HomeMy WebLinkAbout14093-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. Z13585 Date July 3
.................................................. 198.5..
THIS CERTIFIEg that the building 2 Story Addition
Location of Property .... .6.0fi..0..s.o.u..~ py.r.~..~. 3.v.~., ,..s.0..u?.~.q?. ........................
House No. Street Hamlet
County Tax Map No. 1000 Section ....~ ~ ....... Block ..... .~ ......... Lot ..... .1 ...........
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
...... ~.aT..3. ~. ......... 19.8.5. pursuant to which Building Permit No.. ] .~ .0.9.3. Z. .............
dated ........................dune 28 ..... 19 .85. , 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 .........
2 story addition.
The certificate is issued to .... .~.O.B.E. ~ .T..H.....S.M.I.T.H...&..E.V..E.L.Y.U' .B.,..S.~.I?.H. ...............
(owner, I[s~ R~{t~t~x
of the aforesaid building.
N/A
Suffolk County Department of Health Approval ..........................................
UNDERWRITERS CERTIFICATE NO ................. P..E~P.I.N.. 9. .6./.2. 7./.8.5. ...............
Rev. 1/81
Building Inspector
FO~ 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)
NE 14093 Z
Permission is hereby gr~nted to:
4
~. ~...~~ ................ ~~ ~. J~J~t
............ i ............................. ': ..................... ~ .....~'"": ..............................................................
., ,,em,,e, ,o~o,ed o, ...b.-..~/P.....~...~.....~.: ...................................
County Tox Mop No. ,000 Section .......~......~.. ....... B,oc~.....i..~... ......... Lot No ........ /.. ..............
pursuont to oppllcotion doted ........ ....~....~.~/~ ........ ~...L ........ , i9..~.~ ond opproved by the
Building inspector.
Rev. 6130/80
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 in duplicate to the Bulld'ng 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, ndustria bui dings, Multiple Residences and similar bu.!l.din, gsa. nd. in.s.t.a, lla-
tions, a certificate of Code compliance from the Arch tect or l:ng neer respons~o e tor tl~e bU a rig.
5. Submit Planning Board approval of completed site plan requirements where applicable.
For existing buitdings Iprior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of peoperty 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.
Fees:
1. Cert f cate of occupancy $5.00 / land use
2. Certificate of occupancy on pre-existing dwelling
3. Copy of certificate of occupancy $1.00
--Pre-Existing C.O. $15.00
Vacant land C.O. $ 5.00
Date ...............
.................
New Building '!¥r .......... Old or Pre-existing Building ....... Vacant Land ·
Location of Property · "'~' .................. Hamlet
House No. Street
Owner or Owners of Property . ~.O..~..~. · ·Z~. · .'~.'..~../'~z.../.../z~... .~.. .~/~' '/-~/~'v/ ~' ~'~'/~ / ~
Tax Map No 1000 Section ~ Block .~. Lot . ~ ·
County · · ...................................
Subdivision ................................. Filed Map No ........... Lot No ..... ~ ........
Per m it N o.~...~-~. ~/..,~.~,~.. Date of Permit .......... Applicant~. '~ ~O~'7~' '~/~ ...........
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval P~ Planning Board Approval
Request for Temporary CertifiEate~ ..................... Final Certificate .. · .~ .................
Fee Submitted $..~.."~..~. ......................
Construction on above de,ribed building an~.~rmit mead?Il ap.plicable codes and regulations.
Re, 10-10-18
LEFFERTS P, EDS~N
RUDOLPH H, 8RUER
July 2, 1985
Town of Southold
Building Department
Main Road
Southold, New York
11971
Re:
Robert H. Smith Residence
6010 Soundview Avenue
Southold, New York 11971
Dear Sirs:
In connection with the above matter, please be advised that a
smoke detector will be installed on the second floor at ~hp~t~O~.
"~o~ the'stairs on We'dne~y, Ju-~3, 1985.
On the basis of the above, we understand that you will issue a
Certificate of Occupancy on the subject premises as applied for.
If you should require anything else, please let me know.
~.Sincer ,
R~dolph~PL Bruer
RHB/cas
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y, 11971
TEL.: 765-1803
^pprove - . 2-...¢...., lg 7 ,it ..7
Disapproved a/c .....................................
Application No ..................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
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 pursuaht 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 inspg~Ci~ns./-/--- .~ .
(Marling address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises ..........
(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 Trade's License No. . ~.) ~ .............
OF OCCiiPAN y
1, Location of land on which proposed work will be done ..................................................
· ................. ................
House Number Street Hamlet
County Tax Map No. 1000 Section .... 5.~. ......... Block ~" Lot /
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 .... . .~.f.l.~.... '..~...t'y).;.}.~r...4.(~..O~.... :. ~...,, "': ....................
b. Intended use and occupancy / ! ' ":~" .... "'"'
3, Nature of work (check which applicable): New Building .......... Ad Etion ....... Alteration ..........
