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HomeMy WebLinkAbout11665-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building inspector Town Hail Southold, N.Y. Certificate Of Occupancy No. g 3.1.~ .6 .......... Date ..... D?. c ei~.b~e ~'. THIS CERTIFIES that the building ................................................ Location of Property . .7.5. ................. ~.l..d..C..hg._Re.¥' .Ig.a.F. .............89.u.~?. 9.1.cl' . . House No. b'treet Hamlet County Tax Map No. 1000 Section . . .05 2 ...... Block . .0.3~ ........... Lot ...C~ 7. ........... Subdivision...8.1~qr.~.~.~.~..~.g ................. Filed Map No. 5.5.8.4. .... Lot No...5 ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated .... Hag.../4 ........... , 19 ~.2. pursuant to which Building Permit No..1.1..6.6.5..g. ............ dated ..... .~.a.y. J .6 ................ 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 ......... ... aa ,iugJe. ou=cl..a~rimraing, l~.c~ol ................................................ The certificate is issued to . .~.~.1'..r'.e.cl..g .a.l..o.l.a. .......................................... (owner, of the aforesaid building. Suffolk County Department of Health Approval .... r~/a ................................... UNDERWRITERS CERTIFICATE NO ............ ff. 515.6700 ............................. Building hispector Rev. 1/81 TOWN HALL, SOUTHOLD, N~ ~. BUILDIHG (THIS PERMIT MUST BE KEPT ON THE'PRFW~jlS~ UNTIL F COMPLETION OF THE WORK AuTHORIZED)' Bu!l~lng I~specto~. fee ~.~ .............. JLL ~o. 11 ~ 6 5 Z ~ot~ .... ,,,...,~.,,.,. .......... ............. , ............ , Perrhission is hereby granted to~.~. ~ ~ , ~i ...... ..... ~.: ....... ~x...'.....za~..~; ....... ......... ~ to ..;....~ at p~emises located at ; .......... ~ ........... :.. ., ~: ............. , .......................... . ... ~ond ~jpprovod by tho 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 subn~ tted 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 similar buildings and installa- tions, a certificate of Code compliance from the Architect pi' 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 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 $1.00 /- , ..... ...... Subdivision..~/~.~.~ ~..i~ill. iii'; ed Map';o. ~'¢ ~'' 'Lot N' ' 'P ....... Perm,t No. ~.~:.. Date of ~rmi~fi. ~ .~Oi,cant ...~ Health Dept. Approval .Labor Dept. Approval ...................... ,.. Unde~riters Approval . lanmng Board Approval .................. ~ .. ~ ....... h ...................... 'i000663 THE NEW YORK BOARD OF FIRE UNDERWRITERS -6/23/82 ng BUREAU OF ELECTRICITY, ~C~TO~ OF N564813 8.'5 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only the electrical equipment as ~scribed belo~ and intr~uc~ by the applicant named on the above application number in the premises of ~f~ ~ola, S~y-S~re ~. & Wild ~ Way, off ~. 48, ~u~ld~ N.Y. was exa~nined on ~ and found to be in co.zpliance with the r~qulrements of this Board. FIXTURE OUTLETS DRYERS RECEPTACLES SWITCHES 2 FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS FLUORESCENT MULTI-OUTLET SYSTEMS NO. OF FEET OTHER APPARATUS: 1-G.F.I. E R V I C OF HI LEG NO OF NEUTRALS (Swimming Pool) "~$ certificate covers o~mpli~ce a~ t~ dace Of inspection only. b~cauae of La, usual enviror~ents it is advisable to ha~a frequer~~ ce~t and/or repairs made by a qualified person. AW, O, OF NEUTRAL RFD 169 - F~rton Ave. ~ttituck, N.Y. 11952 lic. 1227 G~=NI:RAL MANAGEE Per- 11 Th~s 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 [EETI~lCATE ~S~NoT$~ A~,ERED IN ANY MANNE". ' O0uuo THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRIC,ITY S5 JOHN STREET, NEW YORK, NEW YORK 10033 THIS CERTIFIES THAT only the electricel equipment as described below artd introduced by the appllca~t nemed on the above appltcat~on number m the premtses of ~red, ~tony-Shorc Drive & Wild ~ ~y, of~ in the following location; ~ Baseme.