Loading...
HomeMy WebLinkAbout17428-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPArtMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCBPANCY No Z17696 Date JANUARY 20~ 1989 THIS CERTIFIES that the buildin~ Location of Property 42205 C.R. #48 House No. County Tax Map No. 1000 Section 059 Subdivision ADDITION Block 03 Filed Map No. SOUTHOLD Street Hamlet Lot 25.1 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPT. 8r 1988 pursuant to which Building Permit No. 17428Z dated SEPT. 15, 1988 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 2nd STORY DORMER ON EXISTING ONE FAMILY DWELLING. The certificate is issued to JIM MOTT (owner, of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROYAL UNDERWRITERS CERTIFICATE NO. H007461 JAM. 17~ 1989 PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 Building Inspector F023~[ NO. ~ TOWH OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, hi. Y, BUILDING PERMIT CTHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 017428 Z Permission is hereby granted to: .~....~....~.~ .............. ~-~- :..i'~...~..~...~.~..~...o..'.......: .............................. ..~ ~..~..:V..:....!zt~.~...: .... , © ,~ .,..~~,.....~.....~.~_...:~...: ............ ~.~...:..; .......... ~ ............. . ~.t premises located at .....~.,..~'...'..~....°-.~.--.........~[......L~...~. ........ ~ ....................... County Tax Map No. lO00 Section ...... ..C:)...~....~ ...... Block ......... .C~)...~. .... Lot No ......~,.~.:...I ..... pursuant to application do,~ ...... ~ ~~ ............... ~ ............ , 19~.~.., and opprov~ by the Building Inspector. Fee $...~--~.:..~/ Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 - BLDG', DEPT. TOWN O~ $OU~HO~ APPLICATION FOR CERTiFiCATE OF OCCUPANCY Instructions A. 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 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-existng" 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: Additions $25.00 POOLS $25.00 ALTERATION $25.00 1. Certificate of occupancy New Dwelling $25.00, Accessory ,$10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.V~c~nt L~nc~ C.O. $ 20.00 5.'..~ ~. 5.Updated C.O. $ 50.00 Date .... '..~-~ ..l.~.~'.~... NewCons t-ruc t,ion... ... Old or Pre-existing Building ............ Vacant Land ............. Loca,,on of Property ..... ............................ ................. House No. Street Ham/et Owner or Owners of Property .. '~ ~ , . , County Tax Map No. 1000 Section .... ~..~. ~ ..... Block ..... ~..~. ...... Lot .... ~, .~.o. ! ..... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No.~.( .~..~.~. ~.."~Drate of Permit .~'-./.5-~-~/.Applicant . ~.~ ~.. J~. r~_~-T-~..r~ ~'/~;.lr~,v5 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 I~rmit meets all ~pl~ye codes and regulations. FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME & .PLUMBING (2nd) INSULATION PER N. Y. STATE ENERGY CODE FINAL IONA'L COMMENTS: 765-1802 BUILDING DEPT. [ ] FOUNDATION 1ST [ ] ROUGH PLBG. REMARKS: ] FOUNDATION 2ND [ ] INSULATION ]FRAMING [~i~AL i?¥~? 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [/.~SULATION FRAMING [ ] FINAL DATE ?/~'~'~/~ 'NSPECTOR~f~'~/ .~,~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ J F~NDATION 2ND [ ] INSULATION / [//]/FRAMING [ ] FINAL REMARKS: ~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1803 Disapproved a/c ..................................... (Buililing Inspector) APPLICATION FOR BUILDING PERIVIlT INSTRUCTIONS BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK ...................... SEPTIC FORM ................ NOTIFY CALL ..................... MAIL TO: a. Tkis application must be completely filled in by Wpewriter qr 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 ~emoval or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, hous!ng code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (S)gqature ot apphcant, or name, if a corporanon) .?: !! - · (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... .......................................................... Name of owner of premises ...~.l.~.. ~ P..~..~.' .......... ' ........................................... (as on the tax roll or latest deed) If app~ant ~ co_r~,~,nature of dui(authorized officer. .... ,, , ,~, a~m.e and title of corporate officer) B~lder's License No ..... .~.~.~.1~. [...~r.~[. ...... 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. I000 Section ....... .~. · .~ .......Block ~ Lot .... $2. ~", ~ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing ..... ,.,:~ · .: -~..., ... ;: ...................... 3. Nature of work (check which applicable): New Building ... ' . Addition ....... Alteration ...... ' Repair .............. Removal .............. Demolition ........... ~... Other Work ............. ~.. Y~,_,~'d) I-°~.- (Description) 4. sUmated Cost .°. .' ............ Fee ....... ' . (to belpaid on filing this application) / t' 5. If dwelling, number of dwelling units .............. Number of dwelling un[ts on each floor .............. If garage number of cars .-7 ' .-- 6. If business, commercial or mixed occupancy, specify tnature and extent of each t e of use ............ S. 7. Dimensions of existing structures, if any: Front .,~t...x! .~;~. ..... Rear .~..t'.'7 ./{~~...... Depth ...~. ~'. ....... ''"' Height ]. 7 .~ Number of Stories ~ · 4 Dimensions Of same structure with alterations or additions: Front ...$,q.~ .~... i ..... Rear ................ Depth ...................... Height ...................... Number of Stories .................... Dimensions of entire new construction: Front .~, ~.. ! ....... Rear ....... ; ....... Depth ...t.y f. ...... Height ~. ' Number of Stories 9 Size of lot: Front --- Rear ~ IDepth 10 Date of Purchase '--- Name of Former Owner ' 11 Zone or use district in which premises are situated ' 12. Does proposed construction violate any zoning law, ordinance or regulation: .. tq~.~ ........................ 13. Will lot be regraded ........ {- ......... Will excess fill be removed fror¢ premises. 14. Name of Owner of premises ~'l'.v~.. J~..o..T. ........ Address . .~.a~J'~ ~.~., .~..op~*.l~hone No.."/.6.}-.% .1.. j... Name of Architect ................... Name of Contractor [lt,~..ff~..1~?.~.|~..~. ' ....... Address ........... ,o 6~ ~'~ ~.~' ~',' Phone No ................ 15.Is this property located within 300 feet of a tidal wetland? *YES .... *If yes Southold Town Trustees Permit may be requiredI. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. in~dicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF NFr~-YOI}~X--2_ /~" S S COUNTY 0F .~I.A.'-~[ .~... · ....... N '--' ' ' r ............................ being duly sworn, depc ~es ~d says that he is the applicant . ( amc ofi~dividuai signing contract) above named. lle is the ......................... ~ ................ ~ ............................ f(Contractor?agent, corporate officer, etc.)' ~~ i. of said owner or owners, ~d is duly auth rform or have performed the sg~d work and to m~e and file this application; that all statements contained ~ this application are true to the best ofhi~ knowledge and belief; and that the work w~l be perfo~ed in the m~ner set forth in the ~plication filed therewith. Sworn to before me this k ............... . / ..... ...... _ ~ ~/ ~ ~ (Sign~e ofapplic~t)