HomeMy WebLinkAbout17447-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDTNG DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z17775 Date FEB. 17, 1989
THIS CERTIFIES that the building REPAIRS
Location of Property. 870 FAIRWAY DRIVE
House No. Street
County Tax Map No. 1000 Section 109 Block 05
subdivision FAIRWAY FARMS Filed Map No.
CUTCHOGUE
Hamlet
Lot i4.5
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPT. 16~ 1988 pursuant to which
Building Permit No. 17447Z dated SEPT. 20, 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 REPAIRS TO DWELLING, FRONT ENTRANCE CORNICE, SIDING~ CORNER
BOARDS.
The certificate is issued to
WALTER S. RUSHMORE
(owner, - - )
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Building ~ns~pe~tor '
Rev. 1/81
FOBM~ NO. S
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Permission is hereby granted to:
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~,~ ~ ~ ~o. ,0oo ~,:,,o, ...~.~ · ~.~ ..... ,,~ ...~ ~....~ ......... ~,,o..Z.~..~
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
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted m emmmm~a 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-existing"
land uses:
1. Accurate survey of p~operty showing all property lines, streets, buildings and unusual natural or
topographic features.
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 $25.00, Accessory ,$]0.00 Business $50.00
2. Certificate of occupancy on pre-existing dwelling $1OO.OO
3. Copy of certificate of occupancy $ 5.00, over 5 years $60.00
o.00
5.Updated C.O. $ 50.00 Date... ( .....
NewC°nstruction ...... Old or Pre-existing Building ...~. ..... Vacant Land .............
Location of Property...~. ~.~. .......... ~~.~.J,.._.~ ~ .. ~~
House No. , /I, r~ ~-~ Streetl .....
Owner or Owners of Pro eft . /~.~ .~.'~. ~ ........
County Tax Map No. 1000 Section .... / .~..~. ...... Block ..... ~ ..... Lot . . . ff.~. ~.'. [~-..
Subdivision..~.-~..~, .... ~ .Filed Map No ........... Lot No ...... ~.'.
Perm it N o-~/.~/. ,~.~/TDa~t'o f Permit ~,)..A~pp licant
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 permit meets/ill applicable codes and reaulations.
Applicant... ~~.~.~/.~~~ . .~~ ........
Rev. 10-10-78
1.
FOUNDATION (1st
FOUNDATION (2nd
ROUGH FRAME
.FLUMBING
INSULATION PER N.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS:
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL,: 765-1803
Disapproved a/e .....................................
Application No ..................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
a. This application must be co~npletely 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 nec~s~aT~sp~ons.~,, ~
(Signature of applicant, or name, if a corporation)
....
(Mailing address of app ' )
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
,da
...... .......................
Nameofownerofpremises.~.~...~.t..~"T'~;'~"'~:'(ason~g.~otl~d~e.j. ' ' ~it ................
If applicant i corp~atlon, signature ot duly authorized officer, i~5~ ~OJl~g~
Builder's License No.. 1.7.~..~.~..'.~. :'.~.. ......
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No ...................... ¥~ lit ltr~?~ltfft~!,)..' .? ?~ )~ ~-
t. Location of land on which proposed work wall be done..~.' ..... ~d ........
...... . ............. .........
House Numoer ~ Street 16 ~Ham~e~ I ,~/I /
~o~,ty ~, ~ ~o. ~0_0 s~,~2~. ~o~ .................. ~o,... ~ .... ~ ....
....... ............... .... ¢ .........
2. S~at~ ~x~st~ use and ~ccu~ancy ~ Pre~ses a~d inte~ded us~ ~nd ~ccuPancy ~ ~r~s~d c~stmcti~:
a. Existing use and occupancy ..... ;. ~ ................................................
b. [~tcnded use and occupancy ...... ~ ...........................................
........... RemOval .............. Demolition . .. Other Work ...............
(to be paid on filing this application)
5. If dwelling, number of dwelling iunits ..... /. ........ Number of dwelling units on each floor k. ..............
If garage, number of cars .... i ...... ,~ ................................................... ' ...........
6. If business, commercial or mixed occupancy, specify nature and Cxlent of each type of use.' ....................
7. Dimensions of existing structures, if any: Front ..... "'P)' "" "' Rtar~ ;,'2.~' '~ ..... D~pth.. :,.. ...........
Height ............... Number of Stories ........ ~./~.. ~ i
Dimensions of same structure with alterations or additions: Front Rear
Depth .................... i.. Height ...................... Number of StoJ:i,es ............ ; .........
Height ............ Number of Stories../..~".[/. ~ .fl' '~~~ ~rT~
10. Date of Purchase ........... ! .................. Name of Former Owner .............................
1 1. Zone or use district in which premises are situated .....................................................
12. Does proposed construction vioiate any zoning law, ordinance or regulation: ...... ~ ...... ~ ................
13. Will lot be regraded ...... .. · · ~.,~.~ .... ~. · -~ ...... Will excess fill be removed from premises: Yes No .
Na e of Architect .... , ...... .................. Address . Phone No .................
PLOT DIAGRAM
Locate clearly and distinctly alli buildings, whether existing or proposed, and, indicate 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 corner lot.
APP D Al II01TD
FOLLOWING INSPE/~I'ION8:
1, FOUNDA~
.
STATE OF NEW YO~PL
0OM ~ C..
......
................. ~ .RE~~, ~.~?[~N;~: · ' ·
(Name
above named.
OCCUPANCY OR
USE IS UNLAWFUL
WJTHOUT CERTIFICATE
OF OCCUPANCY
.b.eihg duly sworn, deposes and says that he is the applicant
He is the ...................... i ......... ' ......... .i~ ........... i ....................................
~ (Contractor, ag~nt, corporate Officer, etc.)
of said owner or owners, and is dul~ authorized to perfor/n or have performed the said work and to make and file this
application; 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 manne~ set forth in the application filed therewith.
Sworn to before me this
~[t~ ~ ~ V0E (Signature of applicant)
t~i[~ rA~'{Y PJJ~]LJ(~, State of ~w Y0dL
No, 470789'8 Suffolk