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HomeMy WebLinkAbout11635-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z~I~ 68q Date .............. .1~7..19. THIS CERTIFIES that the building . .N.o.w...I~..o.l.l.i..rig ................................ Location of Property . .q.~..0..qq~..ey. fi.~..~.o.k..R..D.. .... (pY.~; .r.d. ~¢) .... ~.o.utho~Ld ....... House No. Street Ham/et County Tax Map No. ! 000 Section .... 0.7.~ .....Block .... 0.6 ......... l,ot ....0~ ,5 .......... Subdivision ............................... Filed Map No ......... ]Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...~.p?.5.1...2.0 ......... ,19.85. pursuant to which Building Permit No. ~.~L6557, ............. dated . .~.~.~r..~ ..................... 19~. 3., 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 ......... ~or a new one family dwelling The certificate is issued to ...... !4~T~DS!dAT~ .BU/I,BIlgG..CO~ ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval 9-8o-25 UNDERWRITERS CERTIFICATE NC} N58~] Building Inspector Rev. 1/81 FOEM NO. 2 TOWN O~ ~O~'rU0UD ~ BUILDING DEPARTM~N~ TOWN HALL ;:: $OUTHOLD~ N~ Y.' : BUILDING PERMi1~ (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL COMPLETION OF THE WORK AUTHORIZED) ~- N? ~1635 Z Permission is hereby granted to: County Tax Map No. 1000 Section ~ ..... . Block .......... ; Building I~spector. ~e~ i~.Zk..;...~.~ ...... and approved by the 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 fil~ed 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 buiMings, 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 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 er land use 3. Copy of certificate of occupancy $1.00 New Building P~ Old or Pre-existing Building(Z) ....... ~/Vacant Land Location of Property .................................................. ~ ......... - .......... House No. Street Hamlet Owner or Owners of Property ............. ~; .-.- ..................................... County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. PermitNo. ~?.', .. Date of PermJt /~..~.Applicant //vi! ~/~'. ~.~U .... ~ ................. ~(~ ?, Health Dept. Approval ........................ Labor Dept. Approval ..................... ~.. Underwriters Approvat ........................ Planning Board Approval ................. , , .~ Request for Temporary Certificate ..................... Final Certificate ................ Fee Submitted $ ............................. Construction on above described building and permit'meets all apP~cable_.codes and regulation_s~..~ looo??1 pm THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ ~ ~. ~2 ~ ~o.~ S*RE~*, ~ ~o~. ~5~-~'°°~ ""'~ ~"""~""""~"'""~"~ N 581545 THIS CERTIFIES THAT only the electr~ ~q~iR~t ~ ~cri~low ~~ ~ca~t,~ ~ i ion ' tep ' es i. th~fo.ow~., ioc.[~Ob~ was examined on FIXTURE OUTLETS DRYERS 1st FI. ~ 2nd Fl. Section Block and found to be in compliance with the requirements of this Board. Lot FIXTURES RANGES OVENS EXHAUST FAN~; 1ECEPTACLES SWITCHES FLUORESCENT ~ 17 SYSTEMS NO. OF FEET OTHER APPARATUS: E R V *~h~_re Appliance Fee~er/s: 1-3#14,1-2#12,1-3~8 ~btor/s: 1-F i-G.FoC.i. 1-~aDke Detector P~Lana ~lec. Co. P.O. Box. 143 ~m~ticu~¢, N.Y. 1195Z This certificate not be altered in ,y manner; to the office 1&c.242 Board COPY C A, W, G NO. OF NEUTRALS A, W G, OF HFLEG OF NEUTRAL 1 2/0 Per may be identified by their ANY FIELD ~NSPECTION FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY QODE o FINAL DATE COMMENTS ADDITION~ COMMENTS: ., 2or Apyrcv~] 'o~ Cor:struetion Only Approved: , . ~ ~,., % for thi~ resJ~,ence will conform to the standards ~ ~ ~ ~ ~4' 43'g0"~ 7'~faT MOL E ---o ~YOT~E~5 ?.r. ;;obert t~endel! Winds ~ay Building Gcrp. Glenn Road 8outhold. N.Y. ~I~1 TO: TI?ZE ~UA,~,aAITFF CO. ,,4YVI£ 5 OU T(./O L D ~CALE I".$0~ FORM NO. 1 TCWN ©? SOUT'.dOLD BUJLDDJG DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ....... .... .................. · ...... , ..... . Application No..'/./..6'..~.~T .... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Build 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 Iayout of property must be drawn on the diagram which is part oP'this ap cation. c. The work covered by this appIication may not be commenced before issuance of Building Permit. d. Upon apprc:al of this application, the Building Inspector will issue a Building Permit to the applicant. Such per. shall be kept ou the premises available for inspection .throughont tbe work. e. No building shall be occnpicd or used in whole or in part for any purpose whatever until a Certificate of Occupar shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for th~ issuance of a Building Permit pursuant to Building Zone Ordinance of the Town ~f Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describ TEe applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, ;md admit authorized inspectors on premises and in buildings for necessary byspte?ions. .