Loading...
HomeMy WebLinkAbout3085-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z13170 Date Jan. 24 ., 19.8..5 THIS CERTIFIES that the building ....... .N.e.w...D.w.e.l. 1..i.n.g. ' Location of Property 3 5 5 Robinson Lane Peconic House No. Street Ham/et County Tax Map No. 1000 Section .... 0..9.8 ..... Block .... 0..5 ......... Lot 010 Subdivision ........ .P.e.c..o.n.i.q..B.ay..O..a.k.e.s...Filed Map No ......... Lot No...1.6 .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .M.ay. ...... 1..1 ...... 19 .6.6. pursuant to which Building Permit No ........ 3. .0 .8.5.Z. ........ dated ....... .M.a.y...1.1. ............ 19..6.6, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which tiffs certificate is issued is ......... Private One Family Dwelling The certificate is issued to ................ STANLEY SLAMA (owner, le~eea*~t~na~ of the aforesaid building. Suffolk County Department of Health Approval ...A.p.p :..R.o..b.e.r.t...V.i.l.l.a...~.u.q: .1.6.,. 1. 9. .6.8 ..... UNDERWRITERS CERTIFICATE NO. N6 7 5 06 8 Building Inspector FOP~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 3085 Z ~ 19..66.. Date ................................ 1~.. ................. Permission is hereby granted to: .......... ~.ta~l.e?..Ikr0a ...................................... .......... ~3.....~3....~.~..s.t .................................... ............ ~.Laral..~.a.vk ......................................... to .... ~lli~.d.. ne.~., one...£aaily...flt~e 3ZLi~g .................................................................... : ............. at premises located at ....... ~t......~.& ....... ~Oonie--~a~'-O~;~ .................................... ............ d ...... ................ ~. Kq~m~.o,~.. I,e.~te ............ 2e~.o~ ......................... : ......................... pursuant to application dated tv~Z.......~-..i: . , 19..~.~, and approved bY.the Building Inspector Fee $ ....... 10.DO. .... TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. ~ 3170 Dote ~ti~. 21 ~9 68 THIS CERTIFIES that the building located at .~/.~...~)~).~)]k~.O~..~1~. ........................... Street Peeon:te ~y O~a ~r-~ v Map No........................ Block No....~ ............ Lot No....]'~t .......... ~.~.,,~;L~...~.~.,~.t ................... conform~ substantially to the Application for Building Permit heretofore filed in this office doted ~9 ~ ................. .................................. ~.~: .......... ].~ ........... , ...~ .... pursuant to which Building Per,it No ~08~ dated ..................... ~ ..........~] ............ , 19.~.., was issued, and conforms to all of the requirements of the apphcable provisions of the law. The occupancy for which this certificate is issued is .... ~..~..~:~:y:..~e&~&u~ .......................................................................................... The certificate is issued fo .~...~..~..~ .......... ~ ........................................... (owner, lessee or tenant) FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall $~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in dup£tothe 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--iS-9 form or equal). 3. Approva[ 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. Co Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $15.0 0 . 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 I Date ....... New Building .~.~ '~ Old or Pre-existing Building Vacant Land Location of Property ........ d I ~ ¢'~ '~' ~' .' $E¢ .................................................. ,ou .o. . . Owner or Owners of Property ..... County Tax Map No. 1000 Section ............... Block ............... Lot ........... Subdivision ................................. Filed Map No ........... Lot No ............ ; · Health Dept. Approval .... '. .Labor Dept. Approval ........................ Underwriters Approval .~...~..~..O....~?.~ ......... Planmng Board Approval .. ,A ............. ..~. · · qo..Request for Temporary Certificate. ?..¢3.. Fee Submitted $..~), ......................... Construction on above described building and pe '~t ee~ all apl~c~ble codes and regulations. Applicant .............................. F ' S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date 4UG Bldg, Permit No. TO WHOM IT MAY CONCERN: at ~he sewagt disposa~c~iities (Give deed location) for a structure located have been inspected by this department and found to be satisfactory. District Engineer FOI~M NO. 1 SOUTHOLD, N.Y. /Po. ,.. (eg' c~.,~--~-e O. [~ ~?,oAP,4r c~t'~.,h xomlned ......... ........ . App, tion ............ Approved ........................................ , ~ ........ Perm,t No. ~ .................... ~ $ ~ .~_~ ................... ......... r .......................................................................................................................... .~- ~o:., ,,,.~-~-, m~.~,,, ~ ~ ~ '~"~ ~,,~ (Building Inlspector) ~' ~2~I' /'~e,o~ ,~-~W~ .../,6-L,..5 /~2~/7~'g AI~PLICATION FOR BUILDING PE~,r.