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HomeMy WebLinkAbout14100-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z13663 Date ., 19 THIS CERTIFIES that the building .... .d.o. qk...~Rd., 9.??.o.r...8.d.d.5..~ .i.o.u.: ............... Location of Property .. .... ~..65 ................. .N.e.w...S.u.~.~.o..1.k..R.d. r ........... I~OUSe Ho. Street Hamlet County Tax Map No. 1000 Section ... J.Q9 ..... Block ........ 7 ...... Lot ..... ~. ........... Subdivision ............... .x. .............. Filed Map No. ~: .Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 19~..>. pursuant to which Building Permit No. qgdOOZ dated ...... ./r.~.~..Y..3 ............... 19~. ?. ,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 ......... Deck and arbor addition to existing one-£amily dwelling. The certificate is issued to ................ J07:~T..QF~.O.~..~..R ....... (owner, ~ .................. of the aforesaid building. Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 FO~ NO. ~ TO~N O~ $OUT~OLD BUILDIHG DEPART*'V~ENT TOWN HALL SOUTHOLD, N. Y. BUILDIHG P~IU~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CON~PL~ION OF THE WORK AUTHORIZED) 14100 Z Permission is hereby gronted to: ...-.~.~....~.:.....~.~.~ ........ i~.~...~ ................................................ .... ..~~.~....~.:.~"~ ....... . i I.~.~' ~ ...... ~~.j ~ ~ ~ ~..~.~...~..~...~ ~..~..~.~.~,~J~ .................................................................................................. o, ....... ......... ............ County Tax Map No, 1000 Section .... /,...O....c~ ......... Block ...... ...~......~ ....... Lot No ........ ~..~ ............ pursuont to opplicotion dot*d ...... .h[..~,~...~.~..~:;~ .................... , 19.~>.~., ~nd oppro¥c~:~ by the Building Inspector. 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 Ja. z3m Instructions A. 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: I. 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 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. Certifieate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3, Copy of certificate of occupancy $1.00 4.Vacant Land C.O.- $5.00 New Building ............. Old or Pre-existing Building $15.00 Date d ~.~/.. ~S~'../,~, ~, .~, .J~,,~,(,~.,, .. Vacant Land ............. House No. Owner or Owners of Property ...~.'.,.. ,~.~./~...¢'. .......................... County Tax Map No. 1000 Section .... /~..~. ..... Block ..... .~..~. ...... Lot .... ~. ......... Subdivision ...... ¢~ ................. Filed Map No....-~../.~...Lot No....~,)/../I~.... Permit No. Date of ......... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ .... ~....O. ~ Construction on above described building and permit meets all applicable codes and regulations. O-"'O':J~ ~ tg~(¢'~ Applicant .... ~; .... % ..................... Rev, 10-10-78 COMMENTS F}ELD"INSFECTION 1. FOU_~N DA~TI.O_N . ( 1 s t ) FOUNDATION 12nd) 2. ROUGH FRAME & ?LUMBING INSULATION FERN. STATE ENERGY CODE Ye FINAL ADDITIONAL COMMENTS: 'FORM NO. 1 ' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL,: 765-1802 Examined...~. ~.4.~..\f.~...., 197 .~7 Approved . . '.'~..., 19 S.&. Permit No. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Ii ~LDG, DEPT, Received ........... ,19.. · Date ~ Jl~ 19 a~.~ INSTRUCTIONS a. Tins 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. 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 othe,r applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations,, or for removal br 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./~ g~,,.~ .t (S/igngture,.of applicant, or nanle, if a corporation) · ..... ..... (Mailing address.of a State whether applicant is owner, lessee, agent, architect, engineer, general contractor, el¢c~rician; plumber or builder. Name of owner of premises .... d. ~I~.~... J.'....~...i~....~...~. ~ .................................. (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 ....................... 'N Other Trade's License No ...................... 