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HomeMy WebLinkAbout7906-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall $outhold, N.Y. Certificate Of Occupancy No.. $.1.0.8 1 2 ......... Date ....... .lq.e.c..e.m.b.e..v..1.1 ............. 19 .SJ. THIS CERTIFIES that the, bml&ng . { p 0.02.. &..f.~n¢ e..~.r~¢ J..o.s.u ~'O J ................... House No, Street Hamlet County Tax Map No 1000 Section ...0.31 ..... Block ...1.3. .......... Lot .. 9.0.?. ........... Subd,vision ........ X ................... Filed Map No...X...:..Lot No...X. .......... conforms substantially to the Application for Bmldmg Permit heretofore filed in this office dated .... :.~.a:y..(.~ ........... 19.75. pursuant to which Bmldmg Permit No...7.9.0..6..Z. ............ dated ..... ?l.a.y.. 9 ................ 19..7~, was ~ssued, and conforms to all of the requirements of ti~e apphcable promsmns of the law. The occupancy for which th~s certificate is issued is . .a.n. ..... The cerHflcate is issued to ....... .V.&QlCy..P. 2 p$.o.n, .~ .tgt.v.r.o..1.a.k.e.s. ....................... (owner, I~a,o,, of the aforesaid building Suffolk County Department of Health Approval ..... }] 4'~ .................................. UNDERWRITERS CERTIFICATE NO ............ N. 5..4 ~.8.9. ! .............................. / Bmldtng Inspector Rev 1/81 FO]tM ~O. 2 TOWN OF $OUTHOLD BUILDIN~ 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) 7906 Z Permissi°n is hereby granted to: aeaboar~..O~..~+,T,,..,l;ne.....A/C..¥ ~.* ~tavolakos ........... ~.~.--.-I~_ _ ~d -~ng-.Road ............................ .................... · ae:lFa ......... -R,,.¥,, ......................... t o .build.. aec.. ~ ~l. va. te-.. (- J~-t~eun~ .)...s~..po o~'. ~1 ~h.-~e ~e ~'s oryw"&"f e~e lng ..... &n..~e~ul~ed, ........................................................................................................................... at premises located at ..... ~/~.-.-I~s~-/~l-.~Ol~ .................................................................................. ................................................................. ~..~e~io~ ...... J~...~. .................................................... pursuant to application doted ......................... ~. .......~ ............. , 19.~.~.., and approved by the Building Inspector. NOT~I Undertn*lters eer~;tfteate reqtttred £o~' C/O Fee $.~.~ .......... credit $ ~.00 ~or C/O ............. ~uii~/i;;'~"&~ ..................... FORM NO. 6 TOWN OF SOUTHOLD Buildin~j Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCC Instructions A. This appl~cauon must be filled in typewriter OR ink, and submitte¢ tor with the following, for new buildings or new use: 1. Final survey of property w~th accurate location of all buildings, natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disp 3. Approval of electrical installation from Board of F~re Underwr~te 4. Commercial buddings, Industrial buildings, Multiple Residence. t~ons, a certificate of Code compliance from the Architect or E 5. Submit Planmng Board approval of completed s~te plan requ~remer~ts~here ap~lTc~bf~. ~ --- $5.00 ......... New Building ............. Old or Pre-ex~sting Budding ............ Vacant Land ............. Location of Property IJ..Z..o. ......... ........... Owner or Owners of Property . .~. .k,.~. .~.I:~:~(T',~... ~'C.~ ~ County Tax MapNo lO00Sect,on ..0,,~.~ ...... Block .......... Lot...QC~...~..... Subdiws~on - .Filed Map.No, ,. -"-"--- .Lot Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planmng Board Approval ...................... Request for Temporary Certihcate ..................... Final Certificate Fee Submitted $..k~.,. ....................... Construct,on on above descr,bed bu,ld,;l~ a%per~,~ applicable codes and regulations. Applicant~tN~N~ ~ v' Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-exmtmg dwelling or land use 3. Copy of certificate of occupancy $1.00 For ex~sting buddings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses' 1. Accurate survey of peoperty showing all property hne.s, 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 requtred to prepare a certificate. BUILDIHG DEPARTMINT TOWH CLmC'S O,'P Examined ..... ......~.~.......~.~ ..... 19..2.~. _, ~_, _ Application. ~o.~.....~.'~. ......... :~"'~'""i;" Approved ................ .U.. ............ .L...., 19.../..~. Permit No....~....a'..,..~:~ ............ APPLICATION FOR BUILD'lNG PERMIT INSTRUCTIONS .~ a. This application must be completely filled in by typewriter oe in ink and submitted in triplicate to the Building Inspector, with 3 set~ of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing Io~ati°n of'lot and of buildings on premise~, relot~onship to:edioining premises or public streets o~ areas, and giving a detailed descriptlOn of layout ofpraperty must be drawq on the diagram which is part of this application./~ c. The work covered by this applicati°n may not be ,commenced before issuance of Building Permit. ~j~ 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 been granted by the Building Inspector. APPLICA~'ION I~S HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone OrdinanCe of ~.he Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the ~-onstruct~on of buildings, additions Or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing cnde, and regulations, and to ndmJt authorized inspectors on premises and in buildings for necessary inspections. