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HomeMy WebLinkAbout13958-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Occupancy THIS CERTIFIES that the building .... .d.o.e..lc..8.d.d..5_~.i.o..n: ........................... Location of Property ~LO0 Budd' s Pond Rd. Southold House No. Street Hamlet County Tax Map No. 1000 Section . 5.~. ........ Block ....... ~ ....... Lot ..... ~..8 .......... Subdivision...~/.5.~.}9.w..P..o.5.n.~. .............. Flied Map No..~.6.~.2....Lot No... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...~..q¢ ............ 19 .~. pursuant to which Building Permit No ...... ~ ~.9..~..8.~ ......... dated ........... ~I.8~.. ~.~ .......... 19 .85., 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 ......... ........ l~eel~ .adcLLt: J. or~ .~o. eX~J:~T~g. 9.n.e.-~f. ~.m.5.1.7..d.v?e. ~..1.5_.n.g: ................. The certificate is issued to ................. (owner, ~ ..................... of the aforesaid building. Suffolk County Department of Health Approval ................. ~J/~. ...................... UNDERWRITERS CERTIFICATE NO ..... Building Inspector Rev. 1/81 F01~.~' NO, ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CT'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 13958 Z Permission is hereby granted to: i~.:....~~....~.., .................. ,~...~....~.:..~.,..J..L.~..'7.L ........ ,o...~ .............. ~ ~....~.,~ ...... ~.:~' ~ -- ~ .... ~.....~' ' .... · .~'~'";" -"/-! ..... ~'~'" '~';'-= "'_- m"";' '~¥ ~.'"=~""~'~_'":""":'"~ ............ at prem,se, located et ....~.,..~....[J~,%....~'.~ ....... ~ ....... ~ .......... County Tax Map No. I000 Section ..... ,.(~......~.. ...... Block .....,~.. ............. Lot No. Building Inspector. Bu~iTding Inspector Rev, 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hart Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted in duplicate 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 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 ...' ......).... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property...~.Q0 ..... ./,~. ~..~. ~.~.'.. }2.0.~' .l~.....~.q/.~...JO ~...L/~.©./.~. ............. House No, Street Ham/et Owner or Owners of Property ... ~. [ ~,~-0.C-. ..................................... County Tax Map No. 1000Section .Q.~..'-~.. .... Block ...... .~. ....... Lot...(~./. ~. ....... Subdivision ........ 0...~... .l~.~. .......... Filed Map No ........... Lot No .............. Permit No. {.~/~..~.. Pate of Permit . ( .J..Applicant..~-.0~)~.. . .~./.~. pt App Health Dept. Approval ................ Labor De . royal ........................ /~.//~ Pla i g Bo d Appro I Underwriters Approval .................... nn n ar va ...................... Request for Temporary Certificate ..................... Final Certificate ...... .~-~.. ~'. ............ Fee Submitted $ .... ~'...(~....~..~. 5."J J .I ...... Construction on above described building and permit n~eets all applicable codes and regdlations. App,c nt .......... Rev. 10-10-78 FI~LD ~ Si~ECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY QODE COMMENTS FINAL ADDITIONAL COMMENTS: ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BLDG, DEPT, TOWN OF SOUTHOLD Received ........... ,19... a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ts 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 luilding 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. 'he 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 inspections. .~.~..O~.~m..(3~! .~¢.c..370. ~.. ....... (Signature of applicant, or name, if a corporation) 3.~...~..~..o.o.t.~. :~..Cd.,..,5a~3:h ~).~. ...... (Mailing address of applicant) ~tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ,....qe~.~.. C~cx¥.. ................................................................. ~ame'ofownerofpremises ..~C, .,~..'L.~.C.,.~0~Q,.JI'; ................................. T' (as on the tax roll or latest deed) appli~qnt 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 .................................................. ... .................... .... ............... House Number Street Hamlet County Tax Map No. 1000 Section ....(~..~...~). ........ Block ....O..'~. ........... Lot...0..~,~. ............ Subdivision...(fl~.), ].}.~U,.~....~.O.t..~..'~. ............. 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 ......... dfff~c~.. ................................................... b. Intended use and occupancy ........ ~C .Cd~.. ...... i.~..~ ¢~.6.Q-.%¥~%..~-.~.. ............... 3. Nature of work (check which applicable): New Building ..... ' .....'Addition .... .~..... Alteration .......... Repair 'i~ ............ Removal .............. Demolition .............. Other Work ............... ~ fi/- (Description) 4. Estimated Cost ..... ~.J.{P. · ~. ...................... 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 busmess, commercial or m~x~d occupancy, specify natur~ and extent of each type of use .......... / .......... 7. Dimensions of existing structures, if any: Front ..... .,~..~. ......Rear .... 42~. ~/. ......Depth. .... q-~ ....... Height ............... Nt tuber of Stories ........................................................ Dimensions of same structure w~th alteratmns or additions: Front Rear Depth / ~ Height ' Number of Stories 8. Dimensions of entire new corn truction: Front .... ~2.~. ....... Rear .... .~..~. ....... Depth ...[2- ......... Height ............... Nr mber of Stories ........................................................ 9. Size of lot: Front ......... i ............ Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ............................. 1 1 Zone or distri t i wh' h p~em' 'tuated · use c n lC lses are si ..................................................... 12. Does proposed construction viglate any zoning law, ordinance or regulation: .............................. 13. Will lot be regraded ...... :~.i , . .q .° ......... t ..... Will ex, tess fill be removed from ~Dremises: Y.~s.... (~o~ 14. Name of Owner of premises V.i~.~cdroC..COCQO~[\.,... Address {~, .~.afi&. [4x.~.'[°.~.~Bh?No ......... Name of Architect ......... i ....., ......... ~... Address .~ ................... Phoa~e No ................ Name of Contraetor~.qhra. ~f~.'.~.~.l. ~.~ ld&qq~. C,-Address ........ 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, S S ..... ~ %7~.~C~x..~.:. ~.CC ~O) ............... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ~ (~.QC~ (Contractor, agent, corporate officer, etc.) of said owner or owne~, ~d is d~ly authorized to perform or have perfomed the said work and to m~e ~d file this application; that all statements contained ~ this application are true to the best of his ~owledge and belief; and that the work will be perfomefl in the m~n~r set forth in the application filed therewith· Sworn to before me this , ~vo 470787 ~.,.~,,W~v Yot~ (Signature of applicant) .P~O,,,.,D AS 'NOTED NOTIfy BUtLDIN~ ~~ 765 180~ 9 AM ~6 4 PM FOR FOLLOWING 1. FOUNDATION.: ~O R~UIRE~ 2; ROUGH - ~RAMING & PLUMBIN~ 3. INSULATION . , 4, FINAL _ COk,,STROCTioN MU~ ALL CmNSTp~CTiON SHALL ' THE ~E~{HqSA~FK}TS OF ~HE S~ATE CONgTRUCTION & ENERGY, CODES, N~T RESPONSIBLE FO~ ~" ' :" ICY