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HomeMy WebLinkAbout14165-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Zq595q Date Oc.t. ober q5 1985 THIS CERTIFIES that the building deck addition. Location of Property .. ~.0.0. ............. .~.~.~e..n.e.s..}{..cl.. ................ .C.~.~.c..hg.g.~.e.... House No. Street Hamlet County Tax Map No. 1000 Section ....9~ ...... Block ...... 8 . .Lot $ Subdivision ........ .X ...................... Filed Map No. X . .Lot No. X conforms substantially to the Application for Building Permit heretofore filed in this office dated ...j..~.~. ~r..q.~. .......... ,19 .~..~pursuant to which Building Permit No .... .q.~? .G.~.Z. .......... dated ...... .~.u}.7....29 .............. 195.~.., 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 ......... ..... ,~.e,e.k., ~..d.d~. $ 9.n..~. o...e.x.~, s..~n.~..d×e.~..~.i.~.~.. ................................. The certificate is issued to ........ FIZCHAEI, & lvi/LRy (owner,~ of the aforesaid building. Suffolk County Department of Health Approval .................... 1J./~ ................... UNDERWRITERS CERTIFICATE NO ............... Building Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. ¥. BUILDING PERMIT (THIS PEP, MIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NM 14165Z Permission is hereby granted to: ........... ~..~.~/~.~ ......... ~........~m~ ..... ....... ~o.~.......~.~..?~.,~...~.. ........... ,o ...... .~.o...~v...~ ~ ~.~. ....... ~..~/~....'~.,~. ,~..~..~./.~.:.. .~.~......~. .~..~.Z z..~.~ ............. ............ ~.~/~./.~.~ ................................................................................................ /.... ............. ~ at prem,ses located at .......... ~ ................ ~.~'.z~..~.~.. ...... ~/~....0 .............................................. ......................................................................................................... ...... County Tax Map No. 1000 Section .... .~...~...?. ...... Block ......~..~... ......... Lot ,o....~....O'.~.., .......... pursuant ,o application dated ........ ~,.~.. ....... ~.~.. ................... , 19....~.,ond approved by the 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 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: 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, Commemial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Amhitect 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 p~operty showing all propertv 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, Certificate 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 $15.00 New Building ............. Old or Pre-existing Building ............ Vacant Land ............. House No. ., ~ /? Street Ham/et Owner or Owners of Property ..... ?.. ~/..~.~?.< .~.~..~. · ~?~.~.?./ .... · ./~. ·./...~. ~..~<~. .............. County Tax Map No. 1000 Section .... -..~. ?. ~ .... Block ...~. ,?. ....... Lot.. (~...~.~.~'.~ ...... 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 permit n)~eets.all applicable codes.and regulations. Rev. 10-10-78 FIELD INSPECTION COMMENTS FOUNDATION (1st) FOUNDatION 2. ROUGH FRAME & (2nd) I~LUMBING iNSULATION PER N. sTATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD I~UILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 ,pproved .... )~sapproved a/c .......... : :. ............ ~) ......... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received ........... ~ 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 ~r 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 s~all be kept on the premises available for inspection throu~out the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until g Certificate of Occupancy s~hall have been granted by the Building Inspector. i APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with ail applicable laws, ordinances, building code, hou~s~g code, and regulations, and to admit authorized inspectors on premises and in building for necessary insnectigns.// .... '. ./. ./':/. r.-':. . ...... (Signature of applicant, or'nam%, if a corporation) .. (Mailing address of applicant) ~essee, agent, architect, engineer, general contractor, electrician, plumber or builder. ,State whether applicant ................................. :.,,....,,. ..... ....... ..... ................................ .............................. (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 ....................... ~1. L~%d on w.~c~h propose~:work will be~done ....... ?.~r .................. " ./:'ix.,.. e..:.e..-> ................................. House Number .......... XJ ' Street ' ' Hamlet County Tax Map No. 1000 Section ..... ~' '~ '" ~fi.. ~' .7 ....... Block .... "~)~.' ........... Lot . . . ~.' .............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed cgnstruction' a. Existing use and occupancy . . . .~)..~...~./.~I.///.~.~}.. ?.~'./4.~ .... b Intended use and occupancy ,~.~. fi,} t~/~/: ~, ~. %,X~. ?/, ~,~'~; ~~,~ .... ......... ;...>.., ..... ., " ' y ; ...... . .... ~.:i,.~.,rm,~?~,,, .~i~ ....... 3. Nature of work (check which ~pphcab e): New Budding .......... Repair .............. Removal .............. Demolition ... · 4 Fee If garage, number of cars ...: ~ ......................... . 6. If business,,commercial or mixbd occupancy, specify nature and extent ~- 7. Dimensions of existing structures, if any: Front ............... Rea ddition. ,Z'. ~.. ..... Alteration ........... Other Work ............... ,-o (Description) (to be paid on filing this application) telling units on each floor ................ )f each type of use .... -.'-;:;~ ............. .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................. !... Height .......... ~, ........... ] 4umber of Stories ...................... ~' 8. Dimensions, of entire new construction: Front ..... 1.9::.' ........ Rear I .~.t ....... Depth .c[ He~_ght ~ ~ ...... ~~ ~ ~ ~ 9. Size of lot: Front ....... lJ.~'~,~O.O. ........ Rear ..... ? ~.' .~ ~?. ......... Del~th .. ~..,>o~: ~.d.. ........... 10. Date of Purchase ......... ./.+.'~ 9. .............. Name of Form{ · Owner . ~.'.~?*q .... ~ fO P4. ~..~.°. ~. ....... 1 1. Zone or use district in which p~emises are situated ..................................................... 12. Does proposed construction vi61ate.any zoning law, ordinance or regula ion: ...... 13. Will lot be regraded .' ...... i...~..~ ............... Will excess fill ~e removed from premises: Yes 14. NameofOwnerofpremises ' .~.'(~.~f./. /.//f.~f~' e.~.~:t.4; Address .q2 /.~'. ~ :~e~e ~ /Z~f.p- ., ..... :-l~.. none ~o. Name of Architect ........ ~ .................. Address ................... Phone No ................ Name of Contractor ....... i .................. Address .................. Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or propo: ;d, and. indicate all set-back dimensions from property lines. Give street and block number or description according to dee, 1, and show street names and indicate whether interior or~ corner lot. STA~FE OF NEW,YORK, COUNTY OF .~ .... S.S ........ t~.[..d-~FD./gY~.,'~' '.~.~ .t~ ).c[~..~-el,//ff/~. .........being duly s gorn, deposes and says that he is the applicant (Name of individual si ning contract) above named. He is the ~'- ............. ~ ............. , i (Contractor, agent, corporate o !fleer, etc.) of said owner or owners, and is d6ly authorized to perform or have perfo 'med 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 there' vith. Sworn to before me this ,19.Z. ....... ........ Notary Public~~,~...~ ........ ~ ~ ....... County ~.~~ ~..~..~ ~./~../~... &~ ....