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HomeMy WebLinkAbout11592-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. g..~ .1.0. Q2. ...... Date ...... .H.a.g, .2.0.. /.... ............. 19 .8.2. THIS CERTIFIES that the bail4iag .. po~al ....................................... :. Location of Property . .1.~ 6 ~) ............... T. h..e..~.r.e. ~ .c.e.n..t. ....... ~A~. t... ?I.a.r.i..o.ri.. House No. Street ...... Hamlet County Tax M~p No. lOO0 Section . D~Q ....... Block .. D2. ........... Lot . ...0.~ .......... Subdivision. Pe.hble..se~cb..Eavr~ .... ~...Filed Map No. 6~.6.~...Lot No...~ ......... conforms substantially to the Application for Building Permit heretofore fried in this office dated ·.. ~lar. ch. 22. ........ ,19 82. pursuant to which Buildin~ Permit No...~.~59~..~ ........... dated .... ~ar.¢h. 2t5. .............. 19. ~2, 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 ......... · .. ~p..t,r~r~.u.r~ .d..s.~:~r~n.~.q~. p.o.q ~, .............................................. The certificate is issued to ........ .~.q 3, ~' gRrl ~. [I.... G I; ~3, .............................. (owner, lemae.m, ea~a~) of the aforesaid building. Suffolk County Department of Health Approval ... ?./.a. ................................... UNDERWRITERS CERTIFICATE NO ..... ~. 5 5.7.5.~ O ................................... Rw. 1/81 BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. ~ BUILDING (THIS PERMIT MUST BE KEPT ON TH,E PREMISES COMPL~rlON OF THE WORK AUTHORIZED)- , · UNTIL F~LL ..~..~.l~.. 19 Date Perm~ssiomls hereby granted tO> ..... ......~.~.~./.x~ ............... x~/~ ~ .... ~ ..... · ...-.~.o ............................. ' 't' '~'"'~ ............ , .~L~'~"~ ~ : ~. ~'.....~...,.~ ...................... at p~emlse~ located at ,..~ ............. ; ......................... ..~~....~ ........ ~ ~r( ...... ~ .... ~ ................. ?....~ .... purs0ont t~ application dated .~' ~ : ~' , Building I~spector. Fee $.Z~ ....... , .... ! and approved by the Rev. ;6/30~80 FORM NO. 6 TOWN OF SOUTHOLD BU ilding Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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 ail buildings, property lines, streets, and unusual naturat or topographic featu res. 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 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 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 Dete .... .. New Building .~(-~.0. ..... Old or Pre-existing Building(X) .......... ~ tVacant Land ........ Location of Property ......................................... ~ ......... - ......... Hou~ No, Street Ham/et Owner or Owners of Property ~.P.~.~O ~.~.~, County Tax Map No. 1000 Section .... 0 J~ Block ~ Lot. Subdivision .~.~ ~.~..~..~.~.~ ..... Filed Map No. ~. ~.~'.~...Lot No... ~ .f ........ Permit No.././.¢~..¢Date of Permit ~/¢.~/~.Applicant .~ :~ .~,'.~.~. ~.~. ........ Health Dept. Approval ........................ Labor Dept. Approval ......................... Unde~riters Approval .~ .~ ~ ~.~ ..... ~..Planning Board Approval .................. Request for Temporary Certificate ..................... Final Certificate ................. Su mitt $ .... ............. Construction on above described building and permit~ ml~e.~s, all ~p~cable~code~ i~nd regulations. PO. /~ ~'/ A~ cant /IJ)¢~-~¢~,~ ~ ....... ~ ...... ,,. v.,' .... ~ ~/. . .~, · .~ .. ~~ ........... .u0o3 4 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ Date~]f~j. -J-~J~ ~Z 85 JOHN STREET, ..... NEW YORK,[6~0~.~zNEW ~ORK 10038 THIS CERTIFIES THAT only the el~ .ica -~pmen~s~ib~dt~t~ ~tr~d~d~ ~'~*~ ~pli~ .named o~ the abo~e application n~.~ber in the pre~ises o~ was examined on o~ EIXTURE OUTLETS ~ECEPTACtES l~ ~na ri. 0ut:s:i~e Section Block and found to be in coo~pllance with the requirements of this Board. Lot SWITCHES FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS INCANDESCENT FLUORESCENT Z 1 DRYERS OTHER APPARATUS= 1-G.F.I. E R V I C (Swium~ ?ool) 'i~is cerCificace covers compliance at: the d~te of iasp~etion only. ~ecau~e of u~usual environamnts it is advisable ~o have f~equen~ Ce~C aDA/or repair~ made by a qualified person. Phil Gol~bn, 1i~ Deali ~t:.,· ~ / / Th s certificate must v ~~~~1~ This '' not be altered in any manner; return to the office of the Board if incorrect. Inspectors ma be ]dentifled ~ ~als. FIELD INSPE'C-TI~ COMMENTS ,, .. ~ ,. FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N. Y. