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HomeMy WebLinkAbout14282-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ...... g.'l. 3.8.9..0. ..... Date ......... .O.c.~.o.b..e.~..! ............. 19...85 THIS CERTIFIES that the building ....... .~.e.c.k...a.d.O:.J:~. ?..o.n.: ........................ Location of Property ~40 Old CoYe Rd. Southold h~[~s~ ~Jd ....................... 's'th4i ....................... h~t3iei County Tax Map No. 1000 Section ~ 0/4- . .Block q 2 .Lot 9 Subdivision...~..~.P..A..I?@ .~.~.~.u...~p.5.n.~. ....... Filed Map No .... ! .5.6..Lot No ...... q. 9..5 ..... conforms substantially to the Application for Building Permit heretofore fried in this office dated ·..~.ugu. s..~..2.9.. ........ , 19 .8~.. pursuant to which Building Permit No ...... .'1.~.2..8.2.Z. ........ dated ..... ~.~p-~.e~.b.q .:¢..q.6. ........ 19..8.5, 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~.~k. ed.4~;i.o~ .~;9..e.x~.~.5.n. ~..one.-r~..~.m.~.~.y..~.w.e.~..~.i.n.g: ....................... The certificate is issued to .................. ~.~.~. ~.. (owner~ ..................... of the aforesaid building. Suffolk County Department of Health Approval ............. .lq/g.. ......................... UNDERWRITERS CERTIFICATE NO ..................... .N~.~. ......................... Building Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (']'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK ^UTHORIZED) Permission is hereby granted to: ~~.~ ......... ~.~, /I~.~-~, . ,o.~.~ ~....~& ~....~.~.....~~ ...... ~ ..... at premises ,~ated at ...~..~ ........ S.~.....~..~.: .......... ~~ ................. County Tax Map No. lO00 Sectio~<~.......~. .......... Block ...... 1 ............... Lot No ....................... pursuant to application dated ...~~..~...,.....~.....~ ............ , 19,?.,,..,, and approved by the Building Inspector. Fee $..,~....:....'~.. ....... Building In,~ector Rev. 6/30Z80 FORM NO, 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tot with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic featu res. 2.Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3.Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, ~ndustria~ buiMings, Multiple Residences and similar buildings and installa- tions, a certificate ofCod~ compliance from the Architect or IEng[neer_respon~i~le for the bui!ding .... 5.Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 2.Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: Pr ~' {~'O ~ /$- 6'O I, Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use ~jd 2-~-~'~- ~'~,~, ~ ~' © ~ ~. 3. Copy of certificate of occupancy $1,00 Date . .S.e.p~,..~,?... ~,985 ....... New Building ............. Old or Pre-existing Building .... ~. ....... Vacant Land ............. Location of ProperW .. ~.L~O...0.~.~, ,~.oy.e., .~.o,~,~ ..... ~9~.~.b,9~..~.,. ,. ~'~..~,3,cj?~L ................ House IVo, Street Ham/et Owner or Owners of Property . .~..~. ~.~ .I.~.~...~.z'.~. ~.e..~ .......................................... County Tax Map No. 1000 Section ,....~.0.~ ........ Block ...~.~..~.2. ...... Lot.. c) ............. Subdivision ?..~]~..A., ~§.~.s..~.u. ?.o.~ ~ ........... Filed Map N~.(~ .......... Lot No ..... ~cj~. ..... Permit No..3,J~.2,~.. Date of Permit .9/'. l(~.~J~.Applicant .g Q~z£~o ~me.rzl;. g&s ~,. &nc, ....... Health Dept. Approval ~'/~ .................... Labor Dept. Approval ........................ Underwriters Approval ....................... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ...~. ................... Fee Submitted $.. ?.; .0.0...~..~.../9..~.~.~. ...... R~ 10 I0 78 ~ 'iELD {NS~CTION COMMENTS OUNDATION (2nd) ~UGH FRAME & PLUMBING ISULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined .~.~. ] ¼., 19~./. atpproved .~e~. ~..'U?~..~..~.~., 19~.~./. Permit No. [ .~..~.~...~..~7.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT BLDG. DEPT. TOWN OF SOUTHOLD Received ........... ,19... .~./.~. ~' 19 Date .................. , INSTRUCTIONS a. This 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 E~uilding 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 ldmit authorized inspectors on premises and in building for necessary inspections. .yr... ............ (Signature of applicant, or name, if a corporation) (Mailing address of applicant) ~tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~ame of owner of premises .~. / 2~./. '.~.t,Y/ &.rT..t~.~. ~ .77. .......................... .............. (as on the tax roll or latest deed) ap/p~~~9~/, signature of duly authorized officer. .... '(iqame and title ov'' '~ ~'o~rate officer) Builder's License No..~.,.~.,..~..l..~. .... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... I. Location of land on which proposed work will be done .................................................. ........ c?... ......... .............. House Number Street Hamlet '"~ - County Tax Map No. 1000 Section X oM Block ~ :x. Lot.. Subdivision..~..a/~...".~..'.../~..~.~ff..~.4:t....~. ~.' ......... Filed Map No.../..I~. ........ Lot.../~.4.~. ........ (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... . .~.~$./.~..C.~.C-..~. .....& .~..~..t~./.'.~.7 .............................. b. Intended use and occupancy ........................... ~,~'~'~:~.,~': ;j*'k' ...{~'~t~ .............. 3. Nature of work (check which a~plicable): New Building ..... '.' .... 'Addition .......... Alteration ......... Ro,~ ~3 ~. ~ j% ..... Removal .............. Demolition ............. Other Work .~9/q. ~t?. ,~ (Description) '4.' Estimated Cost .'~2~,°. ,] .~. Fee : , ~' (to be paid on filing this application) 5. If dwelling, number of dwellin~ units .............. Number of dwelling units on each floor ................ If garage, number of cars .... ~ .................................................................... 6. If business, commercial or mix6d occupancy, specify nature and extent of each type of use .................... 7. Dimensions of exls_tlng structures, if any: Front ..... ~ ....... Rear .. ~ ......... Depth ............... Height ... f.~..'. ...... Number of Stories .... ! ................................................... Dimensions of same structure With alterations or additions: Front .. ,~. ........... Rear.. ~ .% ............ ~ ~ ~ Height .~ (> ' Number of Stories t Depth ............ , ........... 8. Dimensions of entire new construction: Front ....... ~,/ ..... Rear .,~ ............. Depth ............... Height ................... I~ ............... ones ~ 10. Date of Purchase .......... i ................... Nall~e of Former Owner ................... ' .......... 1 1. Zone or use district in which premises are situated ..... ~.'~~ ............................... 12. Does proposed construction vi61ate ,any zoning law, ordinance or regulation: ...~.0 ......... ~ ............... 13. Will 10t be regraded ........ ./X~o~,..~ ............ Will excess fill b_e removed from premis/s. Yes No 14. Name of Owner of premises R?.~'~... (~..~?..~..~.F. .... Address .~. 7Y.. ?~.~.~..~..~.'.~Phone No.. ............... Name of Architect ......... .................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and bloc]: number or description according to deed, and show street names and indicate whether interior or ~corner lot. STATE OF NEW YORK, COUNTY OF ................ (Name of individual si above named. S.S ..................... being duly sworn, deposes and says that he is the applicant ning contract) Sworn to before me this Notary Public, .... He is the ..................... . .................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d¢ly authorized to perform or have performed the said work and to make and fliP'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 manher set forth in the application filed therewith. APPaovED AS NOTED FEE: ~73, NOT~Fy BUILDING DEl, ~i-~TMENT AT 785 ~802 9 AM TO : PM ~R ~E FC ~ PGU:~2 ' CON~ETE 2, ROUGH F~AMING & PLUMBI~, 3, INSULATION 4. F~NAL CONSTRUCTION MU~ B~ COMPLETE FOR C.O, ALL CO~STRUCTION SHALL M~ THE REQUIP~MENTS OF THE N.Y ~ATE CONSI'~crffoN & ENERGY CODES, NOT RE~ O~UPANCY OR -. WITHOUT CER~FICATE / ~ ~' '.::~ OF OCCUPANCY : · , . :. ,, . . , .,: ~?~. , ~',, ,. /,7,~ / L ?. ,~I~PROVED AS NOTED~. 766-1802 9 AM TO ~ ¢'~ FOR FOLLO~NG INSPECTIONS: 1 FOUN~T;ON ~RE~ED FOR POURED CON~ETE ~. ROUGH FRAMING & ~UMBING 3, INSU~TION ~. ~N~ COH~RU~ON MUST BE COMPLETE FOR C,O. ALL CONSTRUCTION ~ALL ME~ THE REQUI~MENTS OF THE ~ATE CONSTRMCTION ~ CODES. NOT ~S~ON~O~L~ '~' / OCCUPN~CY OR . USE'IS UNLAW~L OF OCCU?,~NC¥ . /0