The URL can be used to link to this page

Home My WebLink About9540-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy NOl Z10566 July 9 81 Date ................................. 19... THIS CERTIFIES that the building ................................................ 19105 Soundview Avenue~ Southold, New York Location of Property ............................................................... House No. 5 1 ~tree! 1 ? Harnle~; County Tax Map No. 1000 Section ............ Block ............... Lot ................. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated November 4 77 9540 Z ..................... , 19... pursuant to which Building Permit No ...................... dated ...... .N.°.v..e.m.b.e. r. ~ .......... 19..7.7, 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 ......... A Two Story Addition with Deck to Existing Dwelling Anthony and Helen Marshut The certificate is issued to ..................... [o~,n'e'r,'/~C~Xxx .................. of the aforesaid building. Suffolk County Department of Health Approval .......................................... N392904 UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 (THIS PERMIT MUST BE: KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. §Sz]O Z Permission is hereby granted to: · .......... ~p.~.t;~.l~.....~.:.~... ..................................... to huJ-ld...an..e~Idit ie~.,on,.e~iati~..d~t Li~g,,,(.c ont:Jm~-, f~cilitY*m'Io''~e'''rem°ved from existing part) ot premises Iocoted ot ..~,~.....~O...~.e~..P~V~ ............................................................................ Southold ~.Y. ............................................................ ........................ ~Q.Y ........................ , 19...~.~., and approved by the pursuant to ~pplication dated , b. Building Inspector. ~e, $....~.~.~a ........ FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate 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 s~milar 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 peopertv 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. 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 Date ...... G/. /?.. .~.//.~.'~/ .......... New Building ~ Old or Pre-existing Building Vacant Land House No. ~,~/ Street Flamlet Owner or Owners of Property . .~ ~..~.~: .~,.~/.../.. ly~. ,~../..~.c.t.. ~.-~'.J. ~ ~.~, ?..~. .......... County Tax Map No. 1000 Section ...%~../..../. .... Block .../. .......... Lot .... ./.'?. ........ Subdivision ................................. Filed Map No ........... Lot No .............. Permit NO..~.~'~ .~.d).... Date of Permit/.4/.~/..'"~ .Applicant..,~.G.'~..~. ~)~'.',~.. ~/'~. ¥~..~.~. ..... Health Dept. Approval ........................ Labor Dept. Approval ...~,~.~//~ ............... Underwriters Approval ~..Z~...~.?.~.~(?. .......... Planning Board Approval..~././/4~..~. ........... Request for Temporary Certificate ..................... Final Certificate .... ~ ........... ,~,~, ~,~ Fee Submitted $...~,~... ...................... Construct on on above described building and permit meets all applical~e codes and ragu lations. Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY Jul*'/ 5t iq78 85 JOHN STREET, NEW YORK, I~ ~(~i~K 1003B THIS CE;IFIE$ THAT 1st FI. ~ 2nd Fl. 0 U ~¢ ~ ] d o S~ction Block Lot and found to be in compliance with the requirements of thgs Bo.rd. FIXTURE ~11 RXTURES OUTLETS ENT FLUORESCENT ~v*"~'r 22 4O 31 DRYERS FURNACE MOTORS FUTURE APPUANCE 4 F SERV~E ~N~T I NO. ~ I ~ I ~ C~ MET~ XW OTHER A~ARAT~: Smoke detector O.F.C.I. RANGES t .30 OF CC. COt4D. EXHAUST FANS I F DIMMERS Selvetore C. Praqo Wlg~lns Lane Greenpor,, L.I. LIc, This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUSt" NOT BE ALTERED IN ANY g~II~INER. TOWN OF SOUTHOLD /~ ~--' v~ BUILDING DEPARTMENT ~/..~z,~ / ~ ~/~/-~)~---~ TOWN CLERK'S OFFICE ~/, . ~/~d~ SOUTHOLD, N.Y. ,/,~h ~ ~l~i~,-- , .......... , , ZZ. I=×,'.mined ...................... ., Applicofion No.....,(..Z .............. .,. ....... A~pr.ed .............~'. ....... '~Z ............. , ]9.22 PemitNo. ................................ 9,' Disapproved o/c ............................................................................... ~ i,"" ~~. ................................................................................. · ................................ · ......... ................. INSTRUCTIONS ~ a. This application must be completely filled in by typewriter or in ink and submitted in triplicete to the Building Inspector, with~ 3 sets of plans, accurate plot plan to scale. Fee a~ording 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 layout of property must be drawn on diagram which is part of this application. ¢. The work ex)verad 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 one' the premises available for inspection throughout the work. ~J e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have bee n~- 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 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 code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................... ......................... Name of owner of premises ........... ~~.~i~/.4~..~.. ............................................................................. If applicant is a corporate, signature of d61y authoRzed officer. ~Name and title of corporate officer) [~oo ~ ,~'( - I -- ( 7 Plumber's License No ......................................................... Electrician's License No ..................................................... Other Trade's License No ................................................... ~/~ 1. Location of land on which proposed work will be done. Map No ............... x.....~. ...................... Lot No...'...~ ................. Street and Number .................. ~.~.~z~.L....:~/...~..: .......................................................... ~Z5 .............................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............... e;'-~ -- ____ "'~r~?'~F'6~'~'/'~r' '/~" ....... ~....~.,,~. ....................................................... b. Intended use and occupancy ............. '.~./..~.~...~'/.4~z~.......~~ .............................................. 3. Nature of work (check which applicable): New Building ....................... Addition ..................... teration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .:; ................................ 4. Estimated Cost .. ~..~. ....................... Fee ................................................................................................ (to be paid on filing this application) 5. If dwe)ling, number of dwelling units ..... ./. ......... Number of dwelling un,its on each floor ~ ...... If garage, number of cars ........................................................................................................................................ 6. If business, commemial or mixed occuoancy, specify nature and extent of each tyPe of usa ..................................... 7. Dimensions of existing structures, if any: Front ....... ...~....! ...... 2o t Rear ........................... Depth ....... --.~..- .......... .~ .... Height ........................................................... Number of Stories ..,....,./. ........ ? ...................................................... Dimensions of same structure with alterations or additions: Front ....... :....~....Z::. ....... Rear ......... .~.....~..../ ............. ; ....... Depth .............. ~,~. ....................... Height ......................................... Number of Stories ........ ~... ........................... . 8. Dimensions of entire new construction: Front ....... ~....Z::...!....~... Rear ......... ~.. ............... Depth ~-~'/ Height ................................................. Number of Stories .............~.. ........................................................ 9. Size of lot: Front .......... /¢~.~...:. ............... Rear .......... ................... Depth ............ .-~m~'.~...~.'''--'''''''''''' 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or usa district in wh. ich premises are situated .......... ~/..~...~...~..j~'../..~....~:.. ....... ~ ........................................... 12. Does proposed construction, v)olate~/, any zoning law, ordinance or regulation: ......... ~f.~.. ............ 7-7" ..................... 13. Will lot be regraded .... ~....~....._..: ........ .,.. Will excess.fill bp~removed from premises: [ -] Yes [~4 No (Address) ~ ~ ~ _ (Address) (Phone No.} Name of Contractor ........ ~?.~.~'.~......~..~..~.~..~.., ........................................................ ........... {Address) {Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposd~tnd red,cate all sat-back d~mensionS 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, ) COUNTY OF ................. ;~ ................................... i "~ ............................... being duly sworn, depo.~s 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 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. ,% ~ NOTARY PUBLIC, State of New York No. 52-4643121, Suffolk Cou~ ../--~ yof ,19 ~ (Signature of applicant) _i t