Repair .............. Remeval .............. Demolition ............... O. ther Work .'~ .............
~ ~;~ , ,. ~/ (Description)
4. Estimated Cost .... ]~)]..6~..,..~.Ot~.~. ~.. ~'. ~. ............. Fee, .) ~,. ~. ,~.~
(to be paid on filing this app, lication)
5. If dwelling, number of dwelling hpits .,. ~.(~ .~ ...... Number of dwe Iling units on each floor...~,l ~ ........
If garage, number of cars .... ~.[. ~ ......................................
6. Il'business, commercial or mixed occupancy, specify nature and extent ol 'each typ~'~f use
7. Dimensions of existing structure~, if any: Front ............... Rear ............. Depth ...............
Height ............... Number of Stories .........................................................
Dimensions of same structure with alterations or additions: Front .................. Rear ..................
Depth .................... i. · Height ...................... N nber of Stories ......................
8. Dimensions of entire new constrUction: Front ............... Rear .............. Depth ...............
Height ............... Number of Stories .......................................................
9, Size of lot: Front ...... . ,! ......... Rear ...................... Denth ......................
10. Date of Purchase ]..~.].~O.].~O ..... ,, ,Name of Former ~),wner ~.o. ~.~r.~7.
11. Zone or use district in which pr~mlses are s~tuated...~.' ..:~.~.-~.l tT~.eXt.. ~.0-~.~ ..............................
12. Does proposed construction violate any zoning law, ordinance or regulati )n: ................................
13. Will lot be regraded ..... /~-~..~w..~ ................. Will excess, ~II b [removed from premises: Yes No
14. Name of Owner of pren~. 'scs ~fl.l.'~.. ~ b~.af~y~. Address /0. ~i~.[1 ~/.~,.~:... Phone No... ~ ...........
Name of Architect . .h3t.~.,~ .... ! ................. Address ..... .-a. ............. Phone No ..........
Name
of
Contractor
· .[-e1 .t~...i ................. Address ....... Phone No ................
PLOT DIAGRAM f 7
Locate clearly and distinctly all buildings, whether existing or propose, [, 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.
STATE OF NEW YORK, ,' 'S S
(Name of individual sigffing contract)
above named.
(Contractor, agent, corporate ofl
of said owner or owne~, ~d is duly authorized to perform or have perfon
application; that ~1 statements contained ~ this application am true to the 1
work will be performed in the m~n~r set forth ~ the application ~ed therew
Sworn to before me this
~ARY ~UBLIC State of Now YOrK
No. 52-46552A2, Suffolk Counly
Corem ss on ~plres] March 30,
~rn, deposes and says that he is the applicant
[cer, etc.)
led the said work and to make and file this
~est of his knowledge and belief; and that the
th.
OCCUPANCY OR
USE IS Ui~]LAWFUL .
WiThOUT CERTiFiCATE
OF OCCUPANCY
C/-
CZ-
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3HI ~O.=1 Wd ~ Ol ~4V 6 Z:08LqSg/
i vC'/ [ ~
OCCU~,AHC¥ OR
USE IS UNLA~ffiJL ~ ___
WITHG~T CERtiFICATE ~~ ~/
OF OCCUPANCY
APPROVED AS NOTED
NOTi~ BUILD'i'NG DEPARTMENT AT
765-1802 9 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
~. FOUNDATION - ~O REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING
3. INSU~TION
4. FINAL ~ CON'STRUCTION MUST
BE COMPL~E FOR C. O.
ALL CONSTRUCTION S~ALL ME~T
~HE REQUIREMENTS ~F Tue N Y.
STATE CONSTRUCTION ~ ~,-~Gv
CODES. NOT RESPqNc'~ - ~
DESIGN OR CONSTRUCmlO~ ~p ....
CONSENT
TO
INSPECTION
7~ ~7~.O~7~, ~i/~dK-~//. /~. ~ , the undersigned,
O~er (/s~ N~me(s)
do(es) hereby state:
That the unders~ned (is~{~ the omer(s) of the premises ~ the To~
of Southold located at ~10 ~3g/~)~'~ ~*~ ~ %
,. which is sho~ ~d designated on the Suffo~
Cowry tax map as District 1000, Section ~ , Block ~ , Lot /
That the unders~ned (has) (~) filed, or caused to be filed, an applica-
tion in the Son.old To~ Building Inspector's Office for the follow.g: __
That the undersigned do(es) hereby give consent to the Building Inspectors
of the Town of Southold to enter upon the above described property, ~
· ' locait~t4~ to conduct such inspections as they may
deem necessary with respect to the aforesaid application, including inspections
to determine that said premises comply with all of the laws, ordinances, rules
and regulations of the Town of Southold.
The undersigned, '.m consenting to such inspections, do(es) so ~ith the
knowledge and understanding that any information obtained in the conduct of
such inspections may be used as evidence in subsequent prosecutions for vio-
lations of the laws, ordinances, rules or regulations of the Town of Southold.
(print name)
(signature)
(print name)