HomeMy WebLinkAbout14073-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No..Z.Z.3.8. 77 .......... Date ....... 8..ep?.e..ml??.r..2..5 ........... ,19...85
THIS CERTIFIES that the building ...... .~.d.d.5:~...ig.n' .~..o. p?.e..l~.i.n.g. ..................
Location of Property 17815 Sound Ave. $outhold
House No. Street Hamlet
County Tax Map No. 1000 Section ...0..5.~ ...... Block 01 .Lot. 005
Subdivision .... X. .......................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
April 29 198..5. pursuant to which Building Permit No. 140737.
dated ........ .5 .u.n.e.. 2. .t ............ 19 .8.5., 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 .........
7.-- Solar Room Addition .~o an Existing One Family Dwelling ---
The certificate is issued to KAPLAN, Z. MICAH & GAYLE
(owner, le~e~ ,~e~t}
of the aforesaid building.
Suffolk County Department of Health Approval .....................................
UNDERWRITERS CERTIFICATE NO ................... .Nf?. ...........................
Building Inspector
Rev. 1/81
FO~il~r NO. ~
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PEP, MIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
NB 14073 Z
Permission is hereby granted to: .
...~..~.~,....~ ............. ~..,L ..........
.... ..~...~.....~.~......~.: .........................
...~.,..~.:.~ .......... :..,..~.~.:~:.....: ..........
at premises located at .~...~...~J..~......~.~....~ ...... ..~...~ ....................
County Tax Map No. 1000 Section ...... ..~.....~.'~,.1 ...... Block ............ .I. ........ Lot No.
pursuant to application dated ...... ~.......~.~...: ............ , 19.~..~..~..,--- and approved by
the
Building Inspector.
Building Inspector
Rev. 6/30/80
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
This application must be filled in typewriter OR ink, and submitted i ~ 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.
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 $ [ 5.0 0
3. Copy of certificate of occupancy $1.00
4.Vacant Land C.O. $5.00
Date .... ~..~.; ! .~.,.. J .~ ?. ~'~-
New Building ~ Old or Pre-existing Building Vacant Land
Location of PropertyHouse' '~' ~No. '~- . . .~. .O, . .U~.~ ~.i.~.. ~. ...... Street ' '~' ' '~; ........
Owner or Owners of Property . . .~.~;~/J .~ ...................................
County Tax Map No. 1000 Section ............... Block ............... Lot ................
Subdivision ................................. Filed Map No ........... Lot No ......... . .....
Permit No.. )~ ~.? .~..%ate of Permit~...b~...~'), ! !A~lican, t i ~.. ~:. ~'Tz' ~. ~ ~_~.; .....
Health Dept. Approval ........................ Labor De~t. Approval .......................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $ .~.~. .........................
Construction on above described building and permit meets all applicable codes and regulations.
~.~,..~ :~qQ~ Applicant .......... ~ ...............
Rev. 10-10-7S
BE COMPLETE For
ALL CONSTRUCTION
THE REQUIREMENTS
STATE CONSTRUCTI(
CODES. NOT RES[
DESIGN OR CONSTRU
COMMENTS
~' 1 EL, p INS[~ECTION
1.
FOUNDATION (1st)
FOUNDATION
2.
ROUGH FRAME &
PLUMBING
(2nd)
INSULATION PER N.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS:
FORM NO. 3
ToWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N.Y.
NOTICE OF DISAPPROVAL .
PLEASE TAKE NOTICE that your application dated ... :.~. f..~.....~-~.. ...... 19 267
for permit to :0~.~'~..~.~'.:~.'~. .... -.¢ ..............
Location of Property . / 7~/~ ~a~~ ~
~o~sv No] ........... Stroot Hamlet
County Tax Map No. 1000 Section .. ~ ~ / ...... Block ...~ ....... Lot . ~.~ .C .....
Subdivision ..... u ' Filed Map No ................. Lot No ..................
is returned herewith and disapproved on the following grounds ~. ~.
.~o...~Z~.. ~~~..~.. ~~5.
~~..~/~ .... ~Z~z~. ~./.. ~. ~... ~. .... ~.: ....
~-~.~ ~c. ~z. ~wz~. (~ .~./~.. ~.~ z. ~. % .......
~..~.. ~ ~f. ~../~.5~. {. ~/~.~. ~.~...
Bu~ld~n~ Inspector
RV 1/80
FORM NO, 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y, 11971
TEL.: 765-1802
Examined..~. ~..~.\..., 19~. ?.
. .~..5~A~.....~).., 19 .~?. Permit No..I.
Approved..
Disapproved a/c .....................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Received .......... ,19...
