Loading...
HomeMy WebLinkAbout13768-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupnncy No. Z16574 Date Janu,a. ry 12, 1988 THIS CERTIFIES that tile building A d d i t i o n Location of Proper~y 810 Holbrook Lane (Pvt. Rd 15) Mattituck h~ hiol ....................... 's't/e~i ....................... h~/niei County Tax Map No. 1000 Section .... 1.1.3. ..... Block ...... 6. ........Lot 10 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore flied in this office dated .... ~ 9.r.c.h.. ! .2.,.. ] .9 .8.5. pursuant to which Building Permit No. 13768 Z ~ dated.. ......... Iqar ch 2. ...... 1, 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 ......... .... AdA. itio~.to.~ one family dwelling as applied for. The certificate is issued to EDWARD GIB S ON ..................... io¥.'o;,~~Xk'~ ................. of the aforesaid building. Suffolk County Department of Health Approval ....... ~/.A ................................ UNDERWRITERS CERTIFICATE NO. Pending slip I/7/88 N/A PLUMBERS CERTIFICATION DATED: Building Inspector Rev. 1/81 I~ORM BO. B 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) 13768 Z Permission is hereby granted to: ...~.~....!s......~.~.~.L ............. ~.~....L~..-t. ................................................. ..~.~~ ~,.~. ~,~ ,o ...... · ..i~..~.-~.,.~.,....?~....;.;~.~.g.~,T....:~ ........ .; ............. .:. ...... ~...~..; ......... ,..:.......;. ....... ot ,r,m,ses ~o¢oted ~t ..I.!.~......~....L,~.~....k...;~.L.P.~.....E...~.i.~...L..~.~~.... County Tox Mop No. ~000 S,~,oq . ...... I.L~ ........ mo~k ........ ..Le.. ......... ~ No ........ /..C~ ......... pursuant to applicohon dated ....... ~...~ .................. , 19.~....~., and approved by the Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. 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. B. 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 topograph ic 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 e certificate. C. Fees: Additions $25.00 POOLS $25.00 1. Certificate of occupancy New Dwelling $25.00, Accessory ,$10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.vacant and 20.00 5.Updated C.O. $ 50.00 Date ................. NewC°ns t~r'uc t ~ °n ...... Id or Pre-existing Building ............ Vacant Land ............. Location of Property .......... ~./'~. ........................... House No. $~e??. Hamlet Owner or Owners of Property ~ County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivis on ........ Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ................ ' ........ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate Fee Submitted $ ............................. Construction on above described building and permit meets all applicable coj;J,es and regulations. Applicant..~..C~7.,..~ ............ Rev. 10-10-78 TOWN OF SOUT]~OLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 ~/4/ss TEL. 765-I 802 To Whom This May Concern, We are unable to complete your Certificate of Occupancy because .of the following reasons. /~X An application for Certificate of Occupancy is not on file. /~ No Underwriters Certificate on file. ~_~/ The check is(outdated/not on file.) $25 /5/ No Health Dept. Approval on file. /5/ No final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. ~uilding Permit # 1'3 7~ 6 8 Z Building Dept. ***/5/ No Plumber Solder Certificate on file. ( all permits involving plumbing being issued after April 1,1984 ) I have returned the old check from Edward K. Holland Jr. Please contact the underwriter to have him do an inspection for you so we can clear up this matter. Thank you. FIELD INSPECTION FOUNDATION (lst) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ODE FINAL COMMENTS ADDITIONAL COMMENTS: ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved . .~.OM,~..~./..., 19~. ~. Permit No. 1 3'7.~.~..~.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT 8LDG DEPT TOWN OF Received ........... ,19... INSTRUCTIONS a. Tins application must be completely filled in by typewriter 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 property must be drawn on the diagram which is part of this appli- cation. c. The work covered by tins 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 necessa~arfil~-ff~ions~. ~- .......... ~"(Signature of applicant, or name, if a c~orporation) (Mailing address of applicant) State whether aj212.1icant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........... .................................... Name of owner of premises..~ .~..~..~.{~. ~ ~ ' I. o.::>~.. ~V (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 ...................... 1. Location of land on which/proposed work will be done .................................................. ....... ..... ....... .... House Number Street Hamlet County Tax Map No. 1000 Section .... /.]..'~. ........ Block ..... (4> ........... Lot .... /..~. ........... Subdivision...~..O~..~..~:,...:~..~., .t~ .t~.X ............ Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Ex,st~ng use and occupancy . .~.~: ;~. t{~,¥%.'~-.\ .~,.~.~ ........................................... b. Intended use and occupancy .... .~. ~.~. / 10. 11. 12. 13. --14. 3. Nature of work (check widish applicable): New Building Addition . ...... ' Alteration .......... Repair 2,~,.~.! .~... Removal .............. Demolition .............. Other Work ............... · e~- -1~ (Description) 4. Estimated Cost ........... ~..©..Of~..: ~ ............. Fee . .~.-'~...'.. ~ ........................... (to be paid on f'fling this application) '5. If dwelling, number of dwelling units ..... ./t ......... Number of dwelling units on each floor ................ If garage, number of cars ......................................................................... 6. If business, commercial or mixed occupancy, specify natl~ie.~,~. ~.a~'d ~.~--.extent of each3]. ~/.~r~.tYPe of use_...'~-~... ~.. ......... Dimensions,llf ~listing structures, if any: Front ...... Rear. ..... 'Depth.' 7. Height .......... ~I~. Number of Stories ..... ~ ..................................... t ............ Dimension~o~same structure with alterations or additions: Front .: .~.~. ........... Rear...~ !.~1- .......... Depth ...~.., ................ Height ...................... Number o.f Stories ...................... 8. Dimension~9.f entire new construction: Front ...,/.]..~ ........ Rear ... ].]..~. ....... Depth .. Z~.f ........ Height ~ ........ ,.. >~Number of Stories . Size of lot: Front .... ']~ ............... I~;~iii i~."~i' ~);~i~'iii~.'.~i*iiiill Date of Purchase ............................. ~qame of Former Owner ............................. Zone or use district in which premises are situated... ~..'~ i .~t. $ ?.x.-'li~..~.~. .................................. Does proposed construction violate any zoning law, ordinance or regulation: . .t5, O ........................... Will lot be regraded ..... .I/~ cd. .................. Will excess fill be removedf~, premises: ~ Yes Name of Owner of premises~':/.., ~1'. b.~..~ ~. ...... Address~.././~.~Y.].~./70. ~..~..n~. Phone No. ~,(~ ff.~ ~/.'). Name of Architect ....... ~ ................ Address ................... Phone No ....... ;, ........ Name of Contractor ~'/4'~:~ .t¢...~..t .~<.. ~, ........ Address ./~.~.~:¢'.'2.1,)/.~ . .~'/~.l~.d,~ Phone No.~. g.~. ~ .5~'~ .'~ .... 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 NF::fi~Y~DRK, COUNTY OF..~. '~ .~..~.'.1../c~. .....S.S ................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ....................... ~.~: ....... ~ .... ~.. ~ ................................. (Contractor, agent, corporate officer, etc.) of said owner or ownem, ~d is duly authored to perfo~ or have peffomed the said work ~d to m~e ~d file ~s application; that ~1 statements cont~ed work will be perfomed in the m~ner set for~ h the appfication filed therewith. Sworn to before me this ............ [8 .......... day of ..... Nota, Public, ~...~ ....... HELEN K NOtArY PUBLIO. State Q~ N.~ YDr~ ~ '