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HomeMy WebLinkAbout13728-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z13245 Date ..... March 6 ............................................. 19...85 THIS CERTIFIES that the building Addition Location of Property . .1.6. 9 ................. .S.u.n.n.y.s.i.d.e...R.d... ......... .S. qu. ~.h.o.~.d.... ~. House No. Street Ham/et County Tax Map No. 1000 Section . . .0.6..3 ...... Block . . .0.1. .......... Lot 007 Subdivision ........ X Filed Map No. .Lot No. conforms substantially to the Application for Building Permit heretofore fried in this office dated .... .M.a.~.c..h .... 6. ...... ,19 .8.5. pursuant to which Building Permit No.. 13728 Z dated ...~.a.r.c.h. ................6 .... 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 ......... Deck Addition To Exis%ing Dwelling The certificate is issued to ...... GRAT?AN, KEVIN (owner, lessee-er--tene~O of the aforesaid building. Suffolk County Department of Health Approval ................ 5J../.~ ....................... UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 · OBM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, No Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 13728 Z Date ...... ~ ........................................ , .. . Permission is hereby granted to: ...... ...................... ........ ........... ....... .~~L,.~. ........................................ ,o ......... .,.~~.u~ ....... .~.....~..~..'~......~.....~.....~..: ........... ........... L~ ............................. '~ ...................................... at prem,ses located at.....~..... ~~~ ~ County Tax Map No. 10'00 Section ...... .~..~......~... ..... Block ......~.1 ........... Lot No...~.~.. .......... pursuant to application dated ....... ~.....~ ............... , 19~"'~, and approved by the Building Inspector. Building Inspector 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 featu res. 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 featu res. 2. Sworn statement of owner or previous owner as to use, occupancy and cqndition 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 $ 3_ 5.0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 Date...~.'a~.c~..~, .~.....'~.. New Building ..."~. ........ Old or Pre-existing Building ............ Vacant Land ............. Location of Property . I.(P..q ........ ~..~.~..~.~ 5.~,¢,~,/'~..~. ..... ..,....................... House No. Street Ham/et Owner or Owners of Property .... [ .... , ............................. County Tax Map No. 1000 Section ...~'.~, ......... Block .... 1 .......... Lot....~ ........... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date ~f Permit,~,~,~), .......... Applicant. , ~.~,'~..~ .~..~j.. ! .~:.: , . .~..r;¢'~.~..~..~..~. Health Dept. Approval .... .,;~,~; ~ ............... Labor Dept. Approval .................... Underwriters Approval ..... ~.l~ ............... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ... ~ ............... Fee Submitted ............................. Construction on above described building and permit meets all applicable codes and regulations. . ..... ~ Applicant ..................... FIELD INSI~ECTION FOUNDATION (1st) COMMENTS FOUNDATION 2. (2nd) ROUGH FRAME & FLUMBING INSULATION ?ER N. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS: Approved . .~..~....~... 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N,Y. 11971 TEL.: 765-1803 193 Permit No ............ I NAR - 6 1985 BLDG, [3EPT. TOWN OF SOUTHOLD Received ........... ,~9... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT IN STRUCTION S 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, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessaw inspections, x,~.~ '"i~i~]idr'e'~appli~' 'j ,' P ' ) .B.?.~. fin. ~..6. ~¥.~.~.g~,~ .~.&..,., ~:~ .~-.~..~.& .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner ofpretnises .... .~...~. ~.~. ?.....~.. ~....~..~..~.~.~.t~..v~. ..................................... (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 ...................... 1. Location of land on which proposed work will be done .................................................. .. .................. House Number Street Hamlet 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 ....................................... b. Intended use and occupancy ..... . .~...~....~. .... C~(~.~. .................................... 3. Nature of work (check which qpplicable): New Building ..... * ..... Addition .....~.... Alteration ..., ~ ..... Repair .............. Removal .............. Demolition .............. Other Work. ~)..~..~.~-~'..,.. .0.0 (Description) 4. Estimated Cost ........ : .................. Fee ...................................... ~' (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 If .... business, commercial or mlxed~ occupancy,, specifyl~j~'~nature and extent of each type of use ....... ...~..; ......... 7. Dimensions of existing structures, if any: Front .......... Rear .............. Depth ........... Height Number of Stories Dimensions of same structure With alterations or additions: Front ................. Rear .................. Depth ~ Height ...................... Number of Stories ...... 8. Dimensions of enhre new conslruct~on Front ............... Rear ............... Depth ............... Height ............. Number of Stories ....................................... ;. ............... 9. Sizeoflot: Front ....(e.l?./. ! ............ Rear ...................... Depth . .~.'i ................ 10. Date of Purchase .. ?.-./.~. '. ??. .................. Name of Former Owner .. ~J0 .c.,...~)'~r.~..~. ........... 11 Zone or use district in which p'remises are situated 12. Does proposed construction viglate any zoning law, ordinance or regulation: ............................... 13. Will lot be regraded ....... !...: ................ Will excess fill be removed from premises: Yes 14. Name of Owner of premises .~'.~.~..~.~?..~.f~ Address .~.?.~.~.q .S2.~-.~. .O_..&. .... Phone No ?.a.~.~..,~. ?,.~. .... Name of Architect ' Address ............. Phone No ................ Name of Contractor ....... 2 .................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and bloc number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF .................. ' . ~t~-, .q.\ ~,d... ~..~....~ .rt~...~ ~. ............ being duly sworn, deposes and says that he is the applicant (Name of individual signing con~act) above named. (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is d~ly authorized to perform or have perfo~ed the said work and to m~e and file this application; that all statements coatained ~ this application are true to the best of his knowledge and belief; and that the work will be perfo~ed in the m~ger set fort~ in the application filed therewith. Sworn to before me this Nota~ Public,~. ~~ ............. County ~ __ .