HomeMy WebLinkAbout6120-zFOB.~ NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's O~ice
$outhold, N. Y.
Certificate Of Occupancy
No..Z~.7.~ ..... Date ............. ,~anual~/...~a~.., 19.?.~.
THIS CERTIFIES that the building located at P~..lt~d..13 ............... Street
Map No.. XX ........ Block No.. X~ ...... Lot No..X~ ... 0r:[ellt...l~,]f.o ............
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ........... 8~pt...1.~., 19..7.2 pursuant to which Building Permit No.. 6~20Z.
dated ........... S. el~...1.~.., 19.7.2., was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is . P:ivate. oae. family, dwellin~., with. addition ....................
The certificate is issued to . Mary. L.. Blank ........ (l~nel' ..........................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval ...I~,P~o. ............................
UNDERWRITERS CERTIFICATE No. l~.l ~7~[63 ..... ]~0.~.,.. ~[~... S ~'~3 ............
HOUSE NUMBER ..... 235~ .... Street ... P~.i~af~ .Road .#..1.3 ..................
Building Inspector
I~OBM NO, ~8
'rOWH OF SOUTHOLD
BUILDIHG DEPARTMEHT
'TOWH CLERK'S OFF]CE
SOUTHOLD, H~. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N°· 6120
pursuant to ,ppi,cat,on dated ...... ~..../../. ...................................... , 19 .7..'..., and approved by the
Building In~ector.
Building Inspector
FOBM NO. 6
TOWN OF ~OUTHOLD
Building Department
Town Clerks Office
Southold, N. ¥. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building
Inspector 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 dispcsal--(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
installations, 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 o~ property 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 in-
formation required to prepare a certificate.
Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dweUing or land use
3, Copy of certificate of occupancy $1.00
$5.00
New Building ................... .,~or Pre-exi~i~g Buildi~.:......~....~.~..~. ....... Vacant Land ............................
Location Of Property ...... ,,~..,~,..~,~,,~,.~,,~.~
Owner Or Owners Of Property ............. ~.~..~........~..,...~.....~...~../... .....................
Subdivision ................................................................ Lot No ............. Bloc,~o .............House No .............
Permit No ................... ~ate Of Permit. pplicant ...... ~ ................ ~..~[ .............
Health ~pt. Approval ............................................ Labor ~pt. Approval
Unde~r,e~ *pprovo~ ~Z.~.~.~.~......~*~.....~,onn~no e~d ~rovo, ....... ~...~: ....................
R~uest For Tempom~ Ce~iflcate ........................................ Final Ce~ificote ....... ~ ............................
...........
Con.ru on on obov ond
..... . ................. . ...........
Swo n
....~. day of . .. l.~ n~stom
· .. ..............
~o~o~ eu~,,~ .................................... C~n~
lrO~M NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Disapproved a/c ............................................................................................
Application No....~.~ ...................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, wit~
3 sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Pict 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 diagram which is part of this application. 4~
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 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 be
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, SuffoU~ 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 tq comply with all applicable laws.
ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections.
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder,
...... .......... .................................. ...............
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.: .................... Lot No ..............................................
Street and Number ......... ~.¢l~t,~ll,..~ltl~k ..}~l:~12t~e ....... ~t..~..X, ..............................................................
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
Existin ~ ~e~I,T ~ell~.a~
a. g use and occupancy ................. ..~.~.;~j~l~ .............................................................................................
b. Intended use and occUpancy ........ J~,;~t,;~..~..&t,~'~l~t..~l,~LL~:l.l...~l:t~.~t~..~l~ ~
3. Nature of work (check which applicable): New Building ....................... Addition ~.~..l:~t,Z~rAIteration ...............
Repair ......................... Removal ......................... Demolition ........................ Other Work ....................................
(Description)
4. Estimated Cost ...~.~9QO~ ........................... Fee ......... ~00 ..........................................................................
(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,.22,~ .nature and exten~l~__of each type of use '""'1~1~"~"~;~7~_e6_,, 2~.0 ..............
7. Dimensions of existing structures, if any: Front~l ....... Rear ..]~11~ ............ Depth .~...~) .......
Height ....~J~.O ............................................. 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 .~.!~I ........... Rear ,~,?.6 .................. Depth ....~..I,.0 .................
Height ...~.1~,,~ ................................. Number of Stories -.--.~'VO .............................................................................
9. Size of lot: Front ...................................... Rear .......................................... Depth ..................................................
Height .................................................... Number of Stories ......................................................................................
10. Date of Purchase ..~,9~()...~Jl,~,~ ...........Name of Former Owner ....~'.~.!~11]~.~. .......................................................
11. Zone or use district in which premises are situated ............ .aj~?. ...................................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: .~3~ .....................................................
13. Will lot be regraded _..~...~'~,~t. ............... Will excess fill be removed from premises: [ ] Yes [ ] No
14. Name of Owner of premises .~.t~l~,..1~lLl~....,~l,O..~14~ll~..~rO3,&..i~OIl~..,~).~l~. ....... .:...; ................
(Addre~ ' - (Phone r~o.l
Name of Architect .......................................................................................................................
Address Phone No.
Name of Contractor .................................................................... i~,;J~'~') .................................... il~'~'~'~;~i ...............
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 wheth-
er interior or corner lot.
STATE OF NEW YORK, ) SS
COUNTY OF ......................................................)
.......................................................................................................... being duly sworn, deposes and says that he is the applicant above named,
(Name of individual signing contract)
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 contained in this application are true tq,[h,e b~)~]~hl's ~q~edge and belief; and that the work will be performed in the manner
set forth m the application filed therew~. ~ ~ New Yo~
' ~ ~~ ~22 ,~r~~~2~52~03~a~. sump k Count
....................
................... ........................
~ (Si~mre of applicant~
THE NEW YORK BOARD OF FIRE UNDERWRITERS
C8 BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 10038
Date November 15, 1973 ~4~.¢~tio~o. onyile 693160
127563
THIS CERTIFIES THAT
only tl~ el~ctrt~d~ ~quipm~tt as descdb~d ~ m~ iflt~u~ ~ ~ ~Dli~ ~ on t~ a~ ~Dllcat~n num~r in t~ premi~s of
ye~er U~K, private fa. A~UU--J/O N~W Hirer ~d., O~ient, L.I.
in thefollotvlnglocatiqft; [] Basem~n..~ ~l~t '
~l. [] ~,d FI. 3rd fl outside Section ~l,~ L~t
and fou~ to be ~n compliance with the requirements of th~ B~rd.
FIXTURE ! A [ FIXTURES
1~ ~2 19 [ 19
DRY~RS FURNACE MOTORS FUTURE APPUANCE FEEDER~
AMT. K.W. OIL H. P, GAS H.P. AMT. NO. A.W.G.
RANGES
SPECIAL REC'PT.
EXHAUST FANS
DIMMERS
500MCM
Eleotrlo ~Oom hea~er/s: I-2.Skw, q-2.0kw, 1-1.25kw, Ll-l.0kw, 2-.75kw
500MCM
Theodore Rohlo ff
Orchard Street
Orient, L.I. 11957
GINERAL MANAGEJ~ ~
1 ~/
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
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