HomeMy WebLinkAbout13998-zFORM NO. 4
TOWN OF 50UTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y,
Certificate Of Occupancy
No. g.1.349.7 .......... Date . .89B.c..5 ......................... 198.5.
THIS CERTIFIES that the building ..... .~.c.c.e.s. ~. 97.Y...b.u.i.l.d. ~.nE. .....................
Location of Property .~... 7.1.5. . p.A.~.~..D.~.~.V..E ................. GREEN?OR?
t~ouse No. Street Hamlet
County Tax Map No. ]000 Section . .0.~5 ....... Block ...... .0.5. ......Lot .... .1 .~ ...........
Subdivision ............................... Fi]ed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
·...~.une. 5 ............ 19.8.5 pursuant to which Building Permit No..139.9.~Z. .............
dated ....... ~..u.n.e..5 .............. 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 .........
....A.qq.~.s.s.qp.y bu,:[.~.d.iqg .i.n. ~..~,d.e.y..ard' Z.:.B...~,..Ac.~.~9.n #.2.994..' .......
The certificate is issued to HARRY W. ARMSTRONG
(owner, I~sj(c~ ]~X~t~ X X
of the aforesaid building.
Suffolk County Department of Health Approval ...... .N/.~. ................................
UNDERWRITERS CERTIFICATE NO. N/A
Building Inspector
FO~ NO. 0
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)
N9 13998 Z
Permission is hereby granted to:
.~~.~....~..:....~ .....
G.~.,~......, ~, ~.. j f ~ .~.Y... ,
............................. ............ .........
at premises located at ..:J..(..~. ............... .~=~.~.....I....~..~,.. ................. .L~.~...~./~.. ........ .~, ........
County Tax Map No. 1000 Section .....(~...~.~ ....... Block ......... ..~ ......... Lot No ......... ~...~.. ........
pursuant to application dated ...... ~...~;;~."~. ........................ , 19..~...~., and approved by the
Building Inspector.
Fee $.~....~...!..~..
Building Irtspector
Rev. 6/30/80
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 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 p~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.Oo $5.00
New Building .... ..~.. ..... Old or Pre-existing Building ..
Location of Property ....... ......
$15.00
Date .........................
.......... Vacant Land .............
'"' ...... .......
House No. Street
Owner or Owners of Property ..... .~...?' .... ~~ .......... ;~ ...........
County Tax Map No. 1000 Section ... :-. .......... Block ............... Lot...~,'. ...........
Subdivision ................................. 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 permi, t~mee~ all applicab!e c~des and regulations.
Applicant ,~
Rev. 10-10-78
F~ELD~%NSPECTION
COMMENTS
FOUNDATION (1st)
FOUNDATION
2.
(2nd)
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
ODE
FINAL
ADDITIONAL COMMENTS:
~FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
,~OUTHOLD, N.Y. 11971
TEL.: 765-1803
Approved ...' .a?t.~,e4.. ~ .... , 19. ~. ee~it No..1.~.~ .x.~ ~
/
~Disapproved a/~
.................................
f ~ ~ ~Og Y (Building Inspector)
BL,,G. DEPT.
TO\"J~'q OF SOUTHOLD
Received ........... ,19.. ·
Date ~.~..~/. ?../ ..... 19~5. ..
INSTRUCTIONS
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 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 ~ 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, Ordinti~ ces or
Regulations, for the construction of buildings, addmons or alterations, or for removal or demolmon, as here~n described.
The applicant agrees to comply with all applicable laws, ordinances, building code,rhox~ing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary ins~( ~ kj,~-
(Si~]~u'r~'~f~l~'~nt, or name, if a co poration) ,~
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
;2~'o;2;nerofpremises H~ (4~.~''~dj' ~lV(~0"~ '~';~/'~'~ ...........
(as on the tax roil 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. i000 Section '~ '~ Block .................. Lot.../~
Subdivision...~...~..~..~ ............... Filed Map No ............... Lot...~..~ ..........
(Name)
2. State existing use and ~ccupancy ~f premises and intended use and ~ccupancy ~f pr~p~sed c~nstructi~n:
a. Existinguse and occupancy' ' '~'~~' "'2~/
b. Intended use and occupancy~..~~.. )~4.~x.. ' ....... i .~.'~ ]iii i i i i i i i
6f 0~k ( h *ppli )
3. Nature w check whic cable: New Building ..... ' ..... Addition .......... Alteration ..........
Repair .... ~Rernoval ..............
4. Estimated Cost..
5. If dwelling, number of dwelling units ..............
Demolition
Other
Work
,~ (Description)
Fee ........................
~ (to be paid on filing this application)
Number of dwelling units on each floor ...............
If garage, number Of cars '
6. If business, commercial or mixled occupancy, specify nature and extent of each type of use ....................
7 D'mensionsofexist'ngstructu!es if any: Front Rear Depth
Height Nu'mber of Stories
Dimensions of same structure With alterations or additions: Front ................. Rear ..................
pth i 'ght be fSt ri
De ..................... Hel ...................... Num ro o es ....................
8. Dimensions of entire new construction: Front ............... Rear ............... Depth ..............
Height ............... Nulmber of Stories .......................................................
9. Sizeoflot: Front ......... i ............ Rear ...................... Depth .....................
10. Date of Purchase ......... i ................... Name of Former Owner ............................
II di 'bp' ' ' d
· Zone or use strict in whm remlses are situate ........
12. Does proposed construction vi01ate 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 .
Name of Architect ........
Name of Contractor .......
.................. Address ................... Phone No ................
.................. Address ................... Phone No ................
.................. Address .................... Phone No ................
PLOT DIAGRAM
Locate clearly and distinctly all
property lines. Give street and bloc
interior or corner lot.
buildings, whether existing or proposed, and. indicate all set-back dimensions fiom
number or description according to deed, and show street names and indicate whether
STATE OF NEW YORK, 'S.S
COUNTY OF .................
............................ ..................... 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 dtfly authorized to perform or have performed the said work and to make and 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 in the manngr set forth in the application filed therewith.
Sworn to before me this
'"'"" H[L[N K, DE '00[ ' i .........
NOTARY PUBLI~. State ot ,N. eu. o~k 1 c