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HomeMy WebLinkAbout6176-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20246 Date SEPTEMBER 26r 1991 THIS CERTIFIES that the building Location of Property 1663 BRIDGE LANE House No. Street County Tax Map No. 1000 Section 118 Block 2 Subdivision Filed Map No. ADDITION CUTCHOGUEr N.Y. Hamlet Lot 3 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 11~ 1972 pursuant to which Building Permit No. 6176-Z dated OCTOBER llr 1972 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 ADDITION TO EXISTING ONE FAMILY DW~T~,ING AS APPLIED FOR The certificate is issued to JAMES L. GRAY (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N-159345 - MAY 14~ 1974 N/A Rev. 1/81 ~0~,~ NO. ~ TOWN OF SOUTHOLD BUIL~DING 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) N? 6176 Z Permission is hereby granted to: ........... ~.~.~,,~...~...~.~,~. ..................................... ................ ~,~&ii~..l,~ .......................................... to ~;L~ ..~...~,~.d..S,.~lo~..aU...~i~.t. il~li...c~.eLl~.ug ........................................................... at premises Iocnted at ........;LO~..:I.I.1 ............ tga~.ila,~..P~..-~'$~ ............................................. ............................................ ~t<~e...~ .............. (~e~.o~e .......................................................... pursuant to application doted ............................... 0¢.~.....~.1~ ........ , 19..~'~., and approved by the Building Inspector. Fee $...'!;~,,0~ .......... TOWN OF SOUTHOLD luiMing Detmnmem Town Cledm Office SouthoM, H. Y. 11971 APFLICATION FOR CERTIFICA'r~ OF OCCUPANCY Inltructiom A. This application must be filled in typewriter OR ink, ond 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 oil buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage dlspcsal---(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 opplioable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey o; property showing oil property lines, streets, buildings and unusual n~ural or topographic features. 2. Swam statement of owner or previous owner os 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. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 ~ ~ 3. Copy of certificate of occupanCy $1.00 ,~,~ I ~ / ~ 7~ ./ Date ...~...~/*'1'"~'"~'~"*']' ................ .~.~( New Building ...... ~.. ......... Old or Pre-existing Building, ........................... Voc~e~t Land ............................ Location Of Property ..,f~.~'./../.~'~..~.. .......... ...~......~...~..~...~..~...?.~.~,~. ................................................... ner r ner Pr ..~'~.Z~..~.~'~ ~..~ ~.....~...~ / /' ~ ow o s ........ ........ ........ ........................................... Subdivision .... ----~../......~....&~.~.~..~. .................. Lot No....~.....-- Block No ............. House No Permit No....~../....7.~...../~Date Of Permit ...~..~..~,/Z'.'~'~Applicant ..4.,/,f1~,~--C1~.~..'~...~..~./~.~..~...~.~...~.~.. ..... / Health Dept. Approval ..~;..~.~."~..~.........~...~ ...... Labor Dept. Approval ...... ../~...~..~... .............................. Underwriters Approval .... ..'~..~....~ ...... .7...~.. ...... Planning Board Approval ..... .~....(...~... ....................... Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ....... . .~....-~... ................ on and t meets~al~oplicable codes and regulations. Construction above described building ~ Applicant ...... ~7 ..... "" ....................................................... Sworn to before me th/)e~ ~ ~<'~ ...LL...3.... .......... · ~.... day of ....~ (stamp or seal) ~ 7~~-'- Notary Public .................................... County ~/x'~ e'~ O Form No. 6 TOWN OF SOUTIlOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. ~ For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy -New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 SEPT. 26, 1991 Date ......................................... "~ ti 01d ildi .,ew Construc on ........... Or Pre-existing Bu ng ................. Location of Property 1663 BRIIM~ I4k~E UU't~HO(~E, ~.Y. House No. Street Hamlet ,)nwer or Owners of Property JAM~$ GRAX ,, 118 2 3 ,.ounty Tax Map No 1000, Section .............. Block ................ Lot ...................... :;ubdivision .................................... Filed Map ............ Lot ...................... N- 6176Z ~ _ 10/11/72 JAI~S L. GRAY ~erm£t , o ................ race Of Permit ................ Applicant ....... {ealth Dept. Approval .......................... Underwriters Approval ......................... 'lanning Board Approval ',equcst for: Temporary Certificate ........... Final Certicate ........... ~ee Submitted: $... 25.00 ..~~... ~~ ' . .......... //- .................... CO~ ~Oc~ I~.~ CAN TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ~ "~ ~ ~/%t Disapproved a/c ...... ~,,. ..... ~ ............ ~ ....................... ~'"' ........ ~ / . . ' 1' ~*~ ................................................................................ ; ................................. ...................... ................... ...... (Bui aing nspector _ APPLICATION FOR BUILDING ~ERMI'r;~,~,..~t ~./,~/?~'~ ~ote ............. ~..../.[ ............... , ~.~. ~ '/~/,.~, INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, wi 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, a~ giving a detailed description of layout of property must be drawn on 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 dn 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 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, Suffo[l~ County, New York, and other applicable Laws, Ordinances or Regulations, for the construction bf buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable law% ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. "(Signature of applicant, or name, ' a co';~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder;- ................... ................... i ......................... : .................. Name of owner of premises ............. ~...