~.' ~/~//~7..5- ,~? Dote ............................. ~.I .......... ~.2.. ......... , ~9.~.6.. ...... INSTRUCTIONS a. This opplication must be completely filled in by typewriter or in ink ond submitted in duplicate to the Building Inspector. 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 application. 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 issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of 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[~ for removal or c~egnolition, os herein described. The applicant agrees to comply with all applicable laws, ordinances, ~ co/~e and r~,,~tions. f- . .............................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......................................................... 0 3~1~'t e z'. ............................................................................................................................ Name of owner of premises ....... S.~a.o. ZLe.~....~3~e,]~&..&...W.~P.e ............................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ....~..e..,q.o...n.~.c....~.8.~.....Q.8..~..SLot No.: .....]...6, ................ Street and Number. ...... ~ft.l~.z~D,~.~...,~e,~e.s..~..~.c, oD,~.~. ........................................................................................ ,~ ~'~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ~'X'~a. Existing use and occupancy ........................... ..V..8...q.8,~.1;;... ~.8,~ ............................................................................ /~ b. Intended use and occupancy ....o~e~...-t'.e. tzd. Z~r..cl.~le3.3~L..[ ............................................................................. 3. Nature of work (check which applicable): New Building ..... ~ ...... Addition .................. Alteration .................. Repair .................. Removal .................. Demolitian .................. Other Work (Describe) ........................................ 4. Estimated Cost .......... ~...,..0..0...0.....~../...~. ......................... Fee lO (to be paid on filing this application) 5. If dwelling, number Of dwelling units ........ ..O..~..e. ............. Number of dwelling units on each floor ............................ If garage, number of cars ....~.l~f~ ........ L ......................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ' 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ............................................................................. : ................................... Dimensions of same structure with alterations or additions: Front .................................~.. Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ........... 6~.,-,~ ................ Rear ...... .~,..-.~ ............ Depth ...~.~.,..~.-,.,8.. Height Number of Stories one 9. Size of lot: Front ...... l~' ............... Rear ....... [~ ...................... DePth ..~..~. ....... /..~.~..0. ..... 10. Date of Purchase ...... ~ ................... ~.9.~.)T. ...... i ............. Name of Former Owner ......... .H..:..J..:..S..~...i.t.h.. ......................... 11. Zone or use district in which premises are situated "A" gist 12. Does propo~e~J construction violate any zoning law, ordinance or regulation? ............. ~Q ........................... 13. Name of Owner of premises ...S.tar~ey...S.lama ...... Address .....F.'I Q:E~.I..P. ar~¢ ............. Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .i......$..¢~...e. ................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate 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 whether interior or corner lot. J~ STATE OF NEW YORK, '~ ,. ,. COUNTY OF ....~...'g,~.~..6.'..]...~. ............ .f::,.3,. - Stanley.. Slama ,~ being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the Owner - builder (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 contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the applicatj,qn filed therewith, fO Sworn to before me this k,~ V {~ommi~sion Exp:res k~[ch 30, mt THE ~anuary 17, 1985 NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 1OOS8 306732/84 on iic N 675068 only the electrical equipment as described ~elow and introduced by the applicant named on the above application nu tuber in t~e premises of Stanley S&~Lma, Box 8~ Robinson Lane #355, Pecontc, N.Y. in the followlng location; ~ Basement X ~ Ist FI. [] 2nd FI. Section Block Lot was examined on and found to be in rompliance with the requirements of this Board. January 1~, 1985 FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPARATUS: S E R V I C NO. O COND. OF CC, CONO. (NO VISUAL DEFECTS) electrical equipment in the premises indicated. condition was found. NO. OF HI-LEG OF HI-LEG NO. OF NEUTRALS OF NEUTRAL An Electrical Survey has been made of the exposed No obvious unsatisfactory Stanley Slama Box 86 Robinson Lan& Peconic, N.Y. 11958 This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.