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Home My WebLink About14270-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy deck addition. THIS CERTIFIES that the build~ng ................................................ ~600 l~t. Pleasant Rd. Hattituck Location of Property/~/~s~ ~}o] ....................... 's't/e~i ....................... County Tax Map No. 1000 Section q ~4 .... Block ~ .Lot . X X X Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...3tu..~.u.s.~...2.0 ........ ,19~.?. pursuant to which Building Permit No. dated ...S.~.p..~ ?.m.~.? .~..'17. ........... 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 ......... ~eck addition to existing one-£amily dwelling. The certificate is issued to S~A.NI~EY CHASE ..................... io¥,,'o;~ ..................... of the aforesaid building. Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO ........................... ~.../.k .................... Building Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DFPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO- 14270 Z Permission is hereby granted to: ..~..~ ....... ).S...~..~ ............................ ~...~.~g.~.~ ..................... ~~:..~..,~., ...... ~.(.~.,~.~...., ,o ..~.~....~....~..'..&....~.~.~....~...~....~... ~ Mqr~ ~,~, _ , \ . ./, , at premises located ot ...L~..O..~.......~..~......~.~....~ ....... ~.~ .......... County Tax Mop No. 1000 Section ....... !.!..~. .......... Block ...... ..~..~ .......... Lot No .....~ .............. /----.. pursuant to applicotion dated ,,.~,O~,..~.,,,'~.-...,.,~r,,~,, ................ , 19,,~,.,~,~,,, and approved by the Building Inspector. Fee $..~....:. ............. Building Ins~ctor Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southoid, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY TOW L FG $0[J3:1 OLD 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. 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 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacan~ Land C.O. $5.00 $15.00 Date ...... ' .~/Y/~'...~.. ........ New Building .....~. ........ Old or Pre-existing Building ............ Vacant Land ............. Locationo, Property Owner or Owners of Property ................. ~ ............................. County Tax Map No. 1000 Section .../.4.~ ....... Block . o/ Lot Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. \ .t.~..~3.~)..~:~. Date of Permit %l l~'ll~%PPlicant''' ~'~''' '~--~'(~ ........... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate .., ,~,. ................ Construction on above described building and permit rr~ts all a~ble codes and regulations. . ~,,~, ~ Apphcant ........ ~.~.. :.(...(~.(, .¢. ( ......................... Rev. 10-10-78 I!ELD INSI'ECTION COMMENTS ~OUNDATION (2nd) OUGH FRAME & PLUMBING iNSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS'. 'FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-180:2 Approved .~..~'~..~J_~..[ .~..., 197.~. Permit No ............ Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received ........... ,19... Date ....~/..t~. ........... 19... a. This application must be completely filled hi by Wpewriter 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 propeity 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 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 regulations, and to admit authorized inspectors on premises and in building for necessary inspections. /~, ~ ~ // ! (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (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 ...................... Location of land on which proposed work will be done. r?.~....~..'...~., f.I ..... !~.: ...... ....... /. p .......... .......... ................ House Number Street Hamlet County Tax Map No. 1000 Section .... ~/..~. ........ : Block .... i.d.~. .......... Lot...w( ............... 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 ........ ~. ~.....1~..~: ..... ; ...................... b. Intended use and occupancy · · '1" ................... ~... ~.~t, ~ · ................. 3.1] [I~,~ .~~f~h[~ applicable): New Building ..... : .... Addition 7 ..... Alteration ...,..,. ,.. ~ll~e:]P~i~lili~'~ sl~l[' 'i:~'!R:emgval .............. Demolition .............. Other Work ............... } ~~_ '_~, ? ~ ~___ (Description) ,¥q., - .... ~ ........ -~ ........... . ....... ....: .... :..: ....... ~'".~~vr , , (to be paid on fihng th,s apphcat,on) 5. If ~lw~llin~,~b~r of d~dlingi'units ............... Number of dwelling units on each floor ................ If garage, number of ears .... i ................................................................... 6. If business, comn: ' erc~al or m~xe, d occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of ex! sting structures, if any: Front ............... Rear .............. Depth: .............. Height .............. Number of Stories ........................................................ Dimensions of sar ~e struct re w~th alterations or ad&tmns: Front Rear ................. Depth ................... i.. Height ...................... Number of Stories ..................... · 8 Dimensions of en: ire new construction: Front Rear Depth Height .............. Number of ~tories .................... ~ ................................... 9 Size of lot: From i Rear :" Depth 10. Date of Purchase .......... i ................... Name of Former Owner ............................ 11. Zone Or use distr ~t in which premises are situated ................. ................................... 12. Does proposed ct nstruction vic [ate any zoning law, ordinance or regulation: ............................... 13. Will lot be regrad ,~d ........ .................... Will excess fill be removed from premises: Yes No 14. Name of Owner ( f premises .................... Address ................... Phone No ................ Name of Archite~ t .......................... Address ................... Phone No ................ Name of Contrac :or ......................... Address ................... Phone No .............. PLOT DIAGRAM Locate'clearly an< distinctly al! buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give st 'eet and block number or description according to deeql, and show street names and indicate whether interior or corner lot. STATE OF NEW YOI~ {, i S.S COUNTY OF ................. ........ being duly s~vorn, deposes and says that he is the applicant (Name o~ individual signing contract) Heab°ve~s thenam~d' . i . . . [. ~' (Contractor, agent, ~orporate officer, etc.) of said owner or owflers, and is ddly authorized to perform or have performed the said work and to make and file this application; that all s"~atements coniained in this application are true to th~ best of his knowledge and belief; and that the work will be perform¢ ~ in the manner set forth in the application filed there}vith. Sworn to before me tl is ............. day of ................ 19..~.~" Notary Public, ...... ' ............ County ~ n f.s~m I~ 10, l~4~t (S~gnature of applicant)