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Home My WebLink About14022-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z15442 Date December, 2, 86 .......................................... 19 ... THIS CERTIFIES that the building deck addition Location of Property 1065 Hyatt Road Southold, N.Y. House No. Street Ham/et County Tax Map No.]OOOSection ..0..~.0 ....... Block .............01 ..Lot........1 ..~.-.. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated Pi..a y..3. l, ............. ,1,9 .~.5. pursuant to which Building Permit No....~ .~.0.~..2..Z. .......... dated . ~..u.n.q. 7 ~ ................... 19 .g.~., 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 ......... Deck addition to existing one family dwelling The certificate is issued toBONNIE BAUMAN ..................... x x ................... of the aforesaid building. ffolkC tyD fH lthApp ~ N/A Su oun epartment o ea royal ...... UNDERWRITERS CERTIFICATE NO ..................... N./..A .......................... Rev. 1/81 Building Inspector FO~ NO. ~ TOWN OF $OUTHOLD BUILDING DEFAI~TMENT TOWN HALL SOUTHOLD, N. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) 14022 Z Permission is hereby granted to: ._j......~.>........-..~.~ ....... ] ................................. ..~..~....~.~.,....~.~].~ ............ ...... o, p,em,,, ,Jated a, .~..?....~..~......X.~...~...~]...~,~..:,....~O;~.....~..4. .................. County Tax Map No. 1000 Section .u....~.~ ..... Block ......... .~...~. ...... Lot No ........ ..~ .............. pursuant to application dated ......... ....~.,..~.....~....~ ................. , 19.~.~..., and oppr~ed by the Building Inspector. 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 [nstruotions 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 featu res. 2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approva~ 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.O. $5.00 5. Updated C.O. $15.00 New Cons % r uc t ion ...... Old or Pre-existing Building ............ Vacant Land ............. operty ~u~/.~N.o~. ~.. /'~S't~ '~''~' Location of Pr .............. Owner or Owners of Property County Tax Map No. 1000 Section ....~...~. ....... BIock...~. .......... 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~ermit meets all appl~le codes and regulations. Applicant .............. Rev. 10-10-78 F~ELD~NSi~ECTiON COMMENTS FOUNDATION FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ~,ODE ADDITIONAL COMMENTS: 7G5-~.802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ]FINAL A Ks, ~~ REM R ~ o~/ ~~ DA~ INSPECTOR <;.,~~ 'FORM NO, 1 TOWN or SOUT.OL, BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined...~..~ .~...., 19~.~7 V approvea .,.. ee it No. Disapproved a/~ .................................. '.. · ' ' (Building Inspector) APPLICATION FOR BUILDING PERMIT a. This application BLDG. DEP £, TOWN OF SOUTHOLD Received ........... ,19... INSTRUdTIONS T ., ' * must be completely fille{t in by typewriter'or in ink ahd 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 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 inserts. · ' (Signature of applicant, or name,~ a corpj~ration) r-x (Mailiog a{tdj~ of appljca~It} State whether applicant is owner, lessee, agent, architect, engineer, gen~~o~r, e~ectn/cia~Tp~un[b~r or builder. (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 ...................... I. L~cati~n~f~and~nwhichpr~p~sedw~rkwil~bed~ne....~..~~..~..~~..~~~..~..~-/ .............. ~'~'~e~' House Number Hamlet County Tax Map No. 1000 Section .... O.t~"O ...... Block ......... I ........ Lot ...... / ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises,and intended use anal occupancy of proposed construction: a. Existing use and occupancy ....... ~~.t.~_ .................................. b Intended use and occupancy r.~7~: ~ ~,:':z,~ ,~ 3. Natqre of work (check which applicable): New Building ' Addition ......... Alteration .......... RePair .............. Removal .............. Demolition .............. Other Work ............... 4. Estimated~.! t.'O.~.O.: ......... '- ~J(-~ ~ (Description) ' ~ ': (to be paid on filing this application) ' 5. If dwelling, number o f dwellihg units ............... Number of dwelling units on each floor ................ If garage, number of cars . .. i ......... .~ .......................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ...................... 7. Dimensions of existing structures, if any Front....~.0 ......... Rear ...6.~) ........ Depth..~/?. .......... Height ..... /~).¢ ....... Number of Stories ...... / ................................................. Dimensions of sar~e~tructure iwith alterations or additions: Front ................. Rear .................. Depth ........ ~,~.. ~. ..... .... Height .......... ._..o .... ; .....Number of Stories ............... . ....... 8. Dimensions oLen~re, new construction: Front ....... .~..' ..... Rear .... /.~. s. ........Depth ....~-O..' ........ Height .... ~.",O.: ..... Number of Stories ............. ~ ........................................... 9. S~ize of lot: Front.. ~o,._.(.~002. ¥'.a'- ...... Rear ......... .~.~ ....... ;.. Depth ... ~,~ ~...o .......... 10. tJateofPurchase ..[(tO.~...~.~Y'. ............ Name of Former Owner ...l~tzo.~O~-~..~g.~t~n,o ....... 1 1. Zone or use district in which Premises are situated ......... ~-.~-4,~t, dl~ .......................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...!.~.~.' ........................ 1 3. Will lo~ be regraded ...... .~O.... ""' ............ Will excess fill be removed~fmm premises' Yes 14. Name of Owner of premises ~*.,o~4'~l:rl~t..~.a~.~'~dress 10~'M~,a~ ~1~, ~'h ,, '7.~,- .~ l(~-tL~.~..~.~t~. ~._~. ....... *.,.~[.,~ ..... .~..1~ onel'qo..~.~.~ ..... Name of' Architect .... ~ · ~t~"0~.~. ·X- ..... Address . . . ~.~. Phone No ..... .:. .......... Name of Contractor...~~ .~. .... Address..~.lle.J~~. Phone No..'~.6 ~.. k~k b.J~t ~e~, PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and~ indicate all set-back dimensions from property lines. Gwe street and block number or description according to deed, and show street names and indicate whether interior o~ corner lot. STATE OF NEW/YOtRzK,' , i S.S COUNTY OF 20d, c.g~ace, M~/ .... ' ....~..~.~ .Q ~. '.~ .( .~.. ~t'D~O. q ..................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the EyOJA/~/?._ . ' (Contractor, agent, corporate'officer, etc.) of said owner or owners, and is d¢ly authorized to perform or have performed the said work and to make and file this application; that all statements coata[ned in this application am true to the best of his knowledge and belief; and that the work will be performed in the manner ~et forth in the application filed'therewith. Sworn to before me this ....... , ................ u y 9~ ..... /,/.. ......... ,19 ..... ~ ,/.~/ ~/ /] Nptary Public ..... ~ ............... , County I ' 8o. 41~a11~, ~u~ ~,,~/ (Signature of applicant) Term F, xpIr. I~reh 30, 1~ '3