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HomeMy WebLinkAbout16843-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hale Southold, N.Y. Certificate Of Occupancy No. Z-16726 Date March 21, 1988 THIS CERTIFIES that tt~e building ....... ,Ap.9, ! .~ .~.0.~ ............................... Location of Property ...... 1.4. 5. 5...~.r.a.t..h y.o.h 1...R.o.a..d ....... .~.e.w...S.u.~. ~..o .1.k. ,...~ ? w Y..o .r k . House No. Street Hamlet County Tax Map No. 1000 Section 117 .Block 4 . .Lot 5 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated March 21, 1988 16843 Z ................... ' .... pursuant to which Building Permit No ...................... dated March 22, 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 ......... STORAGE ADDITION TO EXISTING ONE FAMILY DWELLING The certificate is issued to JOHN G. GLANDER . ..................... ..................... of the aforesaid building. Suffolk County Department of Health Approval ........... .~ ./.~ ............................ UNDERWRITERS CERTIFICATE NO ................... .~./?. ........................... N/A PLUMBERS CERTIFICATION DATED: Building Inspector Rev. FORM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT fi.HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No_ 1654~ Z Permission is hereby groni~...,~,,g..x....~,~..,./ ..... zz~....~~..~,~ .... ,o....~-,/~.,~.'.~- ..... ~ ............ ,~~ ............. ii ..... // .~ .... at premises located at .../..~..~..~ .................................... ¥~ ~~ ~'.'7'." .................. County Tax Mop No. 1000 Section ....... /.../.~.. ...... Block ......... ~ ........Lot No .......... ~ ..... pursuant to application dated ........... ~././... ........................... , 19~...', and approved by the Building Inspector. B~n'; Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - ] 802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted i Im,~,a~s 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 o~ 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 property simwing 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. Additions $25.00 POOLS $25,00 C, Fees: 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.Vacant Land C.O. $ 20.00 5.Upda'ted C.O. $ 50 . 00 Date ,..~/¥~.~.C~... ?! ./..I..q.~.~. New C on s t p u c b J on ...... Old or Pre-existing Building ...~. ~,¥..*~.. Vacant Land ............. Location of Property .... ./..,~'~'~. ........~.1.(~..~..-~.~..c~.o..~..Lc. · .(?...'~..x..bJ.G,4~..~..?.~?..~.U.[.c~... House No. Street Hamlet Owner or Owners of Property ~q .¥%.~ ~.~'~'-C.C~t4.O.~.c~. ................... County Tax Map No. 1000 Section . .X/./, ~.. ........ Block .... ':7J. ......... Lot ................ · .kD .... · ....................... Filed Map No ........... Lot No .............. Subdivision.,. Permit No. ~.(0 ~3.~.. Date of Permit .......... Applicant .................................. 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 all app~iea~e codes and regulations. Applicant~~ .¢~..~. . ....... R~v, 10-10-78 *~JI3HN G. GLANDER NEW SUFFOLK, N~.W YORK 11956 ($16) 734-66.t9 OCCUPANCY OR USE 'WITH~7 OF_ OCC~P~C¥ DUNDATION ( 1 s t ) DUNDATION ( 2nd ) )UGH FRAME & .PLUMBING ~SULATION FER N. Y. STATE ENERGY CODE FINAL BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... FORM 'FORM NO. 1 TOWN OF SOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC TOWN HALL NOTIFY °vOUTHOLD, N,Y. 11971 , TEL.: 765-1802 CALL ................ ........... '/. : ,r .,..¢ __MA I L T O : Approved ......... ,19ermit No. Disapproved a/c ..................................... ................................ . APPLICATION FOR BUILDING PERMIT DateO?,~.9.~.. ~ ( .... ,19~f INSTRUCTIONS 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 ail applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspecti~on~s./~_._..,._, ~ .... 7... ................ (Signatur~f applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contra~rp~,~ia~gp~}l~or build, er. .............. .o. ..................................... . . mu~ u~ ua, ~ ,a p ........................ , ......'