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HomeMy WebLinkAbout14097-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ..... gq 5755 Date August 9 19B~... THIS CERTIFIES that the building .. B.c.q~.qr.y, .................................. Location of PropertyHo,~o' .75 ............. No. .~.~. ~-0..O~e rrY, street. W.~Y. ............. S.o.u..t.h. ql.%~r~iei County Tax Map No. 1000 Section ..... ~2 .... Block ....... ~. ...... Lot ...... ~.7. ........ Subdivision .............. :~ ............... Filed Map No .... :~ ....Lot No ....... ~ ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated June 26 19 8~ pursuant to which Building Permit No. .fl.z~Og~. dated . July 3 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 ......... Accessory building. The certificate is issued to DR. AI~RED CAIOLA (OW~O of the aforesaid building. </X Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO .................. N/A Building Inspector Rev. 1/81 FOBlt~ NO. O TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. ¥. BUILDING PERMIT [THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No 14097 Z Permission Is hereby granted to: f'~ , .~...:: ........ ~.: ...... ~..~.:..~..~.1 ......................................................... ~ ..... ~.~L.~.~.:~.~...U.~..~ .......... ,o ot premises I~eted et ..~.~....~ ...... ~ ......................... ~ ~'~ ~......:~¢ .................................. ............ ....... ........................................................................... Cou.~ T.~ ~op ~o. ~000 S.c~o. ....... ~:~7.~.... m~k ...... ~.:~ ....... Lo~ No ..... .~.~3 ....... ...... ~t.....~.~ .................. , ~.~..q ,.d ,,,~o~ ~ ~ pursuont to application doted .... 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 1985 This application must be filled in typewriter OR ink, and submitted ia ~ 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 pa~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. Fees: % C~of occupancy -.__$_5.Q0~__. 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 $15.00 Date ~.~... z~..../~..~..~. · .~. · New Building . ,~, ,~,~,~?~, .....Old or Pre-existing Building ............ Vacant Land Location of Property, Z..~. .... ~ ~/d.~...~. k.~..~.~ ~.. ~ ~...~.,,.. ~ .~/ Hou~ NO, ~e~t Hamlet Owner or Owners of Property . ' ............................................... County Tax Map No. 1000 Section ............... Block ............ Lot .......... Subdivision ................................. Filed Map No .......... Lot No .............. Permit ,o. /¢~ ¢~.. Date of Permit.. ~pplicant .~~ .~. 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/er, fnit m~ets a~l appi~ab!e codes and regulations. ~, ~ .... ~ AppJican~~.~~ ................... FIELD INSFECTION 1. COMMENTS FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION FER N. sTATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined .. .~ ..... 19'.'~. .%.,'~.t~,.~ 8.. Permit No. 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 su~l~mitted 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. e. 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 regffiations, and to admit authorized inspectors on premises and in building for necessary ins~pe?ions. __ ~/ · .... (-4./., ........ (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. Na,ne of owner of premises...~..~.../~....c~.~..~......~..~../~.(2..~...~.. ........................................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duty authorized officer. (Name and title of corporate officer) Builder's License No ........ ./..'~.... ............ Plumber's LicenseNo ......................... Electrician's License No ............. ;. ~. ...... : - Other Trade's License No ...................... 1. Location of land on which proposed work will be done. ?_% ..................................... ... ........ County Tax Map No. 1000 Section ...O~..~.~ ........ Block ....Q.??. .......... Lot...(~...~..f~ .......... 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 . .d~4..~..r~...~ ...... ~.,~.J~ '~'7'~' ' ~ ............................... ~.ff~....~.~..,~...~. b. Intended use and occupancy ................................ 3!i J~'~t~uYe%{ work (check which applicable) New Building ~...~.O= .~.% A '} Repa2r.-.--~ll~,~,~. ..... Removal .............. Demolition ... Estimated cost .......... .x,;.¥ Ro. .,. . . ............... Fee. (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of d, ~lling units on each floor ............... If garage, number of cars .....! .................................................................... If business, commercial or mixed occupancy, specify nature and extent ~,f each type of use ................... Dimensions pf existing structures, if any: Front ...... ~;.O ...... Reaz ... ~ .C? ....... Depth ....-.-.-.-~..~. ....... Height ................ Number of StoNes ........................................................ D'finens{ons of same structure with alterations or additions: Front .................. Rear ................. Depth ....................... Height ...................... I' ~mber of StoNes ...................... D~mens~ons 6f entire new construction: Front /.7~.., ..... Rear .... /... ~ ....... Depth .... /.CP... Height ............... Number of StoNes ~ Size of lot Front ...... ~,.~.(fi .r . ' .................. ; .................... ~ ..... ;- ......... · . ........ Rear ........ ff..~. ......... Depth ....... ~....~. .......... Date of Purchase .......... i ................... Name of Form~ Owner ............................. 9. I0. 11. 12. 13. 14. Zone or use district in which p~;emises are situated ................ Does proposed construction vidlate any zoning law, ordinance or regul, Will 16t be regraded ........ : ................... Will excess fill 1 Name of Owner of pre~nises~-d~../P. ~/..~d'~ ~a:~ ~.~ · ........... Address 8c.o~ ~, Name of Architect ........................... Address ....... Nam e of Contractor .Tg.~. tn.. ~.r.~..S. ,. ~. t.'V..~ ......... Address . e,~ t'~ s .c PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or propose property lines. Give street and block number or descNption according to deed interior or corner lot. :ldition .......... Alteration .......... ........... Other Work ...... -- .....- ,. on: .............. .e removed from premises: Yes No ........... Phone No ....... ~d~¢]lq&i'Ph°neN°' . ....2 ......... . ... d, and. indicate all set-back dimensions from , and show street names and indicate whether ~TATE O F NE,~,,-~ RK, ' COUNTY 0 F~.. (~./y'~..~../.(... ........ ~-~. :'. .... .'./~.~='~. · .~..~'CW.<~...~. ............. being duly s~ om, deposes and says that he is the applicant (Name of individual sign'ing contract) above named. l le is the .. '~"¥"~ . .'~..~ ~'(--)"'~ , .............................. (Contractor, agent, corporate off icer, etc.) of said owner or owners, and is dully authorized to perform or have perfon application; that all statements contained in this application are true to the l work will be performed in the manndr set forth in the application filed therew Sworn to before, me__ .~this Cf/'~~ N°tary PuNic'~'': ;''' 'x C°unty NOTARY PUB,[lC, Stato of New Yof~ \ No 4707878, Suffolk County_ *;; Term Exptres Marc 30, 19-~ ~ed the said work and to make and file this ~est of his knowledge and belief; and that the th.