HomeMy WebLinkAbout16823-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. Z16746 Date March 29, 1988
THIS CERTIFIES that the building A c c e s s o r y
Location of Property .. 720 ORCHARD LANE SOUTHOLD
House No. Street Hamlet
County Tax Map No. 1000 Section ....0.8.9 ...... Block 03 . .Lot...p./.o. I I . 1
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
· ...M.a.r.q.h..9.~..I.9.8.8. pursuanttowhichBuildingPermitNo.........16823Z
dated .... .M.a. r..c.h. .... 16, .. · ·......I 988 .... 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 .........
Accessory building as appled for.
The certificate isissued to ROSCOE & MARJORIE COREY
(owner,
of the aforesaid building.
Suffolk County Department of Health Approval N /A
UNDERWRITERS CERTIFICATE NO ............ .N./.A. ..................................
PLUMBERS CERTIFICATION DATED: N/A
Building Inspector
Rev. 1/81
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
6823 Z
Permission is hereby gr~ to:
,, ...........'r' FV'"*'" '~"-"'~":~; ....
· ~. ~ ~]ii~.~..ZZZ....ZZi ......
..~.~....~..:.?,..u...~.~..t ...........
,o .....
~t prom ~t~ ~t ~.~. ......... ~~ ................................
County Tax Map No. lO00 Section ..... ..(~:~L.~...~. ....... Block ........ ..~)..'~ ..... Lot No. ~.0....~/.:.../. .....
pursuant to application dated .... ..~.CiL~-.~...(~ ........................ , 19.~.~.., and approved by the
Building Inspector.
Building Inspector
Rev. 6/30/80
FO~M 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~ 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
natu raj 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.
B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
I. 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 asto 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.Q0, Accessory,S10.00 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.Updated C.O. $ 50.00 Date . .~f'Y~;~C,/L~...~..
NewConst, ruc tion ...... Old or Pre-existing Building ............ Vacant Land .............
Location of Property ~,~, (~...~.~' ~A.~.. ~c%.'W~L ......... .~.~pT~C~.~-~ L ................
House No, Street Ham/et
Owner or Owners of Property .~-,~..cp.~ .... ~'~.~.Y.. ~.¢ .~..L~... ~. ,~,~ ....................
County Tax Map No. 1000 Section .O..~?. .......... Block ,3 Lot
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No./.(~ ~. $.~.~.. Date of Permit .~.v~,~: ~.~..Applicant . .~.C~ ~, .o.~Z..
Health Dept. Approval ........................ Labor Dept. Approval .......................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate . ~ ....................
/.D ~
Fee Submitted $ ...........................
Construction on above described building and permit meets all applicable codes and regulations.
Applicant...~.~t,~:~.,. ~ . .......................
Rev. 10-10-78
FIELD
FOUNDATION (1st)
FOUNDATION
2.
(2nd)
ROUGH FRAME &
.PLUMBING
INSULATION PER N.
STATE ENERGY
CQDE
ADDITIONA'L COMMENTS:
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION~
FRAMING ,r/~'NA L
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT SEPTIC
TOWN HALL NOTIFY
$OUTHOLD, N.Y. 11971
TEL.: 765-1803 CALL
MAIL
BOARD OF HEALTH ......
3 SETS OF PLANS .......
SURVEY ..........
CHECK ..........
FORM .............
TO:,
l tq ?/
Disapproved a/c .....................................
................................ ......
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date .................. , 19...
INSTRUCTIONS
a. Tkis 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 necessa~~
· .........
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises ~e ~ '~-- a ~/~f~2 j ~ ~z ~,~ ~c~T
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer) .
ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED
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 ..................................................
.... 7. ................ .cl. 5 ........... ?. ?. .°.T?. .5 ......................
House Num her Street Hamlet
County Tax Map No. 1000 Section ..... ~?..% ......... Block ...3 ............. Lot.
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name)
State existing use and occupancy of premises and intended nse and occupancy of proposed construction:
a. Existing use and occupancy ..................... '...,.'.'.~'..~ .....................
b. Intended use and occupancy ·, ,'. .......... ~ .......................
Locate clearly and distinctly all
property lines. Give street and block
interior or corner lot.
3. Nature of work (check which applicable): New Building ........ Addition .......... Alteration - --
Repair .............. RemoVal .............. Demolition .............. Other Work ...............
I' (Description)
4. Estimated Cost .i ..........
· .. . ...... ........... Fee......................................
i ~ (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 ~
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ...... 114 itl ill i iii ii
7. Dimensions of existing stmcture~, if any: Front ...... &>.t ....... Rear .... &.' ........ Depth i
Height .... ,~. ......... Number of Stories /
Dimensions'of same st~dt~u~e{~ilh alterations or additions: Front ................. Rear ..................
Depth .................... ~. Height ...... ; ............... Number of Stories ......................
' 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ...............
Height Number of Stories ;
9. Size of lot: Front /.~.6.. I' , .... Rear ...... l.(~ ............. Depth ....~.~..~ ..............
10. Date of Purchase ..... /.I/?.7. ! ................. Name of Former Owner ...¢.~.aF..'.~7.ff .~.x.c.O.~.~.~r.c9 .......
1 1. Zone or use district in which premises are situated .....................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: .......... o. .....................
13. Will lot be regraded .../'./??. ~.. i .'X~.o. ,¢P ........... Will excess fill be removed from premises: Yes No
1 4. Name of Owner of premises ..~. ~..c.: u....~.'.~.*..¥... Address .. ~.<~...t .~ .~.~. ....... Phone No..?.c..¢...~. 3 .~.75...
Name of Architect .......... ~ ................ Address ................... Phone No ................
N~ane 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 may_ be required. A~O~/ /q,,,¢¢ 15-t~¢'~ ~.tz~o~O ~
PLOT DIAGRAM
mHdings, whether existing or proposed, and. indicate all set-back dimensions from
lumber or description according to deed, and show street names and indicate whether
STATE OF NEW YORK~ ~ I~
COUNTY OF 5a ~:,, ,-- ~ ~.~
........ ~.. ................ .~i .................. being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is the .........................................................................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
application; that all statements contai~ ed in this application are true to the best of his knowledge and belief; and that the
work will be performed in the manner ~et forth in the application filed therewith.
Sworn to before me this
Term E~pires M~rch 30, In rz