HomeMy WebLinkAbout9579-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
UPDATED
CERTIFICATE OF
No Z-26771
Date NOVEMBER 3, 1999
THIS CERTIFIES that the building DWELLING
Location of Property 645 J&~-K~ON STREET
House No. Street
County Tax Map No. 1000 Section 117 Block 9
Subdivision Filed Map No.
NEW SUFFOLK
Hamlet
Lot 5.2
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated DECEMBER 8, 1977 pursuant to which
Building Permit No. 9579-Z dated DECEMBER 8, 1977
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 ONE FAMTL¥ DWELLING WITH ATTACHED GAI~AGE AS APPLIED FOR*
The certificate is issued to
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO. N-519332 - MAY 6,
PLUMBERS CERTIFICATION DATED
ERIC H. & JOAN C. S~AW
1981
N/A
*NOTE: THIS UPDATES CO ~.-10609 DATED/~ 30, 1981.
- Building Inspecto/
Rev. 1/81
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Off ce ~)f the Building Inspector
~ Town Hall
Southold, N.Y.
Certificate Of Occupancy
Z10609
Date ........ .d.u.~.y....3.0 ................ ,19 .$ '.l
THIS CERTIFIES that the building ................................................
L ..... 645 Jackson Street, New Suffolk, N~w York
oca[]on oI Froperty ........................................................
/~$us'e No ' Street Hamlet
117 9 5.2
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
December 8 77 ~
..................... , 19... pursuant to which Building Permit No ..... 9.5.7.9..Z ..........
December 8 77
dated ............................ 19..., was issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for which ti,As certificate is issued is .........
Private One-Family Dwelling
James G. Dill
The certificate is issued to ..................... [o~n'e'r,~e~x'~'X' ..................
of the aforesaid building.
Suffolk County Department of Health Approval N/R
UNDERWRITERS CERTIFICATE NO.. N519332
Building Inspector
Rev. 1/81
TOWN GLERK'S OFFICE
$ouTHOLD, N.. Y.
BUILDING PERMIT
N? 9579 Z
(THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Date ........................................................ , 19 ........
Permission is hereby granted to:~(~..
........ ~.~. ...... ,..r.. .................. :y~ ..........
.............................. . .......... ~rz~~"'~':: ..............................................................
at premises Iocatea at .............. ~ .................... ~ ..................... ........................................
....................................................................... ~c.'..~:.:...: .....................................................
........................................ .~ '~ ................
.................. ~ ....~; ............. ~ ..........................
pursuant t a hcat~on' ated ................................... , 19. and approved by the
Building Inspector.
Fee $ ........................
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, ~ndustria~ 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.
For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses'.
1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or
topographic featu res.
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.
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or land use
3. Copy of certificate of occupancy $1.00
$5.00
Date .... ¢7~ .'~. ~. ~.). .............
New Building .... X ....... Old or Pre-existing Building ............ Vacant Land .............
Location of Property .....
House IVo, Street Ham/et
Owner or Owners of Property .. ,~. ~..~l.~..& .... ¢~... , ~ !').1 ....................................
County Tax Map No. 1000 Section /'/'Y ~ ~-~ .,~. ;~..
............... Lot .....
............... Block .....
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit ,o. ~'~.. XZ-Dato of Permit .....................
Health Dept. Approval .......... ~.', ........... Labor Dept. Approval ........................
Unde~riters Approval.. ~ .~:~L ¢~ .~ ....... Planning Board Approval
Request for Temporary Certificate ..................... Final Certificate
Fee Submitted $ ...........................
Construction on above described building ar{d.[
Applicant . .~. ~~
Rev. 10-10-78
~mit ~eets all applicable codes and regulations.
..................................
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
st be filled in by typewriter OR ink and submitted to the buildin
Che following: for new building or new use:
1. Final survey .property with accurate location of all buildings, property linea
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 build~
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 a
'!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 applicar
If a Certificate of Occupancy is denied, the Building Inspector shall state the
reasons therefor in~rriting to the applicant.
C. Fees
1. Certificate of Occupancy - Mew dwelling $25.00, Additions to dwelling $25.00,
Alterations to dwelling $25.00, Sw~ming pool $25.00, Accessory building $25.00~
Additions to accessory building $25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Buildinm - $100.00
3. Copy of Certificate of Occupancy - ~ .25~.
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15200, Commercial $15.O0
UPDATED CO to Date ~ovembe~ 3~ 199~
JlefLec~garage and dwelling are covered
New Construction ...... o±aor cre-en~isting Building .................
of Property &~5. j~o~us~ $~ . ' ' Hamlet
Location ....
House Ho, Street
Onwer or Owners of Property .... ~r~c.t~. ~h~w. BB~.JO~D.Q,.$b~W .............................
County Tax Map No 1000, Section ............. Block ............... Lot. 5.2
Subdivision ................................... Filed Map ............ Lot .................
permit No ................ Date Of Permit ................ Applicant
Health Dept. Approval .......................... Underwriters Approval
Planning Board Approval ........................
Request for: Temporary Certificate ........... Final Cer~icate ...........
Fee Submitted: ~ ............................
~ARY FLANNER OLSEN,
P.O. BOX 706
CUTGHOGUE, NY
c, '75 ¢'4C,.~0, I:: 100. 41
' EXI GTI l,.l~ '
I~T. FI~.
