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HomeMy WebLinkAbout11661-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Occupancy No. 2~l I .1 8.1 .......... Date ..... Se p.t.arabe~.. 1 3 .............. 19~2. THIS CERTIFIES that the ~.a/hl&~g ...2 o o21. ......................................... Location o f Property . 9. ~3.5 ................ .P g.p.k. *!.~ y. ........................ ~ o..u .~.h.q 1..d. House No. Street Hamlet County Tax Map No. 1000 Section .07 D ........ Block .. 'i ~ ........... Lot . .O .1 ;3 ............ Subdivision .~.q~.~.~h.w. qq.d .................... Filed Map No. 2. 1. ~ ..... Lot No..3:~ .......... conforms substantially to the Application for Building Permit heretofore ~ed in this office dated ·..tl.~.. 5 ............. , 198.2.. pursuant to which Building Permit No...1 3.6.6. 1...g ............ dated .. t4.a.y.. ? 3 ................... 19.8?.., 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. d.e.ak. ~,.d. di tl.oJ~. ~,~..t.]l. ~!<:k~t[~:[p~ .pOp, l,. t~9..~t~ ~ ~.t;.~.r~g..d.~.e. ~. ~..~.rlg, ........ The certificate is issued to ... E/Bi. ard. ~.,. &. Iqaqlel.5,Bo..~,.. $~.t. qtll~ ~.t. ................. (ownar, le~ee, e~te~altt) of the aforesaid building. Suffolk County Department of Health Approval .... .n/.a. .................................. UNDERWRITERS CERTIFICATE NO ............ l~..5.6 t/(3.1.1 ............................. Rev. 1/81 ~. . ¢[ ...... Building Inspector Town OF $OuTHOLD BUILDING DEPARTMENT TOWN HALL $OUTH'OLD, N~ Y. BUILDIHG FE~IT (THIS PERMIT MUST BE KEPT ON THE PI~E/V{~IS~S UNTIL F JLL' COMPLETION OF THE WORK AUTHOPJZED): ~ ~9 llBB1 Z Dat~ .', ~'""'/'~ Permission'is hereby granted to /~ / ,~."~ .. Building Idspector. Fee ~.../...~..': ............... .at premise~ located at. . . " ......... ~ .............................. : .' ~t ~ C0uhty To~ Map No ]000 Sect on : O.:7,,~,...... Block' .~....;4~,. ........... Lot No. ;~,/,~,,...; ..... pursuant tb application dated ......... ~........i:.22.:.., 1 and ~pproved by the Rev. 16/30Z80 FORM NO. 6 TOWN OF SOUTHOLD Building Department~ Town Hail 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: I. Final survey of property with accurate location of all buildings, property lines, streets, and unusual naturel or topographic features. 2o Final approval of Heatth 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 dr Engineer responsible for the building. 5. Submit Planning Board approval of completed sitb plan requirements where applicable. , B. For existing buildings (prior to Ap~i.I 1957), Non-conforming uses~ or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buiidiggs and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and tsondition 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. , Fees: 1, Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Cop,/of certificate of occupancy $1.00 $5.00 S'tu/~k /PC ~/-- . - New Building ............. "'T .... ~ -Z' , . (X)., ........ , /Vacant Land .... Location of Property ...... c;5 .-~. ..... ' Hamlet Owner or Owners of Property ~ / / T~'/t~4~ County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. ' . %( !~ Date of Permit ; .? ~ .~ ...... -f-.Applicant . .4 ........ Health Dept. Approval ............. ~? ..~ .....~, ~ ,Labor Dept. Approval ...... ~.,. . I ~ ~,,~'~1/ ............... Underwriters Approval ....... .......... ~lannin~ Board Aporoval .............. . ~equest for Temporar~ Certificate .................. .... Final Certificate ................ Construction on above described building and p~m~?mee~s all app~eabl~o~and requlations. App / THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK 1003~ ,ate ~ ~, ~z Appiic~tio.. No. o.~,~ 170399/8~ N 5 6 4 8 1 1 THIS CERTIFIES THAT only the elec trical equlplnent ~ described be~w and introduced by t~ applicant ~a~ed on the above application number in the premises of ~;~. Lite. t, 93b Pa~y, ~u~ld, N.Y. i. ~/o,o~ ~o~.t~on; ~ ~.~,~t ~ ~t r~. ~ ~nd Ft. ~tsi~ s~tlo, mo~ rot was examined on and found to be in compliance with the requirements of this Board. J~e 3, ~9~2 1 DRYERS DISHWASHERS EXHAUST FANS OTHER APPARATUS: 1-G.F.I. S E R NO O~E~C~COND A. WG OF CC, COND C AWG, OF HI-LEG OF NEUTRAL ($wbaaing Pool)%hi$ Certiiicate ~overs c~liance at t~ date of ~pect~n only. Be~e o~ ~1 env~o[~ts it is advi~ble to ~ve ir~%t test ~/or repa~s ~ by a q~lizied ~r~%, Gler~ k. bradley to9 l~D-Horton Av~.ue ~mttit~ac~, N.Y. 11952 Li¢#lz27 GENERAL MANAGER This certificate must not be altered in any manner; return to the office of the Board if incorrect InspectoKs ma be identified b tFreir ~redentials COPY FOuR BUILDING DEPARTMENT. THIS cOPY OF CERTIFICATE M[JS~NOT BE- ALTERED I~1 ANY MANNER. FIELD INSPECTION ~ FOUNDATION FOUNDATION (2nd) ROUGH FRAME & FLUMBING INSULATION PER N. STATE ENERGY GODE FINAL DATE COMMENTS ADDITIONAL, COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined. ~.