HomeMy WebLinkAbout17014-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate O[ Occupancy
No..z.7.q2..6 ......... Date June 24, 1988
THIS CERTIFIES that the building ... ,A.d.d.~ t..~p.n. ...................................
LncatinnnfPrnn~rtv 50 Pipes Neck Road, Greenport
County Tax Map No, 1000 Section ..... 0. 5. ,3 .... Block . ...0.2. ......... Lot ...... 0. ! .........
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
.... .M.a.y.. 5. ~.. 1.9. 8..8 .... pursuant to which Building Permit No..1.7.0. ! 4. .z ..............
dated .... .M.a.y.....,........20; 1988 ....... was issued, and conforms to all of the requirements
of tile applicable provisions of the law. The occupancy for wb. ich this certificate is issued is .........
Add to an existin~ deck;..tp..a..n..e,x,i..s.t.i?.g...o.n.e...f.a.m.i.l.y...d.w.e. 1..1.i.h.g.: ....
The certificate is issued to JOBiq & LYDIA ~ICOLETTI
..................... ......................
of the aforesaid building.
Suffolk County Department of Health Approval Iq/A
UNDERWRITERS CERTIFICATE NO. Iq/A
N/A
PLUMBERS CERTIFICATION DATED:
Building Inspector
Rev. 1/81
FOILM NO. ~
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)
N~ 017014 Z
Permission is hereby granted to:
'7' ...... ,~'"E' .................................................
....~.~,~ ~.,~.t....~..:.l......u.~..4.~ .............. ~
........................................................................ ............ ,
o, premises located at ..~.-~.. :?..~.....1~...6~....~., .......... .~¢~..~ ..........
County Tax Map No. )000 Section ...... .0..~'~....~ ..... Block ...... .~.....~,. ...... Lot No ......¢~..) ..............
pursuant to application dated ........ .....~..~..~"~. ...................... , 19.~..~., and approved by the
Building Inspector.
Fee $..~.,,~.~**.: ..............
Building Inspector
Rev. 6/30/80
TOWN OF SOUTHOLD
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~ 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 instaila*
lions, 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 ali 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 octupancy New Dwelling $25.00, Accessory ,$10.00 Business $50.00
· 2. Certificate of occupancy on pre*existing dwelling $ 5 0.0 0
3. Copy of certificate of occupancy $ 5.00, over 5 years $]0.00
4.Vacant Land C.O. $ 20.00
5.Updated C.O. $ 50.00 Date ..........................
New C on s t puc t i on ...... Old or Pre-ex isling Building ............ Vacant Land .............
Location of Property ......... ~,,~. · .~,~- · · · · ~,...L~... ~ .....................
House No. U TMStreet , Ham/et
Owner or Owners of Property ..............................
County Tax Map No. 1000 Section ..... ~.i~. ....... Block .. ,~, .,'~, ........ Lot.. ,~. l ...........
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No ........... 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 applicable codes and regulations.
Applicant ....................................................
Rev. 10-10-78
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN IIALL
SOUTtlOLD, N.Y. 11971
TEL. 765-1802
To Whom This May ¢oncern,
We are unable to complete your Certificate
of Occupancy because .of the following reasons.
/_~/ An application for Certificate of Occupancy
is not on file.
/~///No Underwrfters Certificate on.file.
/5// Tile check ls(outdated/.not ou file.)4fi~~- O0
/~/ No Health Dept. Approval on file.
/5/ No final inspection has been made.
Please contact our office on this matter.
Thank you for your cooperation.
Building Permit # _~ ~ _~ _~ ~ Z
Building Dept.
***/5/ No Plumber solder Certificate on file.
[ all permits involving plumbing being
issued after April 1,1984 )
F~ELD INSPECTION
1.
FOUNDATION (1st)
FOUNDATION (2nd)
ROUGH FRAME &
PLUMBING
INSULATION
PEN N.
STATE ENERGY
?DE
FINAL
COMMENTS
ADDITIONAL COMMENTS:
765-'1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
REMARKS:
FOUNDATION ZND [ ] ~ISULATION
FRAMING [~ FINAL
r
o
Z
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N.Y. 11971
TEL.: 765-1802
Approved..
Disapproved a/c ....................... . ............
" ............................... .......
(Building Inspector)
BOARD OF HEALTH ............
3 SETS OF PLANS ............
SURVEY .....................
CHECK ......................
SEPTIC FORM ................
NOTIFY
CALL .?7~T.?~ ..........
MAIL TO: 0
TOWN OF 'SOU:~hOLD
,APPLICATION FOR BUILDING PERMIT
Date ................... 19...
INSTRUCTIONS
a. Tlfis 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 l~yout 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 iemoval 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 necessary inspections.
(Signature o~ applicant, or name, if a corporation)
-- ' (Mailing address of aplSlicant) ' ' '
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Nameofownerofpremises .~O~M:.'~.~)rdl,'~c. ]k~ 0[~.~'-I .........................
(as on the tax roll or latest deed),
If applicant is a corporation, signature of duly authorized officer. "4,
(Name and title of corporate officer)
Builder's License No ..........................
Plumber's License No .........................
Electrician's License No... :-~:-~c~,.,: .. .............
Other Trade's License No ......................
:
1, Location of land on which proposed work will be done ..................................................
House Number Street Hamlet
County Tax Map No. 1000 Section ...~.~ ' Bloc~ ...~ ............. Lot
Subdivision ... 7. ................................ Filed Map No ............... Lot ......... - ......
(Name)
2. State existing use and occupancy of promises and intended use and occnpancy of proposed construction:
a. Existinguseandoccupancy ff l g ~ la b w l / a.
..... .... . ...... 't~t:::3~ '~ ~:~,"5 ...................
b. Intended use and occupancy · · · ............... "' ....
3. Nature of work (check which applicable): New Building ..... ' ..... Addition .~i~F.;,/~... Alteration ..........
Repair .............. Removal .............. Demolition Other Work...
i (Description)
4 Estimated Cost ~.~('~.O ?.~.
· . .................................. Fee ................................
~ i (to be paid on filing this application)
5. If dweLiing, number ofdwellflig 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 .....................
7. Dimensions of existing structnres, if any: Front..' ........ . ..... Rear .............. Depth ...............
Height Number of Stories
Dimensions of same structure iwlth alterations or additions: Front ................. Rear ..................
Depth ...... ..~ ~; ..... ~ ... Height ......... Number of Stories . .
"8. Dunenslo tire new con~tructton Front ........ Rear .......... Depth ...............
Height ~ ~,Lt. Nfimber of Stories
9. Sizeoflot: 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 zonlng law, ordinance or regulation: ./~.o. ............................
13. Will lot be regraded ............................ Will excess fill be removed from premises: . Yes No
14 Name of Owner of premises . 1 .......... Address Phone No
Name of Architect ~ Address Phone No
Name of Contractor ' Address Phone No '
PLOT DIAGRAM
iLocate clearly and distinctly all 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 whe~ther
interior or corner lot. '
OF s.s
being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is tha ................................
(Contractor, agent, corporate ,officer, etc.)
of said owner or owners, ~d is d~ly authorized to perform or have performed the said work and to m~e and file this
application; that all statements cofitained ~ this application are true to the~best of his knowledge and belief; and that the
work will be perfo~ed in the m~her set forth in the application filed therewith.
Sworn to before me this
.................. day ...... , 1
n~7~ , ~ (Signature of applic~t)
~mn ~1~ ~m~er 8, 1~
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