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....~.1. ....... ~...~.,,,~.~....~../~w,~.~,.,~.... ................................................................. if applicant is a corporate, signature of duly authorized officer. ........ ii Plum~rs Licen~ No. ~.~...~E. .................... Electrician's License'No ............................................. Other Trnde's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot,No ......................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended use al~ld OCcupancy ....... o ~ ............................. 3. Nature of work (check which applicable): New Building./r..~. ............ Add,t~on .................. '~1 rat~on .................. Repair .................. Removal .................. Demolition .................... ~Yd'me-l~k/e~ ,~....~....?.....~... ~...r .~......: ........ ~ ~ ,~ : 1(Oescript.on) 4. Estimated Co~t' ...~...~.?..~ ...................................... Fee .~..~...~......~'........~......,~....~?..~/. ...... ..~....,........'~'.....~.'.:....C~.: ....... ; ....... (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 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 ,~/ ................................ Rear ~.~ .................Depth ................ ........ Height .................... __., w .~.Numb'er of Stories ......................................... __~ .~.7 ........................................................................... 9. $tze of at Front ~....~..~........~--'.. ..................................... Rear ./../.~........'~... ......................... Depth ./.~....~.~.~..~...~.. .... 10.c'~' Date of Purchase ................. .~ ...................................... Name of Former Owner ....................................................... 11. Zone or use district in which premises are situated ................................................................................. -. ................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ~.. ....................... ; ........................... 13. ~/Vill lot be regraded ............................ Will excess fill be removed from premises: (') Yes ( ) No _ 14. Name of Owner of premises ~.e..~..,~J..V.~;~r....A'.~-~ ............... Address ;~',,,.~lg~,~. ........ Phone No. ~..~..~.7../.~... Nome of Architect/~..~..~.~..~--~..~./~;~,T...~.~....~-~...'~ -- .......... Address ./.~1~.~ ~J~/" ~,.~¢~ ....... .Phone ¢~V/ -,-~,'o PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ~xisting or proposed, and indicate all setdx!lck dimensions from property lines. Giw street and block numoer or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF NEM/YORK, I c c COUNTY OF .. ........................... ~f~ ' ' .... "~...~..'/~. ,. ..~=~..... .......... ~. ~ d~,says t~t he is the applican, .......... ~g ~ly sworn, . (Name of i~ividual signing c~tra~ above name. He is the ........... ~~ .................................................................................................................................... ;.. /(Contractor, e~t, co~ora~,~fficer, etc.) of ~id owner or ~ners, and is duly aut~rized to peHorm or h~e perfo~ed th~ said work and to ~ke and file this application; t~t all statements contained in t~s application are tree to ~e be'st of his kn~ledge and belief; and tha~ the wo~ will ~ per~rmed in the manner set f0dh in the application fil~ t~r~h. Swam to ~fom me this~ ' _ . ' ............ ~ ............ ~y ................... , ........ Nota~ ~.,~e~. ~n~ ................ ~ No. ~4S~131 _. /I (~igna~re ot applicant) ~erm ~ires March 30~9~' ~ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY · l.t'~ ]L~]. 1~5 JOHN STREET, NEW YORK, NEW YORK 10038. .ate Ap. licat,.n ~o...fie 149864-81 N 5 4 4 8 9 1 THIS CERTIFIES THAT only the electrical equlopment as c~s~rjbed helow a~d jntrodu~ed by_ tlw. applic~t~med on the a~we application number in the prem/ses of was examined on and found to be in compliance with the requirements of this Board, FIXTURE OUTLETS RECEPTACLE~ SWITCHES FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS FLU~ESCENT DRYERS FURNACE MOTORS FUTURE AI%~JANCE FEEDERS TIME CLOCKS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT S E R V I C NOOF CC. COND. A.W.G. NO. OF HI-LEG A.W.G, ~O, OF NEUTRAL5 A.W.G, PER ~' OF CC. COND. Of HI-LEG OF NEL/TRAL OTHER APPARATUS: Vicky Iai,son SCax-zolakea, P.O. Box 1343, New~, Cc., O6840 This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. © @ ® T."( P I C/~L SEABOARD POOLS~~. I~