~c.~.~../..~'..., 19 .~/.~'~ Approved Disapproved a/c ......... '....~ ............ ~ ........ / (Building Inspector) Application No. '{.~.~./. .......... APPLICATION FOR BUILDING PERMIT Date .. ~.~. ~.~..- ......... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building 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 streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. 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 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. 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 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 code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ....... .... (Signature of applicant, or name, if a corporation) ............ ............ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................. ......... ........................................ Name of owner of premises . .~./~.-ff.~.~ ....... .fi.C/..~../~./~.....~.~../..T.?../?(~ .~. './.~. ........... ~ .. (as on the tax roll or latest deed) If applicant is a corporation, signature of dul.7 authorized officer. ..... ;t.~ ........... .. .... ~. ......... "_z'~ ............ (Name and t~tle of corporate ~,~ficer) Builder's License No ..... /.~. .................. Plumber's License No ......................... Electrician's License No.../~..~.~..~..~../7.~.~/.' ...... Other Trade's License No ...................... Location of land on which proposed work will be done ........ ¢... ?.-. ~.. ................... .... .. House Number Street Hamlet County Tax Map No. 1000 Section ..... .~..~.O. ....... Block ..... ~/i ......... Lot //-~ Subdivision ........ .~.O. ?..'~..rt..uXO..O~. .............. Filed Map No...~-.../. '/7' .... Lot .~...~. ......... (Name) State existing use and occupancy of premises and~?tended use and occupancy of proposed construction: a. Existing use and occupanqy ...~.~.~;.-"//~ '.-/~,e~./~;~. ~'~.' ~../~.~..~. ~.~. .......................... b. Intended use and occup.~y ...~/?./..~./..~.Q ?..z~..~...~...1~../~ ./~...7~..); '.~...~.~.'.../.~.?..L~......~. ~ ......... 3. Nature of work (check which applicable),: New Building .......... Addition .......... Alteration .......... Repair ........ , ..... Removal ............. Demolition .............. Other Work ............... f~/~,, iI ' ~ (Description) 4. Est~matedCost...g.' ...... ~ ...... : ................... Fee ................................. ; : (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 .... , ...... i. ............................................................ 6. If business, commercial or mixdd occupancy, specify nature and extent of each type of use ..................... 7. D~ensions of existing stmctures, ifany~ Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ D~ensions of same structure with alterations or additions: Front ................. Rear .................. pth ' 'gDt b of St i De ...................... Hca ...................... Num er or es ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of S}o~es ........................................................ 9. Size of lot: Front ' Rear Depth 10. Date of Purchase .: .................... Name of Former Owner ............................. 11. Zone 0r use district in which p~emises aie situated ..................................................... 12. Does proposed construction violate any ~oning law, ordinance or regulation: ................................ 13. Will 10tberegraded........~...................' . Will excess fill be removed from premises: Yes No 14. Nme of Owner of premises .. ~ ....... . ........... Address ................... Phone No ................ Name of Architect ' . Address . Phone No. Nme of Contractor .......................... Address ................... Phone No ................ Locate' clearly and distinctly ali property lines. Give street and block interior or corner lot. PLOT DIAGRAM buildings, whether existing or proposed, and~ indicate all set-back dimensions from or description according to deed, and show street names and indicate whether STATE OF NEV}r~RI¢~ ,~ ~ , ~ ,~ COUNTY ',,.-J) Z~,./ being duly sworn, deposes and says that he is the applicant ................. .''.: .... :'i .' ..... ~' /; ..... : (Name of individual slgmng con[ract) above named. ' He is the .......................................................................... ,~..~....~ ' (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dBly 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 manfier set forth in the application filed therewith. Sworn to before me this No~.Ptblt'c~ .... ~. C~)unty _ ~. --. ,., ,~ ..