HomeMy WebLinkAbout19183-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-19309
Date AUGUST 21~ 1990
THIS CERTIFIES that the building
Location of Property CRESCENT AVENUE
House No.
County Tax Map No. 1000 Section 6
subdivision
ADDITION
Block 6
Filed Map No.
FISHERS ISLAND~ N.Y.
Street Hamlet
Lot 11
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated OULY 2~ 1990 pursuant to which
Building Permit No. 19183-Z dated JULY 11~ 1990
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 HANDICAP RAMP TO EXISTING BUILDING
The certificate is issued to
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
AMERICAN LEGION POST #1045
Building I~s~ec~or -
Rev. 1/81
~vO~3~ NO. ~
TOWN OF $O~THOLD
BUILDING DEPARTMENT
TOWN HALL
SOIJTHOLD, N. Y.
BUILDING PEIU~IT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Permission is hereby granted to:
~..~.~..~..~..~..~~
..... ~..~~....~ ............ ~ ...................
~o ............ ~ ....... =~...~.....~..: .....
at premises I~ated at ...... ~..~ ....... ~ ......................................................
......................................... /~.~.~~ ...................................................
County' Tox Mop No. 1000 Section ...~....~.. .......... Block ....... ~....~. ..... Lot No ........ l..~. ..........
pursuant to application doted ......... ~ ...... ~ ........ 19.~..~,., and approved by the
Building Inspector.
Fee $.../...~..~,.~.~.
Building Inspector
Rev. 6/30/80
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NEW YORK
765 - 1802
11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
NEW CONSTRUCTION ....... OLD OR PRE-EXISTING BUILDING ...... VACANT LAND ........
Location of Property ............ ; .,
HOUSE NO. STREET HAMLET
Owner or Owners of Property ................. ~''' . .... ~ ..... . .....
County Tax Map No. lO00 Section . ~.. Block ..~ ~.. Lot' . //
Subdivision ....................... Filed Map ........ Lot ..........
Health Dept. Approval .................. Underwriters Approval
Planning Board Approval ................
Request for Temporary Certificate ....... Final Certificate ................
Fee Submitted: $ ~.~.-~. ..............
APPLICANT .... .
rev. J 0/1.4/88
Co&
'er. 10/]4/88
FORM NO. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN l tALL
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY INSTRUCTIONS
"This application must bei filed in typewriter OR ink and submitted to the Building
Inspector with the following; for new buildings or new use:
]. Final survey of property with accurate location of all buildings, property lines,
streets, and unusual natural or topographic features.
2. Final approval of Heaitb Dept. of water supply and sewerage-disposal(S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from ~lumber certifying that solder used in system contains less
than .2/10 of IZ lead. I
5. Commercial buildings, ]industrial buildings, multiple residences and similar.
buildings and installations, a certificate of code compliance from the Architect
or Engineer responsible for the building.
6. Submit Planning Board !Approval of completed site plan requirements.
For existing buildings (P~rlor to April 9, 1957~ non-conforming uses, or buildings
and "pre-existing" land dses:
I. Accurate survey of property show~ng all property lines, Streets, buildings and
unusual natural or toplographic features.
2. A properly completed ppl~cat~on, a consent to inspect signed by the applicant
and a certified abstralct of title issued by a title company which shall
show single and separalte ownership of the entire lot prior to April 9, 1957.
. If a Certificate of Occupancy is denied, the Buildin Inspector shall state the
!o . g
reasons therefor in wr.mtlng to the applicant.
3. Date of any housing co~e or safety inspection of buildings or premises, or other
pertinent information ~equired to prepare a certificate.
For Vacant Laed Certificate of Occupancy:
I. An application for vacant land Certificate of Occupancy shall be submitted,
and a certified abstract of title issued by a title company showing single and
separate ownership of ~he entire lot prior to April 9, 1957 shall also accompany
the application. If ai Certificate of Occupancy is denied, the Building Inspector
shall state the reason~ therefor in writing to the applicant.
FEES:
1. CERTIFICATE OF OCCUPANCY - New Dwelling $25.00, Additions to Dwelling $25.00,
Alteration to Dwelling $25.00, Swimming Pool, $25.00. Accessory building $25.00
Addition to Accessory buildings, $25.00 -Businesses $50.00.
2. Certificate of ccupancy on pre-existing dwelling - $1~0.00.
O '
3. Copy of Certificat~ of Occupancy - $5.00 - over $ years - $~0.00
4. Vacant Land Certif{cate of Occupancy - $20.00
~. Updated Certiflcat of Occupancy - $50.00
6. Temporary Certific. te of Occupancy - $25.00 Residential
$50.0~ Commercial
FIELD l ....
FOUNDATION
FOUNDATION
ROUGH FRAME &
INSULATION
(1st)
(2nd)
.PLUMBING
PER N. Y.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS
'FORM NO. 1
TOW'~ OF SOUTHOLD
BU I L'D. ING DEPARTMENT
TOWN HALL
$OUTHOLD, N.Y. 11971
;: TEL.; 765-1802
Ex;~ined~ ./j.., 19 ~.~
,,pprove. , . l ! .... i x/. Pc=it No.
