~'.O,.. ,t~,, ,~. ,(.-~W...~,t.. ~ ~,.. ~.. . '. :' ' ' ' .of smd Owner or ownem, ~d is 'duly authorized t0 perform, or have, peffo~ed the said'work and' to' m~e and:file t~s application; that all statements cointained work wQl be perfomed in the m~ner set forth in the application filed therewith:- Sworn to beforel.~ ~me this Nota, Public, . U~ ,~~.