HomeMy WebLinkAbout13672-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No ...... .Z.l.q 57.8 ..... Date .......... ~.u..ly..1 ................. 19~6.
solar room addition
THIS CERTIFIES that the building ................................................
650 Lakeside Dr. Southold
Location of Property ...........................................
House No. Street ...............
90 3 5
County Tax Map No. 1000 Section ............ Block ............... Lot .................
Subdivision Cedar Beach Park .Filed Map No. 9.0. .... Lot No.
57
conforms substantially to the Application for Building Permit heretofore filed in this office dated
85 13672Z
January 8 19... pursuant to which Building Permit No.
dated January 14 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 .........
Solar room addition to an existing dwelling.
ROGER & VIRGINIA CORNELL
The certificate is issued to ..................... ~dv~n'eJ',~(r~tJ~ .....................
of the aforesaid building.
Suffolk County Department of Health Approval N/A
UNDERWRITERS CERTIFICATE NO. N 750945
Building Inspector
Rev. 1/81
FOBM NO. Jl
TOWN OF $OIJTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLlaWION OF THE WORK AUTHORIZED)
No_ 13672 Z gate ...~....~...~... ............. ,~,....~...'.~-
Permission is hereby granted to~')
...~:~~.,....~......./../.~z./
/
pursuant to application dated .~....~.'..~ ................ , 191~.._.'~..--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 m~ 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 pZOperty 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 requ ired to prepare a certificate.
C. Fees:
I. Certificate of occupancy $§.00
2. Certificate of occupancy on pre-existing dwelling $ Z 5 o 0 0
3. Copy of certificate of occupancy $I .00 IR
4oVacant Land C.O. $5.00 ~?l~G
5. Updated C.O. ~~z~kY Date ........................
New Building ~' Old or Pre-existing Building Vacant Land
Location of Property ....~..~..Cl.....~r ~ ?..~.~/~.~. · · .~..~'..'. ~ ......... .~..~..c~..~../~.6... i~.~ ........
Owner or Owners of Property ...0, .~.~ .~. ........ .~£~it?J'..ctr ..... %.6..K'...~, .~..( .! ...........
CountyTax Map No. 1000Section ....(~.0 ....... Block .. (~ ~-~ Lot
Subdivision ................................. Filed Map No ........... Lot No ..............
PermitNol~(PTc~.~. DateofPermit~[c}?.~.?Applicant ~.o~.~r- ~i~.~'~'19t~jo.~
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ...... . ..2,-f ...........
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $ .............................
Construction ~.~ above described building and permit meets all applicable codes and regulations.
' · .... ..... ........................
''0 COMMENTS
FIELD,INSPEC~I N
~OUNDATIO~ ( 1st }
FOUNDATION ( 2nd )
2 o
ROUGN FRAME &
PLUMBING
3.
INSULATION PER N.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS:
2'6S..1802
BUILDING DEI~F.
INSPECTION
FOUNDATION ,ST [ ] RouGH PLBG.
FOUNDATION 2ND [ ] INSULATION
[ ~//FRAMING [ ] FINAL
REMARKS: .....~) :
DATE
' FORM NO. 1
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
,~OUTHOLD, N.Y. 11971
TEL.: 765-1803
Examined ./~. · · · ."..¢. ..... ,19 .~.~--
^pprov~../..~. .... :_., ld/.:..mermit No.
Disappl'~ved a/c. ..... ~ .'; 7-..~-.. ...............
(Building Inspector)
APPLICATION FOB BUILDING PERMIT
INSTRUCTIONS
Received ........... ,19...
a. This 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 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 pxemises 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 ....
(Signattffe of applicant, or name, if a corporation)
.......... ~.~..././.%. ~..~...~.,,?.
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.... \~. ~. ~, ............................... , ....... : .................... .., .............. ~
Name of owner of premises .~C2.3 .~ .~'. .... .~..~0.~. · · · .~' ! C~· j''t'~' I · ](~A-' ...... ~'~' ~" ~' '~' '// ...................
(as ot~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~~ ......
Other Trade's License No ......................
1. Location of land on which proposed work will b,e done ................... , .. .............................
House Number Street
County Tax Map No. 1000 Section .............. Block ...~.~. ............. Lot ...................
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ...... /~.~.C~ ]7~ .....................................................
b. Intended use and occupancy .... '~lQtC....F20.O.,CrO ..............................................
3. Nat able): New Building .......... Addition .......... Alteration ..........
Repair .... ~:.~<5 ~. ?_~e~ .............. Demolition .............. Other Work ...............
-~-~ ~'~- .~.c~ ~. (Description)
4. Estimated Cost ... ,.,,.&,~ ...................... Fee .................................
'" ~ ~'-57'~ *" (to be paid on filing this application)
5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................
If garage, number of cars .... ~ ....................................................................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .....................
ting ' pth
7. Dimensions of exis structures, if any: Front ............... Rear .............. De ...............
Height ............... Number of Stories ........................................................
Dimensions of same structure with alterations or additions: Front ................. Rear ..................
Depth ................... i... Height ............. 't ......... Nulnbe~r of S,~ories ........ i '~ 7 ~;~',~ .....
'X 8. Dimensions of entire new consiruction: Front ...... .c~'.6,..././.',.. Rear .~J..(o...././ ....... Depth .............
Height ............... Number of Stories ........................................................
9. Size of lot: Front ....................... Rear ...................... Depth ......................
10 Date of Purchase ...... i. Name of Former Owner ...................
1 1. Zone or use district in which premises are situated .....................................................
12. Does proposed construction vidlate 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 ~ Address Phone No
Name of Architect ......... i .................. Address ................... Phone No ................
Name of Contractor ' Address Phone No
PLOT DIAGRAM
Locate clearly and distinctly ali buildings, whether existing or proposed, and. indicate all set-back dimensions from
prop~,'rty lines. Give street and bloc~ number or description according to deed, and show street names and indicate whether
interior or corner lot.
STA'I]~ OF NEW YORK,
COUNTY OF ................. S.S
........................................... being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is the '
i (Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
applicationi that all statements cont'ained in this application are true to the best of his knowledge and belief; and that the
work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
.............. ..... day oi ..... ............ 19
Notary Public ....... . . . ,~ ~ .-. .... County
}~OTARY PUBLIC, State o' New ¥od~
," No 4707875 Su folk Couoty~.~. ' ...................
'. ' , I, ~J . (Signature of applicant)
] ,T?