HomeMy WebLinkAbout13722-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Buildin§ Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
THIS CERTIFIES that the building ...... .~.1.~..~..r.a?.J:9 .n ..............................
Location of Property 1835 Mill Creek Dr. Southold
County Tax Map No. 1000 Section . . 0 ~.1 ....... Block ....0.6 .......... Lot . . .0 .3.3 ............
Subdivision ........... .x ................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Bnilding Permit heretofore filed in this office dated
..... F..e..17.. .... .1.9 ....... 19.8..5pursuant to which Building Permit No ..... ..........
dated ........ .M.a.r. qh. ..... .5 ........ 19.8.5., was issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupaucy for which this certificate is issued is .........
..... R..e.mg.v.e...i.n.t.e.r..ip.r.. p.a.r.t.i..t.i.o.n,, .a.n.d.. i..n.s.e.r..t, p,a.t. $9..d. qg.r.s' ,i..n..a.n...e.x.i.s.t. ~..n.g
one family dwelling.
The certificate is issued to MULLEN, RICHARD
(owner, I,~see. oe-~erren.t)
of the aforesaid building.
Suffolk County Department of Health Approval .......... .N/.~. ............................
UNDERWRITERS CERTIFICATE NO ................ N/A
Building Inspector
Rev. 1/81
1~01~ NO. :~
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)
13722 Z
County Tox Map No. 1000 Section ..... ~ ......~ .......Block ...... ..~....~. ....... Lot No ...... ..'~..~ .........
..~.~~ ...... !.~ ............... , 19~..~.~.., ond approved by the
pursuant
to
application
doted
Building Inspector.
Fee $ .......................
Building Irkspector
Rev. 6/30/80
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
,~outhold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
Ao
This application must be filled in typewriter OR ink, and submitte~,l[cct= 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 peoperty showing all property {ines, streets, buildings and unusua~ 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 requ ired to prepare a certificate,
Fees:
1. Certificate of occupancy $5.00 /
2. Certificate of occupancy on pre-existing dwelling/ land
3. Copy of certificate of occupancy $1.00
use--Pre-Existing C.O. $15.00
Vacant land C,O, $ 5.00
Date.. ,~, -,~. ~, .~.~, ,.-~7 ..........
New Building ............. Old or Pre-existing Building ... X. ...... Vacant Land .............
Location of Property., ,/.~,, ,~, ,~,. ~...~,~,~. · ,~. ' ' '~¢~'~ .... .~, · ?,~; · ,~, · ~ .¢~.. .........
House No. Street Ham/et
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 ~,. ~.~., .~.~?..z~?.,.~; ,~., ,~.
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .... /~ ................
Fee Submitted $...-~, · 7-;- ....................
Con struction 0 n above described bu lid lng and perm it meets all applicable codes a nd regu lations.
~P~C~-~(~- Applicant.~,~..~,,.~,.~.~,,~,,~.~.~ ' .,~.~
Rev, 10-10-78
F'I ELD INS~'ECTION
FOUNDATION (1st)
COMMENTS
FOUNDATION
2.
ROUGH FRAME &
PLUMBING
(2nd)
INSULATION PER N.
STATE ENERGY
%ODE
FINAL
ADDITIONAL COMME, NTS:
FORM NO, 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL,: 765-180:3
Examined . .~ .0~. & ·~· ....
Approved ......... .~ .....19 $?. Permit No. 1 .~..~..D': .~"..-~.
Disapproved a/c .....................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
BLDG. DEFT.
TOWN gF SOUTHOLD=,.,~
Received .......... ,19. · ·
INSTRUCTIONS
a. Tkis 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, building code, housing code, and regtflations, and to
admit authorized inspectors on premises and in building for necessary in~e~ctions.
..... ~.,:~/, ~,://...,,.,.~. Z~. ~..~, ............
(Signature of applicant, or name, if a corporation)
..... 5.~./? ..... ~?. ~.~r~. s~.~rvf . .~.. ~. . /(.?. ff . .
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.... ~?~.~ ~. ~/... ¢~':~ .~../r.~.~../~.~. .............................................................
Name of owner bf pre~nises, f~ ~ .~.~ Y..~. ~.~..~. ~ ((.~.~.. ?.7.'~. ..........................................
(as on the tax roll or latest deed)
If applicant is a cor¢oration, signat~regf 0uly authorized officer.
:'~ ~
..
(Name and title of corporate officery
Builder's License No .... ~..?'. ...............