1. Locat~n o~f land on which proposed work will be done .................................................. ............. ....... House Number Street Hamlet County Tax Map No. 1000 Section.. ?..~.q. .......... Block ..... ~ .......... Lot....~... ............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy...~./.O. .... ~...~. ~....~...~...~.. .......................... b. Intended use and occupancy .~.~..~/.~...~....~....(~.~.) ................................... o 9. 10. I1. 12. 13. 14. Nature of work (check which applicable): New Building ..... ' ..... Repair .............. Removal .............. Demolition .. ddition.. X. ...... Alteration .......... ........... O her Work (Description) buildings, whether existing or prop( number or description according to dee Locate clearly and distinctly all property lines. Give street and bloc interior or corner lot. PLOT DIAGRAM Name of Architect ........ ~ .................. Address ..... Name of Contractor ' Address STATE OF NEW,YORK, COUNT)' .... * ................ being duly (Name of individual sighing contract) above named. eis e ,.~ ................... , .............................. .. ~ ' of said~-'~wner or owners, and is drily authorized to perform or h~ve perle applicati6n; that all statements con}ained in this application are true to th work will be performed in the manner set forth in the application filed ther Sworn to before me this .......... Phone No ................ .......... Phone No ................ ad, and, indicate ail set-back dnnensaon~?from and show street names and indicate whether zorn, deposes and says that he is the applicant ~ficer, etc.) ~ned the said work and to make and file this best of his knowledge and belief; and that the vith. NotaryPublic,....~..~..!...~..~..~...~..''' ... County NOTARY PUBLIC, State of New York ' ' ' ' No. 4707878. Suffolk Ceunt~ i apPliC~t) lerm Expires March 30, 19~ Estimated Cost... . ? .......................... Fee ..................................... i '~ (to be paid on filing this application) If dwelling, number of dwelling units ............... Number of d gelling units on each floor ................ If garage, number of cars ... ~ ................................................................... If bukiness, commercial or mix'ed occupancy specify nature and extent of each type o~use Dimensions of existing structures, if any: Front ............... Re, .............. Depth ............... Height ........ ~:.: .... Number of Stories ................................................... Dimensions of same structure with alterations or additions: Front ............... Rear .................. Depth... i .............. !... Height ........... ; .......... ~lumber of Stories ......... ~.~** ~t ......... Dimensions of entire new construction: Front .. ]..~.O...t ...... Rea~ .. ~. ........... Depth ............... Height ............... Number of Stories ....................................................... Size of lot: Front ......... i ............. Rear ...................... Depth ...................... Date ;of Purchase ~/~...~.~. ,~.~ ................ Name of Former Owner . ~,.~....~. ......... Zone or use district in which premises are situated ................ l .................................... Does proposed construction violate any zoning law, ordinance or regula Iion: ............................ Will lot be regraded ....... tO~} ................. Will excess fi be removed from premises: Ye,~ Name of Owner of premisesO4 .... Address /~.~.~ ~. ~.~t.l~. ..... Phone No.'~.~...'/..t~. J o ~¢~v% Checked Pro/vet Prqject No. Drawing Title Detail Drawing No. Scale A'p?~©¥Z,D AS NOTED NOTIFY BUILDING DEPARTMENT AT 76541802 9 AM TO 4 PM FOR. THE FOLLOWING INSPECTIONS: 1. FoUNqAT~ON - TWO REQUIRED FOR POURED CONCRETE 4. FINAL - CON'STRUCTION MUST BE COMPt. ETE FOR C. O. ALL CONSTRUCTION SHALL MEET THE REOU STATE C~F~q'TRUCTICN & ENERGY CODES. F~~ RESPONSIBLE FOR DEsigN ~-' CONSTRUCTION ERRORS, Checked By P~jecl No. Date. 6,,Iv , Drawing Title Scale/(j ~ Deta I Drawil g No. Drawn By Cllm*ked B!/ Drawing Title Scale~ ~ * De Checked Bg Prolect Drawi~lg Title Scale ~) ~ Detail Drawing No,