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: S. now or formerly FF. King FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 / ....... : ...... '7'. ......... :~, ....../..'/ Disapproved (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No. ~t/..~.'~..~ .~. ...... a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi Inspector, with 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 stre~ or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this apl: qation. 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 pen~ shall be kept on the premises avai/able 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 Occupan stroll have been granted by the Building Inspector. APPLICATION'IS HEREBY MADE to the Building Department for the issuance cfa Building Permit pursuant to t Building Zone Ordinance of the Town ~f Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, tbr the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. ....... , .......... (Signature of a~Iicant, or name, if a corporation) ......... (Mailing addre s~fapplicant) ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build, , ncofownerofprc,n,ses ..... / O-. Cr. .... .P. C. .............................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..... ~.~. ( ................. Plumber's License No ..... /~./~. .............. Electrician's License No.' .//. {2./. ~. ............ Other Trade's License No... ~ ............ 1. Location of land on which proposed work will be done~10. ~~.e.. ~..~~y ..... House Number Street Hamlet e~m~ ~ m~ ~. ~ s~ ...... ~ .X~ ...... m~ .............. ~ ............... (Name) 2. State existing use and occupancy of prenfises and intended use and occupancy of.proposed construction: ~. ~,,s,.~ ,,~ ~.~ o,=~=~, ...... ~.¢&~.~ ............................................ b. Intended use ~d occupancy /~.~.~. ]~~d. ~mJ~. ~.~... ~F.'~. ,' .... , ,d~ ~~ ~ ~, o Re. pall'. ............. ~x~,,lo..~,,., ~,. .................... ; -- , /- (Description) ~ [ (to be paid on tiling this a,. iication) ' nbcr of dwell'nc units Number of dwelling units on each ~oor If dwclhng, nm ~ ........... ' ............... nbcr of ca ~ .................. If garage, nul rs .... ; ............... ~ ................................ If business, commercial or mixed occup ~cy, spcc~y n~turc and extent of each type of use .................... of existing stmctur[cs if an]: Front ' Rear Depth I)imcnsions , · ....................................... HeiSt ............... Nufi~ber of: ~ories ................................. ~ ...................... ~' R Dimensions. of same structure ~y~th alter tions or additions: Front ................. ear .................. Depth ..................... ~... Hei~ ~ .................... [. Number of Stories ...................... Dimensions of entire new cons{ruction: :.ront ............... Rear ............... Depth ............. Height ............... Number of I tones .................... .......................... Size of lot: Front : .... Rear Depth ' ~)ate df Purchase ....... ,' .................. : . Name of Fom~er Owner .......... ~, ........ Zone or use dist~ct in which p[emises aI: s~tuated ........................ ~.lh ....................... Does pro~oS,=r construction v~o~te toning law, ordinance or regulabon ........................ ....~ Will 10t bc reoradcd ..... ~.~ ................. Will excess fill be rcmovc~om pr{mises: No Name of Architect .~ .... ~/~ ............ ... Address ..... ~'. ........ Phone No .......... ~... PLOT DIAGRAM Locate clearly ~d distinctly ~1 buildff whether existing or proposed, and.~ndicate ~1 set-back d~ensions from roperty ~nes. Give street and block numbe~ ~r desedption accerding to deed, and show street names and indicate whetMr ,tehor or corner lob TATEOFNEW~O~ ~t~ oo oul Y ddt. , o.o ............ ~ ........ being duly sworn, deposes and says that he is tho appllcant . (Nani~ of ~ndi~ idual sighting coa; >ore named. ~ ~r~ ~rp~rat~ o~fi~: et~ ~s the ; ................................... said owner or ownem, m~d is duly autt fized to perform or have performed the said work and to m~e ~d filo ~is ~plication; ~at ali statements con~tained ir this application are true to the best of his knowledge and belief; and that 'ork will be performed in the mm~er set fo 'th h~ the application filed therewith. ~om to before me this ....... ....... ....... , Term Ex,ires March au, .~ ........