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 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, buil~ling code, housing code, and_regulations, and to
(Signature of applicant, or name, it' a corporation)
5(..gcl, /', ....
['3 74) 379.- ........................
(Mailing address of applicant) //7S/
State whether applicant is owner, lessee,~, architect, engineer, general contractor,
electrician,
plumber
or
builder.
Name of owner of premises ...~..~.. ~ !.~..~..~.....~..~..D.. ~.~. ?.~ .... ~.....~ .~..~.. ¢.E'.... L....~.~. ~.[:.~..~t ......
(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 Tradc's Lic. nse
Location of land on which proposed work will be done ..................................................
1 IVy'
House Number Street Hamlet
County Tax Map No. 1000 Section .. x~ ? Block / Lot .'~.'~...
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
b. n ended use and occupancy ....................................................
3. Nature of work (check which applicable): New Building ~ ......... Addition....~. ...... Alteration .........
Repair .............. Rem6val .............. Demolition .............. Other Work ..............
. (Description)
4 Estimated Cost /~.~. ~ o , Fee ~..'~
~ (to be paid on filing this application)
5. If dwelling, number of dwelling ~nits .../~. .......... Number of dwelling units on each floor..../' ............
If garage, number of cars . t-r:-..: ...................................................................
6. If business, commercial or mixed occupancy, specify nature.and extent of each type of use .....................
7. Dimensions o_fe~xisting structures, if any: Front~ 7./p>i..~..0.... Rear .... ~..o. ....... Depth f~. ?.. i ........
Height ... ?-'.?C ........ Number of Stories/./../.~-. ...............................................
Dimensions of sarp~ S14'u. cture w!th alterations or additions: Front . .,~..O. ............ Rear .,~..(P ..............
Depth ...... .~, .27 ........ i,. Height . . ...~. ....... Number-of Stories./../~'g-... .......
8. Dimensions of entire new construction: Front . . ,~..O: ~..., .... Rear . ./...~.,.~'. ........Depth-. ~.~. .....
~ ~.* ~' Number of Stories ~. "
Height ................................................................
9. Size of lot: Front .. ~,.! ~', , .......... Rea~ ...q,~.t..~. .............. Depth . ./.o..O.. .
,. ~'¢.).~i i il .~i .... Name of Former Owner ~..F.~.~-, ~.,~ g~o.' .~.' .'~'.' 'I '"
10. Date of Purchase . .............................
11. Zone or use district in which pr~mises are situated..../~ .g ............................................
12. Does proposed construction violate any zoning law, ordinance or regulation: .~..O ....................
13. Will Io~ be regraded ........ _,J~.~. ................. Will excess fill be removed from premises: Yes ~
14. Name of Owner of premises ~..~..*~'~...'~f... ....... Address ~.~..o..Tf~..~..tr'.~ .......Phone No. ~..~.'~. :/.,.~ .~.~...--'...
Name of Architect .. _x~.~ .~'~o~/.r~. ............ ~ddress ~?~...r~.r..~,.~.~../fg'.?:~... Phone No.~'.q?. ~'..~'t~.~.~ ....
Name of Contractor ..,~...~.~.. ,~5~..'.~.,4y..~. ?.._g ........ Address . ./T~..~"A~...(~.~ .z~...~... Phone No..~.?.~'.7.~..~'~.~. ....
PLOT DIAGRAM
Locate clearly and distinctly ali buildings, whether existing or proposed, and. indicate all set-back dhnensions from
property lines. Give street and blocklnumber or description according to deed, and show street names and indicate whether
interior or corner lot. i
! I
STATE OF NEg/AYOP,~K., /, ,, ,,
COUNTY O~...~
"' ~'~i~l;vir~t~l si~nnih~'c'o'n~;~c'ti ....... being duly sworn, deposes ~d s~s,that he is'the applicant
above named. ' ~ '
He is the ., ........ , .......... , .............. ' ' 't~ ............... ¢'* ' ' ' ~ ~'~' ': '" / .......
~ (Contracto~agen corporate officer,,~c.)
of said owner or owners, ~d is duly authorized to perform or have perfo~6d t~'~ to ~e and file this
application;that all statements con(ained ~ this application are true tot~ best ~5~ge and belief; and that the
work will be perfomed in the m~n~r set forth in the application filed therewith.+
Sworn to b.efore me this 1
................ ~.~ ..... day of..~ ........... l~q. ,,
, (Signature of applicant)
I L~0N¢ ISLAND SOUND
Ma~ak, ls
/
AVENUE.
MAP OF LAND
N AN ~TE
$OUTHOL, C,
TOWN 01~' SOUT'H~I3 / N.