HomeMy WebLinkAbout14083-z FOR~f NO. 0
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)
Ne 14083 Z
Permission is hereby granted to:
......... ..........................
....... ~..z:=.. ~....~z-z..~ ......................
.......... ~:~...~.~.~...=.~...:~.../.Z.f..Y../.
co,,,,/Tax Map No. ,ooo Sec,o,, ..... ~.<¢....~ ..... ~,~ ..~./ ............ Lot No..a:2..ff. ............
pursuant to application dated ........ C~.~<'.~..~......~..~.. .................. , 19 .... and approved by the
Building Inspector.
Fee $..~ ............
Building Inspector
Rev. 6/30/80
FORM NO. 6
TOWN OF $OUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This apl~lication must be filled in typewriter OR ink, and submitted ~ ~ to the Building Inspec-
tor with the following; for new bui[dings 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 end "pre-existinq"
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.
Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling $1 5.0 0
3. Copy of certificate of occupancy $1,00
4.Vacant Land C.O. $5.00
Date ..
New Building ............ Old or Pre-existing Building ............ Vacant Land ,~ ............ ,
Location et vroper~ .............. , ................. , ................. ~,
Cou~ Tax ~8~ No. 1000 Secdo~ ............... B~ock ..............
~ ' ~ Lot No --
Subdivision ................................. Filed Map No .....................
Health De~t. ~pproval ........................ ~abor Dept. ~pproval ........................
Onde~riters ~pproval ........................ Planwn~ Board Approval ......................
~oquo~ for T~mporarg Gertificate ..................... Final C~rtifieate .... ~ .............. ~: -
Fee Subm~te~ ~ ..........................
Con,ruction on above described building and~er~t meets~ap bJ~ gode0and regulations.
±
Steve'a egeettge,
STEPHEN M. ALBERTSON. OWNER P.O. BOX 1268 SOUTHOLD, NEW YORK 11971
(516) 765-5681
April 29, 1986
Mr. Robert Strong
420 Cove Circle
Greenport, NY 11944
Gentlemen:
Enclosed please find Underwriter's Certificate for work
done at the addition at your home in Greenport.
I apologize for the extended delay, which was due to loss
of paper work. t
Would you please forward your check for $413.00 to cover
the balance due on the bill.
Thank you for your cooperation.
SA
E~i¢.
RTEL~ INSPECTION
ROUND^TION (2nd)
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
~,ODE
FINAL
COMMENTS
ADDITIONAL COMMENTS:' ,
'FORM NO. 1
t TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
Examined· ~df.~/~7....~.?:., 1~.."7.
Disapproved a/c ............... ' ' '~'~'--~' ....... ' ' -O ' '
APPLICATION FOR BUILDING PERMIT
Date .................
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, building code, housing codA and regulations, and to
admit authorized inspectors on premises and in building for necessary, inspections.~. ~/~._~
(Signature of applicant, or name, if a corporation)
· ....
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises . ~.;¢¢A/l .~. ~..~..~.,'(..~. l~.6~/-,....~.~F. ) ~.rT.d. Ct55....~..7.~...n/.~ ............ (as on the tax roll or latest deed'y'
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No .... .cp:~..~.~ ................
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No ......................
1. Location of land on which proposed work will be done ..................................................
House Number Street Hamle~
County Tax Map No. 1000 Section ...C?fl.? .......... Block ..... /.. ' ... ~¢:...~. .............
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
b. Intended use and occupancy ....................................................................
3. Nature of work (check which a plicable): New BQilding .......... Addition .......... Alteration
Repair Ren~oval Demolition Other Work
~ (Description)
4. EstimatedCost., ~..~.~ ........................ Fee,~..~..~.~. ............................
I ~ (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 ...-x~-. 7: ..................................................................
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 ~ .'~Q.. ..... Depth .~r~ .~. .........
Height . fi. ~x. .......... Nu~nber of Stories ... ~ ...................................................
Dimensions.of same structure with alterations or aclditions: Front .. ~ .......... Rear ....~Q..%9. ...........
Depth ·..ht:.Q ............ !... Height .... ,} .'~. ............... Number of Stories ... ~. .................
Dimehsions of entire new construction: Front .... 2: O. ....... Rear .. ~ ....... Depth .~.~.~ ..........
Hedght ..... I.O' ....... ~/.mb~r of .qfnH~ ! .........................
Size of lot: Front .......... g ............ Rear ...................... Depth .....................
Date of Purchase ...... i Name of Former Owner r*.q~t~
11. Zone or use district in which p~emises are situated .....................................................
Does proposed construction viC. late any zoning law, ordinance or regulation: .... Z~.'? .......................
1
2.
Will 10t be regraded ...... .~. o .................. Will excess fill be removed from premises: Yes
13.
14. Name of Owner of premises ~/.~. 1~.~..~. l~qg.b ...... Address .~.o.C~:..~./.,q.~...z~. ..... Phone No. q{.72. 7'.1..°.~;~.. ·
Name of Architect . >'"~ Address Phone No.
· ................ .......... .....
Name of Contractor . .-. '.. O.~ .......... Address r.'~*~.~.t.~d~. ~.g... Phone No ....
PLOT DIAGRAM
I,ocate clearly and distinctly a~l 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.
9.
10.
STATE OF NEW YORK,
COUNTY OF .................
S.S
............................ i ..................... being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named. ~
He is the ............... ! ....................................................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is d¢ly 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 manner set forth in the application filed therewith.
Sworn to before me this
............. . .~.~...,...day ~f ........ ~ ...... 19 .~..~~
I NO?I~I~¥ PUllLIC, Stat~ of Ne~/York
i NO, 4707878, Suffolk Count~..,
lerm Expires March 30, l'~,~_/
(Signature of applicant)