-, c -- (Signature~of applicant, orytameTif a ccffporation) (Maifing address of applicant) State wbetherzgj~plicant is owner, lessee, agent, architect, engineer, general coutraetor, electrician, plumber or build .......... 4: ......... z ....... N,'une of owner of pre se ' LL" ' t>' ............... .?' ........ ~ ............. . ............... (as on the tax roil or latest deed) If applican, kis)a corporation, signgture of duly authorize~kofficer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No. El:ctrician's License No .......... on which proposed work will be done.. · ' r""' ............................... House Number Street Hamlet County Tax Map No.:1000 Section .... .C).7~.. ...... Block .... ~.~ Lot .(~,/~.~.. Subdivision ..................................... Filed Map No ............... Lot ............. (Name) 2. State existiog use and occupancy of premises and intended usq. and occupancy of proposed construction: a. Existing use and occupancy ~'... -.:. b. Intended use and occupancy .. 3. Nature of work (check whic,h applicable): New Buildii~g .................... F'// Addition Alteration ........ Repair .............. Rcmo', al .............. D:molit!cn .............. Other Work ............. " Esti:na~ed Cost ,.~.,.b./. 6oc ~ ? ~c4..~_. (Description) ............................ Fee ': (lo be paid on filing this application) 5. If dwclli.%, number of dwelling units .... ~'}c..~'.. ..... Number of dwelling units on each floor .............. If garb:ge, number of cars ........ a/.(g. Ur. ...... : ................................................ & If business, commercial or mixed occupancy, specify nature and ~xtent of each type of use ................... 7. Dimensions ofcxisting structures, if an>,: Front ' Rear .............. Depth ............. Height ............... Number of Stories ...................................................... Dimensions ef same structure with alterations or additions: Front ................. Rear ................ Depth ...................... Ileight ...................... Number of Stories ..................... ~3. Dimensions of.entire ne',',' construction: Front . '~ .CP.. ...... Rear .... ~ .~.. Depth ~..(o. Hci=ht ..... /..,> ........ Number of Stones . . S aof or- Front ...... ............ ;:':,'"';W::', ............ ....... 2.-: ~:~' ' '.9 · '~ ...... .., ., ................. uepm . .,~/~.~ ............... I0. Date df Purchase ..... ,~t:i~5../,~,~.~.C .~.-/... t ('w.>~(~ame of Former Owner . .~.~.~d4'~ ~,...-f~4zr*,F .......... II. Zone or usa district in xvhich premises are situated.., i .................. ~-" : / i2. Does proposed construction violate any zoning Iow, ordinance or remdation: .............................. ,3. ">,'ilI Iot bc r~grad :d ...... .~.~, ~ .... ,- ...... ~. ..... WiI! excess'-fiI1 be removed from prem ses. Ye, ('~ 14. NameofOv:n~rofp,emls=s ../~..¢'¢-r'~.~t~z:u?./~{y:/XdidZress/.C.~. ~.(~.~/.~.; Na n= o, Arc ~ 'ct / ' .......... Aadress P o N · , , , , , .................. 5 ne t o ............... .... .... /7 ........ -/..~. ...... ~,t ~ ......... rnone rqo,, . ~>. ,'.~, e ...... PLOT DIAGRAM Locate clearly ~d distinctly ~AI bniMings, xvhether e:-fisfip~g or proposed, and, indicate all set-back dhnensions rio: property hnes. Give street and block number or description according to deed, and show street names and indicate wheth~ ,,terior or corner lot. ~'TATE OF NE\~YORK, -- coD:fY s.s (Nanie of individual signing contr3ct) (Contractor, agent, corporate officer, etc.) said owner or owa:~, and is duly authorized to perform or have performed thc said work and to m~e and file fl~i :l~plication; grot all statements contained in this apo ication arc true to the best of his knowledge and belief; and that th, ~iork will be performed in the manner set forth fl~ tim application filed t~crcwith. -bworn to before me this ~'~ I SUFFOLK CO. HEALTH DEPT. APPROVAL ~ . ~ .c 3~ ~ ~ i STATEMENT OF INTENT O ~ ~ ' e ~ I ~ THE WATER SUPPLY AND SEWAGE DISmSAL ~ ; *' ~ ~ SYSTEMS FOR THIS RESIDENCE WILL . ~ c , ~ m CONFORM TO THE STANDAR~ Of THE ~~ ~ ~ ~ ~ i SUFFOLK CO. DEPT, OF HEALTH SERVICES. O :, ~ ~ ~c ' SUFFOLK COUNTY DEPT. OF HEALTH ~ ~ ~" c~ '~c ~s SERVICES -- FOR APPROVAL OF ~ ~ ~ ~ o ~ ~q EONSTRUCTIONONLY ' ~ ~ ~ DATE: ~ DIST. ~CT. ~K ~L. To K ~ wL~ ~u~ c~. rn~ co~. ~ov~ ~ ' LICENSED LAND SURVEY~S GREEN~RT NEW YORK OCC'U?A~C¥ I~R -USE IS, UNLAWFUL WITHG~JT 'CERTIFICATE '~OF OCCUPANC,¥ " F RC) NT 'E'L E \/'A t-i 0 NOT,n'.BU~L?],N~ PM FOR LLOWING INSPECT ON5: FO, -TION 'p~VO REQUIRED FOR pouRED CONCRETE 2. ~OUG~ - F~AMiNG & pLUMBING ~. INSULT ON ~LL coNSTR~C STATE CONSTRUCTION &' ENEMY CODES. NOT RESPONSIBLE DESIGN OR CONSTRUCTION ApI~P-ovED A.$ NOTED ~*? 7~54~0~ 9 AM TO ~ PM FOR THE FOLLOWING INSPECTIONS: 1. FouNDATION - TWO REQUIRED ~THE REQUIREMENTS OF ~HE ~. coNSTRUCTION ~ CODES~~ NOT DESIGN OR ,,p -4" P,¢-, FLOOK. t t o ,