I
I
ME-W F'~NIC P-...
EY, I~T'JI, J~
/ I~T. Fff-., t I
I , COTT'A~ To' i /
i/
THE NEW YORK BOARD OF FIRE UNDERWRITERS
[~:~ BUREAU oF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 10038
9~0160 - 78
THIS CERTIFIES THAT
only the electrical equipment as described bel~ and introduced by th~ applicant named on the able application number in the premises of
irt the followlng location; ~ Basement ~ 1st I,'1, ~ 2nd FI. Section Block Lot
was examined on ~.J~r ~ ,~ q,,2~' 3~ ] and found to be ia compliance with the requirements of this Board.
FIXTURE
OUTLETS SWITCHES
FIXTURES RANGES COOKING DECKS , OVENS
INCANDESCENT FLUORESCENT VAPOR
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEOERS TIfl6ECLOCK5
DISH WASHERS EXHAUST FANS
FAULT~-OUTLET DIMMERS
SYSTEMS
NO. OF FEET
SERVICE DISCONNECT S E R I
' 1 3/0
OTHER APPARATUS:
A, WG
OF HI-LEG
This certificate must not be altered in any manner; return to the office of tl~e Board if incorrect.
GENEI~At MANAGER
may be identified by their credentials.
IN ANY MANNER,
PlASF--..~MATId. FbOOl~ pLAiXl
TOWN OF SOUTHOLD ~~/.~ ,.~~
"UILDING DEPARTMEHT
TO~N CLERK'S OFFICE
~.:.~:......:~ , ]9..:?// ~UTHOLD, H.Y. ~~,~/
Examined
~i~a~r~d ~[~.~ ...........................................................................
..................... ......
.......................
.............. ...... ...............
a. This application must be completely filled in by ~pewr ter o~ in ate to the Building~
Inspector, with 3 sets of plans, accurate plot plan to ~ole. Fee according to s~
g g a a aescnp~mn or myout otproper~ must ee arawn on the diagram which is pa~ 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 o 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 Jn whole or in part for any purpose whatever until a Ce~ificate of Occupancy
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of o Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os herein described.
The applicant agrees to comply with oll applicable lows, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and ir~ buildings for necessary inspections.
.... % ......................
(Signature of applicant, or nome, if a corporation)
(Adyr?ss of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
.......-.
................................... i?" .................. ~' ........ ~":',:7T'~:7",i ..............................................................................
Name of owner of prem ses ..:..~..'~..~....w~..~ r. .k%~. , '¢~ .~/ ¢;((. I/.~! ~
If applicant is a corporate, s~g'nature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No. ~'~
Plumber's License No .................................................
Electrician's License No ............................................. ,
Other Trade's License No ...............................................
1. Location of land on which/~ roposed work will be done. Mop No.: ...... ~ ......... ~....~....,. Lot Nor.~.. ......................
Street and Number .~'.¢..~ :.~..~? ~ .~..~..c~..*..:~ T~.:?.'.' .~.~._46~,¢'
~:' ..... Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Exisiting use and occupancy ~..: ._~¢JL
...............~/~i-~,i ..... :77/ ........ ~': ........................ /:,,o~ '~.'~"~ ....................................................
b.
Intended use and occupancy ........... ~ ....... ~ ..... ~;.~; ................... .,,m..;.....,7...~..~ ...........................................
N
3. Nature of work (check which applicable): New Building~. ................. Addition '~"~ ~AlteratJon
Repair .................. Removal .................. Demolitior~ .................... Other Work ................................................ ....
(DescripHon)
4. Estimated Cost .......................................... ~ee .../ ....................................................................................
(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 .................... Number of Stories ......................................................................................................................
9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................
10. Date of Purchase ........................................................ Nam~ of I[ormer Owner ........................................................
]]. Zone or use district in which premises ere situated ..~'~t;~..~.?, ..............................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: ....... .,~...?;? .........................................
13. Will lot be regroded ...... ~..~.....^..... Will excess fill be removed from premi§gs.~ (~,_ Yes ( ) No
14. Na me of Owner of prem,ses ..'~/.,....t~--,b~....~,'k .......................... Address .................... Phone No .......................
Name of Architect .............................................................. __~r/ ,*-- .~r-- Address ....... ~,~, r-/,'//~'.~-/'"7'"?'/'~"'~'-'"' Phone No .......................
Nome of Contractor ...~.'.,~.)~...~.....~.~..~..~.-~:.~.~:r. ............... Address .....~..~..~....'..~.;.,.. Phone No
PLOT DIAGRAM /~'
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frore
property lines. Give street and block number or description according to deed, and show street names and indicate
whether interior or corner Iol.
STATE OF NEWcY~I~/,/~ ~S S
COUNTY OF ..'.>~:~.':....~,,.. ' _~ ~'
.......................... ~Z~ffr~2:i~i~'..~'..~.~:~ .............. being duly sworn, deposes and says that he is the applicant
(Name g( i~(vidual signing contracf)
above named. ~2 ~
He is the .................................... ~: ..~J;Zf.J~JKZ..~ .....................................................................................................
(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
th;s application; that all statements contained in this application ~,true to t~st~f his knowledge and belief; and
tha~ the work will be oerformed in the manner set foffh in the appear]on filed t~er~.
Sworn to befoqe me th'iis ~r ~. ~ [ // x-~//~ ·
..................... /
........... ....... ...... .............................