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HomeMy WebLinkAbout14127-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of OCcupancy No.. ,g.q 56?0 Date July 2& ............................................... 19 85... THIS CERTIFIES that the building .... .~.q?.e~.~.o.~. ~r: ................................ Location of Property 29.~... Bezme~xts Lane Sou~hold hS&e No. ' ..................... 'S't/e;i ....................... h$r3M County Tax Map No. 1000 Section .... 7.© ...... Block ........ .9. .....Lot ..... !? .......... Subdivision ..... ~. .a .:i_ ?x 5. .e .w' ?.a.~.k ........... Filed Map No...3.3.8.5..Lot No ..... .3.~. ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ·.. ~.u,k.y ~ , 19.8~. pursuant to which Building Permit No. dated ..... .g.u.k.7' .'q.O. .............. 198, ~., 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 ......... gec~o~y, bu~l. di.mg. The certificate is issued to (owner, of the aforesaid building. Suffolk County Department of Health Approval .............. .1~/.4. ........................ UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 TO~VN OF SOUTHOLD EUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No 14127 Z Permission is hereby granted t,~ , __ ..~..~.~C.~L ...~....~ ........... <::G'.~...~...¥.,.....~..~..~...-..t. .......... at premises located at ....~..~.~..".....~...~.-s~t~, ....... .~..~ ................. County Tax Map No. 1000 Section ....... ..O..~.~ ...... Block ...... .~.~ ........Lot No ....... k.°~. ........... ~ursuant to application dated ...'~..J~ .~. ~' ................................ 19.~..~., and approved by the Building Inspector. Fee $..~..: ............ Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY l ....... ~ L.~j RLDG. DEPT TOWN OF SOUTHOLD Instructions This application must be filled in typewriter OR ink, and submitted ia II1~ 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 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 $15.00 3. Copy of certificate of occupancv $1.00 4.Vacant Land C.O. $5.00 7~/~ Date ...................... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property . .~..~.-~. ..... .~. ¢~/V./~..~.../.--7-~.~ .... .~..~. · . ~ ................... House No, Street Ham/et Owner or Owners of Property u r.~?. ~ ~ ~ /)~. 4 ~/~'~<"¢'.. Vf~,'~ ~, g. ,-'~/ County Tax Map No. 1000 Section O 70 Block ?..c} Lot Subdivision..~.a~,r..v?.e..u~. .... /~.~. £..~. ........... Filed Map No. :33 ~ ?..Lot No, Permit No../.~./..~...Z.. Date of Permit ....... pplicant . .~.~. ~.~.C.~.c.e¢....~.,....~.~/~.....~../~'!.'.T-. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Ce_,~rtificate ..................... Final Certificate ....................... Fee Submitted $ ................. Construction on above described building and ~ermit meets all applicable codes and regulj~ions. 3-- q q % PP ............................................. Rev. 10-I0-78 L. oT- ~ $. 8© °19 ' 2 0"£i_ 160,0 Iron iNSPECT±ON COMMLN ~ -- FOUNDATION (1st} FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENT~: I$ OOOUPAN~Y OR USE IS UNLAWFUL WITHOb'r OEII~FiO/g~ .i FEE:..~j,~ ......... :, ~ NOTIFY ~;U~L'U, 24G OEpAF, ITMENT AT 765-1802 g AF,fi TO 4 ~t~ ~R THE 1 FOL~N~,,~kY~O;~ 'W~ ~QUIRED 3. JNSU~t~r'i'~O~ 4. FIN,'& :_.;O.-.:~T~U~TION BE COtv~('~.ET'~ FOR C.O, ALL gONSTRUCT~ON SHALL THE F~QUi~'NT$ OF TH6 N,Y STATE CO['~TfiUCTtON & ~DE$, NOT R~SPONSt~LE FOR D~IGN ON CG:~iSTRUCTION E~RORS, ' ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved ...... 19~.~. Permit No.1. .c}./. '~' ''/. ''~' · Disapproved a/c ..................................... (Building Inspector) . ,, APPLtCATION FOR BUILDING PERMIT Received ........... ,19... 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. c. The work covered by tins 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 ~ 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,.~uilding code, housing code, and regulations, and to admit auth°rized inspect°rs °n premises and in building f°r necess~..~,~)~.'-~ ...4_x~....../..o_a.~..~x,?-..,o:,;..?.xo~)--.... .... (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. Nameofownerofpremises .&/.~9.e4r.~b4.~..'%....4~.......O~. '.~.~'/.~..6"/r'. ~..°r~ ~~ .................... (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 ...................... I. Location of land on which proposed work will be done. ?..~.~.. · ~. fg.rV..~..°:/.~'.-d... ?..~. ....................... House Number Street Hamlet County Tax Map No. 1000 Section ......... ?.~. ...... Block ...~ ............. Lo~. ~. {.~ .......... Subdivision ~ q.~;P.~ ...~.~ .~ ............ Filed Map No. 3.~. ~ ....... 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 ~ocb ~..E 4 3. Nature of work (check which 'apphcable): New Building ..... ddition .......... Alteration Repair ~l ~ . Reinoval .............. Demolition . ..I ........... Other Work ............... [ (Description) 4. Estimafed C6st . ...... ~ ...... Fee ....................... :' . ~' (to be paid on filing this application) 5. If dwelling, number of dwellin~ units ............... Number of d telling units on each floor ................ If garage number of cars 6. If business, commercial or mixed occupancy, specify nature and extent >f each type of use ..................... 7. Dimensions ofexisting?tructures~ . . if any: Front ............... Rea: .............. Depth ............... Height ' Number of Stories Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth Height ] ~umber of Stories .../ ............ Rear ... !.2-~. ....... Depth .. ~ ........... · 8. Dimensions of entire new construction: Front ~._ Height ...~. ........... Number of Stones ..... l. .................................................. 9. Size of lot: Front .......... i' ........... Rear ...................... Depth ...................... 10. Date of Purchase .......... : ................... Name of Forme. Owner ............................. 1 1. Zone or use district in which p~emises are situated ..................................................... 12. Does proposed construction violate any zomng law, ordinance or regula ion: ........................ 13. Will lot be regraded ........ ~ .................... Will excess fill )e removed from premises: Yes No 14. Name of Owner of premises . 'i .................. Address ................... Phone No.. Name of Architect ......... r .................. Address .................. Phone No ............... Name of Contractor i Address Phone No PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or propo~ 1, and. indicate all set-back dimensions from property lines. Give street and blocl r number or description according to dee, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, . S.S COUNTY OF~,~ ................ ............................ ~ .................... being duly s torn, deposes and says that he is the applicant (Nam~of individual si~mng contract) above named. He is the .................... J .................................................................... . ~ (Contractor, agent, corporate o Ticer, etc.) of said owner or owners, ap'{ is d~ly authorized to perform or have perfo 'reed the said work and to make and file this application; that all statemeht's contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manaer set forth in the application filed there vith. Sworn to before me this ~ ;! ....... ...... ~. ? .~. ...... daygf .... ~ ............ 19 ~."~. ~IOTARY PUBLIC, State ~0f New York No 4707878, ,~ffofk Count'~ : Terr~l ~es Marc~ 30, 19J~ . , (Signature of applicant)