Plumber's License No.....fi/..c~/? ...............
Electrician's License No...~...~g..]~..../~. ~Q .~/.'..~. ~ ~ ~4 .Y'
Other Trade's License No.../l,~..o.-.~..~: .............
1. Location of land on which proposed work will be done. · .~/.~.>.' .~. '.~.~l/..~: ".r.~.~./(.(..~).2~.~..C...~.'o.~?..~j/(.o..~.~.. .....
..... ~ .~..~ .~.. ........... ~,/./.c~:.:-/.. ~. ~. ............... & ~.:~& ./.~ ...................
House Number Street Hamlet.
County Tax Map No. 1000 Section .......... .~..~. !... Block ........... ..(~..~.... Lot ........ .~.~. ........
Subdivision ..................................... Filed Map No ............... Lot .............
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ..... ~.~ .~.. . ~.t.~'. .................................................
b. Intended use and occupancy ..... dt, o .... ~..~ .~ ..................................................
3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ..........
Repair .............. Remloval .............. Demolition .............. Other Work ...............
[imat~c t/.~, 20<53 !i (Description)
4 Es os Fee ...................................
(to be paid on filing this application)
5. If d-~/elling, number of dwellingl units ............. Number of dwelling units on each floor .............
If garage number of cars ~ -~
6. If business, commercial or mixed occupancy, spec/fy nature and extent of each type of use T;.: .................
7. Dimensions of existing structures, if any: Front... ~. .......... Rear .............. Depth.. i ............
Height ............... Number of Stories ........................................................ -
Dimensions of same structure with alterations or additions: Front . .~.62 .~.t. ~. ....... Rear ..................
Depth~ ' Height Number of St Ties
8. Dimensions of entire new construction: Front ......... , ..... Rear ............... Depth ...............
Height ............... Number of Stories ........................ ,, ...........
9. Sizeoflot Front...7.5':..: ............ Rear..iil].'~i/iiiiiiiiiiill Depth ..................... ~. 5't:9
10. Date of Purchase . .-VY. ..... ' ......... ..~Name of Fora)er Ow/ncr -- . .
11. Zone or use district in which prlemisesare situated...ZF.¢.~t..o'.~d, gj.o~. :.... i:iiiiiii, i. iiiiiiiiiiiiiiiii
12. Does proposed constr~n violate any zoning law, ordinance or regulation: . ~ ..........................
13. Will lot be regraded ...c)?. "~ !.y.. '/7~; ' ~ ........ Will excess fill be removed from premises: Yes No
I4. Name of Owner ofpremises/Dc, d4,¥¢./. ~.t'/~O Address Phone No .
Name of Architect ........ , .................. Address ................... Phone No ................
Name of Contractor .~. ~.C~./~el ¢. ~¢..~.).*t~...~W.'.. Address .............. Phone No./-,/,~.2 .o. ~.q'...~.....
Locate clearly and distinctly all
property hnes. Give sllreet and block
interior or corner lot.
PLOT DIAGRAM
buildings, whether existing or proposed, and, indicate all set-back dimensions from
number or description according to deed, and show street names and indicate whether
STATE OF NEW YORK,
AT?Y C~q-'D AS ~OT~D
DATE:
765-1802 9 AM TO 4 PM FOR THE
FOLLOWING INTPEC'I'IONS:
1. FOtJbF'z'~~ ION - TWO REQUIRED
FOR [?'qJP. ZD CONCRETE
2. ROUGH .. ~RAMING & PLUMBING
4. FINAl -. C~N.'?FPU~'dqN MUST
COUNTY OF ................. S.S ALL COk?','f)! 'r'?'!ON SI-!AI,.L MEET
............................. .................... heing du,
(Name of individual sign~ing contract)
above named. CODES. N~.T RESPONS~BI F ~R
He is the '
(Contractor, agent, corporate officer, etc.)
of said owner or owners, ~d is duly authorized to perform or have perfo~ed the said work and to m~e and file fills
application; that all statements contained ~ this application are true to the best of his ~owledge and belief; and that the
work will be performed in the m~ner set forth in the application filed therewith.
Sworn to before me this ~
.............. [ ...... day o ................... 19
' ":.' ' ' .... ,
N01tJW PUi~I lC ~gl~te o New York ................. [ ..........
N~ 410787/t Suff011~ C,nmt~ (Signature of applicant)
l~t,l* gxOo'os March 30 19.~