HomeMy WebLinkAbout13715-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. Zq 3599 Date July 8 19~.5.
THIS CERTIFIES that the building deck addition.
Location of Property 965 Osprey Nest Road Greenport
hJ~s'o ~'oi ....................... 's't/e$i ....................... h$r~iei
County Tax Map No. 1000 Section 35 .Block 6 . .Lot 2~. fl
... Cleaves Point
Subdivision ............................... Filed Map No. 2752 .Lot No. ~lZ~ & ~ 5
conforms substantially to the Application for Building Permit heretofore filed in this office dated
February q 5 19 ~.~. pursuant to which Building Permit No... q 37q 5Z
dated march ~ 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 .........
Deck addition to an existing dwelling.
BILL & SILKE FRANKEN
The certificate is issued to ..................... ~o~n'e'r,'~ .....................
of the aforesaid building.
Suffolk County Department of Health Approval ............... ~../..~ ........................
UNDERWRITERS CERTIFICATE NO ..................................................
Building Inspector
Rev, 1/81
FOBM NO. ~1
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
fTHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Date '
~_ ~37~s z ..~.~.../... ............................ ,,..Z.~
.................................................................. ......... .......................
County Tax Map No. 1000 Section .:,~.~....~.......:.~B_lock ....~...~... .......... Lot No.
,ursuant to o~licatio, dated ...~.../~ ....................... , 19.~nd oppr~ by tNe
Buildlr~g Inspector.
F. ~...~o....~.
Rev. 6/30/80
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
BLDG. ·
TOWN OF SOUTHOLD
A, This application must be filled in typewriter OR ink, and submitted ~ ~ to the Building Inspec-
tot 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 property showing all property lines, streets, buildings and unusual natural or
topographic 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 a certificate.
C, Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling $15.0 0
3. Copy of certificate of occupancy $1.00
4. Vacant Land C.O. $5.00
Date ......................
New Building ............ Old or Pre-existing Building ............ Vacant Land .............
Location of Property .................. ~.'~.~.""~ .........................
House No. Street Hamlet
Owner or Owners of Property ~ '~ Z~' ~' ....
C nt TaxMa No lO00Section ¢3~. Bock g Lot ~// .
ou y P ' . ~, .........................................
Subdivision ~.¢¢~ ¢~ ~, ~: :,:' r ..... F ed Map 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 bu ding and per, rf~t ,,mee,ts~ppEc,~i'~'~:o-~es and regulations.
¢ ~'~'~ \ - Applicant .... .~..t~::~,, ~¢¢.~::~,: ~::~.:_~. ..... .....................
FIELD INSPECTION CGMMENTS
FOUNDATION .~ (1st)
FOUNDATION
2.
(2nd)
ROUGH FRAME &
PLUMBING
3. ,j)
INSULATION PER N. Y.
STATE ENERGY
qOSE
FINAL
ADDITIONAL COMMENTS:
'FORM NO. 1
TOWN OF SOUTNOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
Received ........... ,]9.. ·
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date .................. , iD...
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 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, build~g~fode, housing co~_e~and ~eg~lons, and to
admit authorized inspectors on premises and in building for necessary insp~j~fs. ~ ..~. / ~/
..... : .::m. . "/. ............
(Signature of applicant, or name, if a corporation)
7.:/.. :.'. ?.. :...
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises . . .
(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 ......................
House Number Street Hamlet
County Tax Map No. 1000 Section ....~..Y ........... Block . .~. ............... Lot. :'~..~...': ./.~. Y ......
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
3. Nature of work (check whicl~"4
~icable): New Building ..... ' ..... Addition .~.Z~.'~ ./'~. · . Alteration ..........
~al .............. Demolition ............ Other Work ...............
·, ~ -- ~ (Description)
4. Estimated Cost ....... /.~.~ ,,. ¢..D. .................. Fee ....................................
~" 4, (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 mixqd occupancy, specify nature and extent of each type of use .....................
7. Dimensions of existing structures, if any Front ~1 ~ . Rear . ~ / ...... Depth
Height Number of Sto~es g.~ ................. ~ ....... "
D~ensions of same structure with alterations or additions: Front .. ~ ............ Rear . ~ / .
~ ~ · ~ "~ .............
Depth.. ~ .............. ~... Hmght .... ~ ............. Number of Stories ..... [.~ .........
8, Dimensions of entire new construction: Front ............... Rear ............... Depth ...............
Height ............... Number of Stories ........................................................
9. Size of lot: Front .......... ~ ............ Rear ...................... Depth ......................
10. Date of Purchase .......... : ................... Name of Foyer Owner .............................
I I, Zone or use district in which premises are situated
12. Does proposed construction viOlate any zoning law, ordinance or reeulation.
13. Will lot be regraded ..... ~.~ ........ ~ .... ,.; ....Wall excess fill be removed from premises: Yes
14. Nme of Owner of premises ~(~/~[~ .~,f. Address .... Phone No.
~t ..... ~ ~. :.~ ............... Address~W6~g 2~ fg~aZ Phone No ................
N~e of Contractor ... 3'~C ............ Address ....~ ........ Phone No...5~ ......
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and~ indicate all set-back dimensions from
property Iines. Give street and blocl/number or description according to deed, and show street names and indicate whether
interior or corner lot.
STATE OF NEW YORK,
COUNTY OF .................
S.S
: g d ly ppli
................................................. bein u sworn, deposes and says that he is the a cant
(Name of individual sig~ing contract)
above named.
He is the ..................... i ...................................................................
i (Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duiy authorized to perform or have performed the said work and to make and file this
applicationi 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 mannqr set forth in the application filed therewith.
Sworn to before me this
[ ' Term [xDires Matcll 30, 't,c~ / (Signature of applicant)
DATE:
FEE:
NOTIFY
765-1802 9 TO 4 PM FOR THE
FoLLDWING IF
1. FoUNr~A-qC - TWO REQUIRED
FOR cONCRETE
2. ROUGH - '~ING & pLUMBING
3. INSULA~rl CON'SI-,qUCTION MuST
4. FINAL -
BE COMPI ETE FOR C. O,
ALL CONSTRUCTION SHALL MEET
THE REQLIlREMENTS OF THE N.Y.
STATE CONSTRkJCTION & ENERGY
CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS.
PRINTED ON g20H CHARPRINT VELLUM
.................. cCI'O"
FW:h >71<£1~I l-loun £-
1/0~ APP"OVED BY
DATE:
DRAWING NUMBER
~ CHARRETTE PRO-FORM 920PF PRINTED ON g20H CHARPRINT VELLUM