The URL can be used to link to this page

Home My WebLink About14302-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z13894 Date October 3 .................................................. 19 85 THIS CERTIFIES that the buildfl~g a d d i t i o n. Lo ~.:~_~,-n_. .... 455 Tuckers Lane Southold House No. Street Hamlet County Tax Map No. 1000 Section 5 9 .Block 1 1 .Lot 6 Subdivision X .Filed Map No. X .Lot No. X conforms substantially to the Application for Building Permit heretofore ~ed in this office dated September 5 1985 pursuant to which Building Permit No. 14302Z . dated ...... ......................September 24 1985...,wasissued,andconformstoalloftherequirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Addition to existing one-family dwelling. The certificate is issued to STANLEY RAKOWIC Z of the aforesaid building. Suffolk County N / A Department of Health Approval ......................................... N/A UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 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 ail 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~Coperty 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 occupancy $1.00 4.Vacant Land C.O. $5.00 New Building .... ~ ..... Old or Pre-existing Building ............ Vacant Land ............. Location of Property. ~.~.Z. ~..~ ............ House No. Street Hamlet Owner or Owners of Property ....... .?.~..~.~. ~ .~./. .... . .~T?..~. ~. ~ .~...._~../.ct. :~.. ................. County Tax Map No. 1000 Section ............... Blbck ...... /..~ ...... Lot... ~ ....... Subdivision ................................. Filed Map No ........... Lot No .............. Permit Uo./~/. '.~. .D.~..~. Date of Permit . ~.?./:t'.C.Applicant...'..~. p.~7~. .... .~. f..~./..~ ...... Health Dept. Approval . ..~. .................... Labor Dept. Approval ... Underwriters Approval ...................... Planning Board Approval ..................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ...... ~ .o.o .~..~..~.~.?. Constr~gtion on abov~ described building and permit meets all aF}plicable codes and regu lations. TOWN OF $OUTHOLD BUILDING DEI'ARTM~:NT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NB 14302 Z Permission is hereby granted to: ...~..o..~...L~.~ ......................................... ..... Ot premises located at ....~...~..~.".........~.,d~n~..~ .............. ~ ................ County Tox Map Noff1000 Section .... ..~.....~...c~. ....... Block ............ !..J ....... Lot No ........ .~. ............. pursuant to appllcotion dated ..---~a ........................................ , 19..r..=., and approved by the Building Inspector. Bt~ing Inspector Rev. 6/30/80 ~jlELD INS~'ECTION 1. COMMENTS FOUNDATION (lst) ~OUNDATION (2nd) OUGH FRAME & PLUMBING NSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: DATE:~/,~/~' _B.P. ~ /~'/)~0~ "~ NOTIFY BLf~LD~NG DEPARTMENT AT 765-1802 9 AM TO 4 PM FO~ THE FOLLOWING l. FOUNDATION - ~0 FOR PGU~ED CONCRETE 2. ROUGH - FRAMING ~ PLUMBING 3. INSULAT~CN 4. FINAL - CO~;3~pU~Th~N MUST BE COMPLETE F~ C. O. ALL CONSTEL~CT~ON SHALl_ MEET THE REQU~R~h',~NTS OF THE N 1 Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. "FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL.: 765-1803 Approved~.~..~. · .~..~. ., 19~. ~ · Permit No. ·] .~.~- .O.&. . :~. ./ Disapproved a/c ..................... ................. (Building Inspector) APPLICATION, FOR BUILDING PERMIT Received..~./.~. .... ,19 .~. Date ~?~- ~ 19.~. INSTRUCTIONS "a. This application must be completely filled in bY typewriter or in ink and submitted to ~the Building Inspector,with3 ;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- ~tion. 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 .all 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 ~ Certifidate 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 legulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ['lie applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to ,dmit authorized inspectors on premises and in building for necessary in~ ~/~.~ ,, .... o. :o., .d:/. (Mailing address of applicant) / State whether applicant 'is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. ....... . .'7~ ~.,.4.~.~ .~. .......................................................................... Name of owner of premises ..... . .~?~t?.¢~// ..... .~.~ ??..o...~--_-_-_-_-_-_-_-~¢./..C..~.... ................................. (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 .................................................. ..... ~ ?...~..~. .............. . .~7. ~.c ~.,.~....~. ~. ............. .~..~...~.~./. ~. ~ ~. ~ House Number Street Hamlet County Tax Map No. I000 Section ...... .~..~. ........ Block ..... ff. .......... Lot ...... .~. ........... 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 ....... . .~...~L~.¢,.. t .~.~d.~.~q...c-r. ......................................... b. Intended use and occupancy .... ~5. t ~~. ~ ~'~ ~w4 ........... ~¢~.~.;;~. ~- ,~ ............. 3. Nature of work (check which applicable): New Building ..... ' .....'Addition... ~... Alteration .......... Repair .............. Removal .............. Demolition ............ Other Work ............... (Description) 4. Estimated Cost ....... ..~.o..~? r..~.~. ......... Fee ................ i ~' (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 mixpd occupancy, specify nature and extent of each type of use ........... ~; ....... 7. Dimensions of existing structures, if any: Front .... ~ .~ .r. ..... Rear ...~. ! ........ Depth....~... i~. ~' ~/' Height ..... ff'. ........ NUmber of Stories ....................................................... Dimensions of same structure with alterations or additions· Front .~ ~ r n~ ~ r Depth ....... ~'. ...... [... Height ...... ff.t.. ~' ........... Number of Stories ..... F. ............... '- 8. Dimensions of entire new conStruction Front .... ~.t. ...... Rear ~./r Denth /~ r .... r e ...................................... O'~ ..... 9. Size of lot Front ~..~.. Rear ~ r~,,,h / ~ .... 10 Dat~'ofPurchase i Name of Former Owner 11. Zone or use district in which premises are situated ..... ~.. ~ A .~.. · .-'r¢7.~.4 ~ ....................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ...... ~. ~ .................. Will excess fill be removed from premises: Yes No 14. Name of Owner of premises 2T.~.."(. q~.~..~ ?. ~ ~..%~-.. Address ~ ~7~ ~.~ .~r- Phone No. .. Name of Architect ........ ~ .................. Address ................... Phone No ............ ... i PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, i S.S COUNTY OF ................. ................................................. being duly sworn, deposes and says that he is the applicant (Name of individual sigping contract) above named. He is the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dt~ly authorized to perform or have performed the said work and to make andi 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 ~n the manner set forth in the application filed therewith. Sworn to before me this ........................ day ............ , ..... .... Term Exptre~ Id~reh ~ 1~.~,,/