The URL can be used to link to this page

Home My WebLink About16987-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z.1.6.9.4.3 ........... Date June 1, 1988 THIS CERTIFIES that tbe building ...... D..eg.k ...................................... Location of Property 5180 Sound Avenue Mattituck County Tax Map No. 1000 Section . . .1.2 ........ Block .... ~ .......... Lot ..... .1 ........... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated April 27, 1988 pursuant to which Building Permit No. 16987Z dated. ........... May 13,. 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 ......... Replace Concrete deck addition with new CCA deck Tile certificate is issued to ..........Edward. &. ~en~¥i¥~. Wp~ner ro ,.ec k akkk k ..................... of the aforesaid building. Suffolk County Department of Health Approval N/A UNDERWRITERS CERTIFICATE NO.. N/A PLUMBERS CERTIFICATION DATED: N/A BffrIding Inspector Rev. 1/81 F~u~ NO. ~ TO~N O~ $OUT~OL~ 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: ~/' ~ ......~...o~ ............... tl~ ~ ................................................ . . · ~. , ,o ....... at premises located at ............ ...~..:_...)..R.~.....~..-,~. ................ Count/ Tax Map No. ~000 Sect,on ...... ,/.~Z ........ ,~k ....... mJ ........ Lot No ..... .~.,I .............. pursuant to application dated ...... ..~........~...~ ................... 19..~....~.., and approved by the Building Inspectar. Fee $..~.....:..~ 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 ~ ~ 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 natura~ 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 occupancv New Dwelling,$25.QO, 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 ~,and C.O. $ 20.00 5.Upclal~ed C.O. $ 50.00 Date ................. NewCons truc tion ...... Old or Pre-existing Building ............ Vacant Land ............. Location of ProperW ..... ,~,'~ ,O../u~, ,~,~,U,~, ,~, ,L~, .~. , ,2' 'Street Ham/et Hou ;v;.' ' ' ................ Owner or Owners of Property,¥~, t~rF~ ........~ ................ ~ C~E/vE.~t~£ ...........' ~/~,~ ,~.:~(Z~,~, ..... County Tax Map No. 1000 Section ..... .~. ~. ...... Block ....... .~. ...... Lot ........ ~ ....... Subdivision ................................. Filed Map No ........... Lot No ............... Permit No. 1.~?.~.~... Date of Permit . .5~.~Z'..~/~.~..Applicant . .~.~..P~..¢.. ~)0.~.~..~....A~-~-.~. ..... Health Dept Approval Labor Dept Approval " Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate .................... ... Fee Submitted $, ..~, ~''' ~ Construction on above described building and permit me.ets all applicable codes and regulations. Rev, 10-10-78 FIELD INSPECTION 1. FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N. Y. STATE ENERGY FINAL COMMENTS ADDITIONAL COMMENTS: BOARD OF HEALTH ...... 3 SETS OF PLANS ....... 'FORM NO. 1 SURVEY ......... TOWN OF SOUTHOLD CHECK .......... BUILDING DEPARTMENT SEPTIC FORM ............. TOWN HALL °.,OUTHOLD, N,Y. 11971 TEL.: 765-1803 Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT NOTIFY CALL ................ MAIL TO: 1II! -t1 19... INSTRUCTIONS a. T~s application must be completely filled in by ~pewfiter or in ink an~b~{~{,~ilRt~sp'~, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of build~gs on premises, relationg5ip t6 adjoiniag premises o'r~'ph~c streets or areas, and givhg a det~led description of layout of property must be drawn on the diagkam whic~ is pag. o(t~s appli- cation. c. The work covered by t~s application may not be commenced before issuance 0f Bufld~g Permit. d. Upon approval of this application, the ~1~S ~c$or will issued a Build~g Pe~it to the applicant. SuCh pe~it shall be kept on the premises available for ~~t the work. e. No building shall be occupieds~[ ~~l~[[or any purpose whatever until a Certificate of Occup~cy shall have been granted by the Buildi~~' ~..~'~ ~ ~~- ~PLICATIO' IS HEREBY MADE~f~¢b,~g~¢~,p~,tment *r the issuance of ~ B~lding Pemit pursuant to the Building Zone Ordinance of the Town of ~/~l~ounty, New York, and othSr applicable Laws, Ord~ces or Regulations, for the construction of buildMgs, additions or alterations, or for removal or demolition, as here~ described. The applicant agrees to comply with all app~cable laws, ordinances, bu~d~g code, hous~g code, and regCahons, and to admit authorized inspectom on premises and ~ bulldog for necessaw inspections. · ........ (Signature o~pplicant, or name, if a co poration) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ,,~., ~.. ~".~z~...¢f~.c',d-.-~,r:/J/'./~.--/~ ......................................... (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 ...................... Location of land on which proposed work will be done ............................ · ..... ./_ .............. ............. .. .... ............ ............. House Number Street Hmnlet County Tax Map No. I000 Section ..... /. ~/. ...... Block ..... (~..~/. ........ Lot....(~.. J ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing b. Intended use and occupancy ...~,~¢f..~. · ....................................................... 3. Nature of work (check which applicable): New Building .... ' . Addition ~ ....... Alteration .' .~.~.i .... Repair .............. Removal .............. Demolition .......... i ....Other Work ...... ......... I~ ~ ~ / /~y-1~:l~¢4ll~- I~ ~/,~',~f-(Descriplion) 4 Estimated Cost Fee ' (to b~ paid on filing this application) 5. If dwelling, number o f 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 tjpe of use ..................... 7. Dimensions of existing structures, if any: Front .... Rear ~ Depth ight f St ' He ............... Number o ories ........................... Dimensions'of same structure with alterations or additions: Front ............ i ...... Rear ... ............... Depth ...................... Height ...................... Number o~ Stories ...................... Dimensions of entire new construction: Front Rear ' Depth Height Number of Stories ' 9. Size of lot: Front ...................... Rear ...................... , Depth ...................... 10 Date of Purchase Name of Former Owner 1 1. Zone or use district in which premises are situated ........................ ~ ............................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ...! ............................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ,,~.~. t4,.J~. ~',~'~/~.,~.. Address ~.,~.c~,4~2~..~-~,~- .... Phone No.,~..~.~.~/~fi.,4.~ .~... Name of Architect ........................... Address .............. i ....Phone No ................ Name of Contractor .......................... Address .... : ......... i ....Phone No ................ 15. Is th±s property located w±th±n 300 feet of a t±dal wetland? *Yes ..... No ..... *If yes, Southold Town Trustees Perm±t maybe requ±red. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate ail 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. STATE OF NEW YORK, COUNTY OF ................. OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY S.S ! APPROVED AS NOTED 7~5 IE,t)2 9 A:u~ 'iO ~ PM FOR THE 1. ~OUNDA'rlO~x~ 'two REQUIRED FORiPOU~ED CONCRETE 2. ROU~GH FRAMING ~ PLUMBING 3. INSULA11ON 4. FINAl . CONSTRUCTION M~ST ................................................. 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 sbid work and to.make and file this application; that all statements contained in this application are true to the best of his knowledge and beliefi' and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this 47. ........ day of. ~ 19 .~'. No~;...D. ,¢, .U .~.. ...... County (Signature of applicant)