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HomeMy WebLinkAbout14212-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ...... Z.! .3.8.3.2. ..... Date September 6 1985 THIS CERTIFIES that the bunding ....O?.q~..s~.0:.~. ~..~?.n... ............................ Location of Property .... 2.700 ........................................................ Soundview D~. '~ I~atti~;uck House No. Street Hamlet County Tax Map No. 1000 Section ..... 9...q- ..... Block ......... .2. .... Lot. fl. 2 Subdivision .......... .X. ................... Filed Map No. X .Lot No. X conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... .G.~4]~3r. 3.©. ....... ,1985. pursuant to which Building Permit No ...... ? ?.27..2.~ ......... dated ....... ~,u. g.u~.~.. ~. 9 .......... 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 ......... .... D. aek. a.ck~$~5 J-.o~, ........................................................... The certificate is issued to ........... 0-.O..t~....c9.S.~.4 .................................... of the aforesaid building. Suffolk County Department of Health Approval .................. .I}1/~ .................... UNDERWRITERS CERTIFICATE NO .......................... ~l//fi, .................... Building Inspector Rev. 1/81 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) N.o 14212 Z Permission is hereby granted to: ..~__ ........ at premises located at ............. v County Tax Mop No. 1000 Section :.~...~**.~,.. ....... Block ..~...,~, ......... Lot No. ~,,rsuont to opp,cation doted .,~/~...~..O ............................. , approved by the // , Building inspector. Fee $., .~.~...~. ..... 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 This application must be filled in typewriter OR ink, and submitted ~ Ii 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 netu ral or topographic featu res. 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. Su bm it P lan n ing B card approval of comp leted site p lan requirements where applicable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" ~and uses: 1. Accurate survey of pz'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: 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 Date ..... ~./. ,~../..~.J../~. ......... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ,2~ 20 O CJ' ,C).. ,~t~., .~,' House No. Street Ham/et Owner or Owners of Property ........... 4 ........................................ County Tax Map No. 1000 Section . O ~' .~, Block O o 2-- Lot .... 9../, .1.~.. Subdivision ................................. Filed Map No ........... Lot I~lo .............. Permit No./. ?..2..z ~..?~. Date of Permit ......... Applicant ....................... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $..~.--~'..~'.....~..~...~..~..0. ~ ....... Construction on above described building and permit r~ts all applicable/co, des and regulations. ~_..¢~ ,¢~,_/~,~__j~q q Ap p, ica n t ...... ~~ ......................... Rev. 10-10-7a FIELD INSFECTION COMMENTS FOUNDATION (1st) FOONDATION (2nd) 2. ROUGH FRAME & FLUMBING INSULATION PER N. S?ATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS SEPT. 21, 198Z AT MATTITUCK DAT£ ~ dULY ~.~, 198l TOWN OF SOUTHOLD NOTES: SUFFOL.~ COUNTY, NEW YORK I. m:MONUMENT SCALE:; I" ;~ 50' NO. : 8J-419 ' FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-180:1 Disapproved a/c ............ ~..../ ...... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .... /~..o ........ , INSTRUCTIONS i a. Tkis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ets 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- :ation. 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 ~hall 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 ~hall 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 3uilding 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 tdmit authorized inspectors on premises and in building for necessary inspections./'). .., (Signature of applicant, or name, if a corporation) ..... .... ............. (Mailing address of applicant) Rate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. qume of owner oS premises ..... .~.o. ~ ~ ~- o,~'~.~ .......................... (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.. .... C].......fi'dp ............. Pinmber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section ..... ~..~...~. ....... Block ... {~..O.. ~ ....... Lot .... .d?.~... ~ ....... 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 ..................................................................... b. Intended use and occupancy ...... ' ................ t~' ,', ..; ,:,... ~ ~,~s~ .................... 10. 11. 12. 13. 14. Repair .............. Removal .............. Demolition . .4 ........... Other Work ............. i .a ,r~ (Description) EstimatedCost....~...Q~...J ............. Fee~5-O ~ .. *" (to be paid on filing this application) If dwelling, number of dwellin units ............... Number old ~lling units on each floor ............... If earage number of cars .. If'l~siness ~emmercia~.,,o~r ~nix~d occupancy, specify nature and extent, ff each type of use .................... Dimensions e~f existin~ it~4ctuies, if any:~Front .......... Rea ............. Depth ............... Height ..... '... i Number of Stories . . . Dimc/~ ~'f~ strUcture with alterations or additions: Front .... [ ............. Rear .................. Depth ........... i :..; ..... i · · · Height ...................... umber of Stories ...................... Dimensions 6f entire new construction: Front ............... Rear .............. Depth ............... Height .......... ' .... ~. Number of Stories ......................................................... Size of lot: Front ......... i ............ Rear ....................... Depth ..................... Date of Purchase ......... q ................... Name of Forme Owner ............................ Zone or use district in which premises are situated ...................................................... Does proposed construction violate any zoning law, ordinance or regula :ion: ................................ Will lot be regraded ....... i .................... Will excess fill be removed from premises: Yes No Name of Owner of premises . .~ .................. Address ................. Phone No ................ Name of Architect ........ q .................. Address .................... Phone No ................ Name of Contractor ....... 4 .................. Address .................... Phone No ................ .. i PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or propos property lines. Give street and block number or description according interior or corner lot. and. indicate all set-back dimensions from and show street names and indicate whether STATE OF NEW YORK, COUNTY OF ..... S,S · : ............................................... being duly (Name of individual signing contract) above named. He is the (Contractor, agent, corporate o of said owner or owners, and is d~ly authorized to perform or have perfo: application; that all statements con, tained in this application are true to the work will be performed in the manner set forth in the application filed there, Sworn to before me this ................. ;f ................ 19 Notary Public ...... ??..-~.. . . ?.~'. ....... County . ~llr~ ~. ~ ~O[ ': ..... i NO~IY _P~J~JJOo ~lte of lklf York ¥orn, deposes and says that he is the applicant Ticer, etc.) med the said work and to make and file this best of his knowledge and belief; and that the ?ith. (Signature of applicant)