Disappr6~ed a/cF'J. ....................................
BOARD OF HEALTH ......
3 SETS OF PLANS .......
SURVEY ..........
CHECK ..........
SEPTIC FORM ............. :
NOTIFY
CALL ;d: ..............
MAIL
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
a. This application must be completely filled in by type~vriter or in ink and submitted to the Building I~'spectt~r, 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 dcta/led description of layout of property must be drawn on the diagram which is part of this appli-
cation.
¢. 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 Buitding Permit ursuant to th
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other anplicable wsP. Ordin c s e
Regdlations. for the construction of buildin-s, additions or a terntinn~ ,~ o, ...... ' ~ ~ C · .... ,La_ , an e or
The apphcant agrees to comply w~th all applicable laxvs, ordinances, building coda' }~:~i~g~-~;~g ~n-~eas~.r~'} descnb, ed.
admit authorized inspectors on premises and in building for necessary inspections ..
S'- .... '" '~ td ;,, .............. -.
( ~=nature of applia~a~l;,or,,~gm, e, ifa corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
· ...........................
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
title of corporate officer) ·
ALL CO~!TRACTOR'S MUS~ BE SUFFOLK COUNTY LICENSED
Builder s License No ....... .~./.r..~.-~ ..........
., ·
Plumb.r s L~cense No. '
Elcctr c an s L No.
' ' icense
, ·
Other Trade s Lmense No .................
1. Location of land on which proposed work will be done] '
fi;;-i ......................... . ......... : ...........
b St .......
s um er feet Hamlet ...............
County Tax Map No. lOOOSection ...~ ........... Block ................ Lot ...............
Subdivision..
................................... Filed Map No.
Lot '
(Nmne) .............. · ...........
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing Use and occupancy .... ~. ~.~
b.l"icndeduscandoccupancy .... ~~ ~~---~i' -- ' ~'- - '
.............
$. Nature of work (check which a cable: New Building .......... Addition .......... Alteration
Repair .............. Rem~oval ........... Demolition ............ Other Work .........
4. Estimated Cost ..... ~ ~ (Desc o
~ ~ (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 c~ ............
6. lfbusiness, commercialor ' ~ r ea '
7. Dimensions of existin, st~ctt r~ ;r
He ~t ............... Number of Stories ... ' .......
D~ensions of same structure with alterations or additions: Front ........
De ...... . , ................. Rear ..........
· · i~t ' ·
............ ~. He ....... Number of Stories ...............
8. D~ensions of entire new coast etlon: Front .....
He ...... ; ........ NumberofStofies . ·
9. Size of lot: Front ........... ~ ...... Rear ....... Depth
....... = ............. Name '
1, Zone or use district in which prdmises are situated ............... ·
4. x~ ..... '2 · · .~ .... . ..... wut excess fill be removed
tame o; uwner oLprem~ses~~/~. Address ~.~.~... Phone No..ff~% ~ ....
N~e of Architect .... , .... .v ..... j ........... Address
N~e of Contraclor , '~~ Address Phone No ............
5. Ia chis prdper~y located within 300 feeg of a gida% we:land? *Yes ..... No .....
· If yes~ Southold To~ Trustees Pemit may be required. ..
.. ~ PLOT'DIAG~M
Locate cle~ly ~d distinctly ~1 ~buHdmgs, whether existing or proposed, and. indlcate MI set-back d~ensions from
rope~y Hnes. Give street ~d block number or deschption accord~g to deed, ~d show street n~es and indicate whether
Itefior or comer lot.
OCCUPANCY OR
USE IS UNLAW LJL
W THotrr CERTIRCATE
OF OCCUPANCY
7ATE OF NEW YORK,
3UNTY OF S.S
.... t'' ' '('.~ ................... ~ ........ j .......... being dui}' sworn, deposes and says that he is the appli t
amc of individual sienin contract can
ore named. '
: is the .......................
~ (Contractor agent corporate officer )
said owner or owners, and is duly ~uthorized to perform or have performed the said work and to make and file this
.~lication: that all statements contained in this application are true to the beat of his knowledge and belief; and that the
'ri: will be performed in the re:tuner sit forth in the application filed therewith.
'om to before ,ne this I "
NOTARY PUBLIC, Stale of New
. No. 47078'18 Suffolk C~/
~erm £xp res I~rch ~0,
II;
, i
II
ko~lFy BUILDING DEPARTMEN~ AT
,' FOUNpAT~ON,. ~OI REOUI~ED
[ ~OMPLE rE FOR C.O ~ /
THE ~EQU, ~ENTSl OF/~= N.Y. I
S~ATE CqN RUCTIQN &
DES. NC RESPONS~BL~ FOR,
OR iNS~RU~ON RS
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