.' '. ..... j ' 'BIOT[FY"B[.UEDtNG' DEPAR/7'~ENT A'T ' ' ' fas on me tax ron or2g~e~¥S~eo~ AM TO 4 Pf~ FOR THE If applicant is a corporation, signature of duly authorized officer. FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POUa~o CONCR[*E ........ '(ffai4J k~i 'titid gF~gh;gkkg ;kfi~gr')': ....... z ROUGH-FRAMING & PLUMBllq¢ ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED 3. ]NSULAT!©N Builder's License No .......................... 4. FllqAL - CON%TPUCTION MUST c) ~-~ oc~/,l BE CcW',~o! ~'TE F'OR C. O. Plumber's License No ......................... ~LL CONCTq' ~C-r!Olq SHALL MEET THE RFcu 'm:~!FNTS OF THE Iq. Y. Electrician's License No ....................... STATE CoNsTRUCTION & ENERGY CODES. N~'r RESPOlqSIBLE FOR Other Trade's License No ...................... 1. tocatio~ of land on which proposed work will be do~e .... /,Y.~ST.,..~..c'~..~.~.. ~°,§k .C.~. C.? ................. .... ( M .S.S.. ?? .~..-~. ?..ok ~..?.-???... N %~... ~ .~.C.~??~..~. :~ .................... ~ ............. House Number Street Hamlet County Tax Map No. 1000 Section . ..././..~. .......... Block .... ~. ............ Lot...~. ............... Subdivision ....... ~.~.0..O[r, ....................... 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 ~7 .r~..~..~.t?rT. ??..~.T. ~ ?..?~ ~ .*?..o~.~: ............................... b. Intended use and occupancy .................................................................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteratior, .., ........ Repair ..... ~ ..... Removal .............. Demolition ... ~ .......... Other Work ......... ' ...... · I , (DescripIion) 4 Estimated Cost ~ ~,1 ' (to be paid on filing this application) 5. If dwelling, number of dwe, lling ~nits ............... Number of dwelling units on each floor ................ If garage, number of cars ..... ................................................................... 6. If business, commercial or mixec occupancy, specify nature and extent of each type of use ..................... 7. Dimensions.of,~.~st[ng structure ;, if any: Front .............. Rear ............. Depth ....... Dimensl, )pti~f same structure wi)h alterations or additions: Front ................. Rear .................. 8. Dimensi [~}.t~f entire new constr~tjpn:.,.__ Front .......... ..... Rear ............... Depth ............... Height ~~.~.~ ~[ St eries ........................................................ 9. Sizeofl~t ~IsmrL~.~&~t: F ~...,,~ ...... Rear ...................... Depth ...................... 10. Dateof ~--C-'. .............. Name of Former Owner ............................. 11. Zone or use district in which pre~ rises are situated ..................................................... 12 lng la · Does proposed construction viola te any zen w, ordinance or regulation: ............................ ' .... 13. Will lot be regraded .......... , .................. Will excess fill be removed from premises: Yes Np 14. Name of Owner of premises .... , ................ Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No ................ Name of Contractor ......................... Address .... : .............. Phone No ................ 15. Is this property located ~ithin 300 feet of a tidal wetland? *Yes ..... No ..... *If yes, Southold Town TruStees Permit maybe required. I PLOT DIAGFOkM Locate clearly and distinctly all Cuildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block n~mber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S. COUNTY OF ................. ............................... i ................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. fie is the .......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly aathorized to perform or have performed the said work and to make and file this application; that all statements contaim d in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner s~ t forth in the application flied therewith· Sworn to before me this , ............ .~../.., ....... day of .,. ~. ........... , 19 .~..f- NELEN Il DE [tOE ......... ?~,~o./E;i',,711~a, 8o/)0;k County ,~.,~ (Signature of applicant) '