-~.....E......'~,.......~T....:....,~.....~......J~...~.. .................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which prolE)OSed work will be done. Map ..o., ~/~_.._._.__ Lot No......_ _ .................................. Street and Number ....................... ~..~......~ ................'......~. ...... ..'-~..z. 4..,..~.~.~. ................... .....'.............. ............. /Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........ ~ .................................................................................................................... Intended use and occupancy . ...~....~_....G'.. .................. ' .... .~ ~.~ll~ of work (check which applicableS. New-Building ....................... Additio~ ...i.ii...~. Alterafi~ ..d~...~,~... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) Fee .~ ..................................................................................... 4. Estimated Cost .,.,,,~,,,,,,7,,?,..¢~,,, ,~,, ................... (to be paid on filing this application) 5.If dwelling, number of dwelling units ...... L ........ 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 Wpe of usa ..................................... 7. Dimensions of existing structures, if any: Front ..L..7-~....~.,.,~..... Rear .....~....~.....~...~. ....... Depth ......~......~;....f. ................... Height ..... ,~..o~... ........................................... Number of Stories ..........~ ............................................................ Dimensions of same structure with alterations or additions: Front ....Z'.....~:x...~.....~ ..... Rear ! ~--4' / Depth ....... ~..~..~.. ............................ Height ........ ~ ........................ Number of Stories ~'- 8. Dimensions of entire new construction: Front ....~ .................. Rear ...... ..~:....~..;. ............ Depth .....~'.~ ....................... Height ................................................. Number of Stories ......................................................................................... 9. Size of lot: Front ....~1~......~. .............. Rear ....... ..~.....w~....~...../. ................ Depth .....'~.....~..~..~.....~ ............................ Height ........................ .~ ...... ~7~ .......... Number of Stories ...................................................................................... 10. Date of Purchase ....~..~...~......~.._?. ........... Name of Former Owner ..~.~......~..~.....~'..~......., ..................................... 11. Zone or usa district in which premises are situated ...... ~..'...~.~.- ....................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ~..~.. ............................ ,, .............. 13. Will lot be recjraded .... Z~....~. ................ Will excess fill be removed from premises: [ ] Yes [~No 14. Name of Owner of premix'es ........ ~/~....~...~....~......~...:.....~...~..~..~......~.......~:~....~.~.....~.....~......~.........-~..~.~ ......... , /. __ , ~ (Address) -- nel(Pho e No.) Name of Architect .. ',~?../~....~'...~..~...~...~...~..?..~,........../~..~....~..,,,,~.../.../.?....~,,~..~.....Z~. ............ ..~......~.~....~.......~...~...'-~...~ ..... (Address) (Phone No.) Name of Contractor .......~...~.~...'~... ................................................................................................................. (Address) (Phone No.) /~ PLO~~C- .~.~ Locate clearly and disti~:tly all buildings, whether ex,sting or 'j~b~ all sat-back dimensions from aprr ,OntPeerirtYo~inoreS;oGr in~er ,Stotre. el/~3d~loc~ number ~,~esaription accord'm~l~?~ow stre~.~ ;nd indicate wheth- STATE OF NEW YORK, ) ~ COUNTY OF ......................................................) ~ ............. {Name o. findiv~duai"*ignin~ontract) being duly sworn, deposa$ and says that he is the applicant above named. He is the ................................................................................................................................................................................................................. {Contractor, a~ent, corporate offwer, 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 application filed therewith. ...................................... day of .................................................. 19 ............. /~ , . .. ~'~ ~ . / · 1. ,E. (Signature of applicant) THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY" ' ~ ~ BN BB JOHN STREET, NEW YORK, NEW YORK 10038 ,,.,. N 159345 THI~ CEEIFIES THAT only the e~t~M ~uipment ~ ~se~ ~ a~ int~ by t~ ap~t ~m~ on t~ ~ appl~a~ numar ~ t~ p~m~ o~ J~es L. Gray, s/w end Bridge Lane, Cutchogue, L~I. inthef~lo~ingl~ation; ~ B~ement ~ lstFL ~ 2~ FI. garage, outside ~,io. ~exami~on May 10, 197~ a.dfou~tobeln~mpliancewithtaerequirementsofth~Boa,d. F XTU~ / I I RXTURES I RA~ ~C~KIN$ D~KS I OVENS I DISH WASHERS EXHAUST FANS ~ /~7~1 ~. ~ I ~o I' I ~l"'~ z~9'~l ~RVlCE ~N~ ~ NO. ~ ~ S E R V I C E 3 200 CB I x 2 500mcm 2 500mCm ITHER ~ARATUS: i~naces: ~-[/Bhp, 5-2/~hp *F~e App. Fee~e~s: [-3~6, E[ec. ~om fie~e~s: 2-3.0~ ~-[.0~ ~,~o~o~/s. h-2i?, i-Ibp, [-[/~hp Ya~e[bo~=~/~. [-[Be~r. [25~mp) [-2c~r. [00~p, [-2~c~. [25a~p~ [-[2c~. [00amp 1-10amp garbage compactor Gray Electric Inc. 29 Seabro Ave. North Amityvil!e, New York llTO1 1-5cir. 70amp, 1-12cir. Per COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BI: ALTERED IN ANY MANNER.