~ ~ 1st Fl. ~ 2nd Ft. Section Block Lot and found to be in co.tplia~ce ivith ~he r~ulrente~ts of this Board~ ~.~ ~.~.~d o. J~e 3, 1982 FIXTURE SWITCHES FIXTURES RANGES COOKING DECKS OVENS DI~H WASHERS EXHAUST FANS OUTLETS , FLUORESCENT 1 DRYERS SYSTEMS NO, OF FEET E R V I C ~C~ A- W O, NO OF NEUTRALS A W.G. NO, Ol~E CONg' OF CC COND. OF N~UTRAL OT ER P ARATUS (~w~ir~ P~ol)'£~s certificate cover~ compliance a~ ~he da~e of !irmpec~ion ~ly. Because o£ L.lr.~U. ml. ~vironmen~s it is advisabl~ to have ~requ~l~ te~t ancot re~airs made Dy a qualified person. ~YD-169, Horton Avenue O~N'~R~[/,~I~EE Pmttituck, N.Y. 11952 Lic~27 ,.,..~ll. / ~This must not any manner; return to office the Board if [0correct. Inspecto~ mo~ be idenfih%d b~/h~ir credentials. certificate be altered the Of coPY F°R BUILDING DEPARTMENT. THIS cOPY O~ CEETI~ICAT~ ~S~NOi ~B~ A~T~RED IN ANY ~ANNER. FIELD INS?ECTY'~ COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & FLUMBING INSULATION PER N. Y. STATE ENERGY c,p~E FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1802 / Disapproved a/c ....... '. ;....':~ · ............,¢ ........ .',/~- ) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No.././fi. ( .~.7 ...... Date . 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 dia~am which is part ~'this apl cation. c. The work covered by this application may not be commenced before issuance of Building Pe~it. d. Upon apprc.'al of this application, the Building Inspector will issue a Building Pe~it to the applicant. Such pen~ shall be kept on the premises available for inspection throughout the work. e. No buildiag shall be occupied or used ~n whole or in pa~ for any purpose whatever unt~ a Certificate of Occupan shall bare been granted by the Building Inspector. APPLICATION 1S HEREBY MAD[ to the Building Department for th~ issua~e of a Building Pe~it pursuant to t Building Zone Otdh~ance of the Town of Southold, Suffolk County, New York~nd/other appl~cable~ws, Ordinances Regulations, for the construction of buildings, additions or alterations, or fo~rem~val or de~litio~,;hs herein describe Tke applicant agrees to comply with all applicable laws, ordinances, buildi~ co~, housing/~de, ~ regulates, ~d admit authorized inspectors on premises and in buildings for necessa, inspe?~ /~ f ' ~/-~ ~Signature of applicant, or name, if a corporation) lesse age~ general contractor, plumber or build State whether applicant is owner, ~ architect, engineer, electrician, N,'une of owner of premises ..... T ..... .--. ................................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly attthoriz~d officer. (Name and title of corporate officer) Builder's License No .......................... Plumber s L cens~. No ......................... Other Trade's License No .... 3.5. ............. 1. Location of land on which proposed work will be done ...................... , .......................... ....... . ................... .......... .... ..... ....................... House Number . Street ~ Hamlet C~nW Tax Map N~. ~ ~ ~ecfi~ .................. Block ............... L~t ............ Subdivision .~0:~ ............... Filed Map No ....... Lot ........... (Name) 2. State ex/sting use and occupancy of premises and intended us, and occnpy of tion: .... ..... ........... ~ ~. Inten&duse ~d occupancy ........ ~~....: :~. ~.'.~. ~.~..~...' ."~... 1. Nature of work (check whict,!applicable): New Building .......... Addition .......... Alteration ......... , . , ..... Other Work .............. Repair .............. Removal. ,I ........... Domolition ~ (Description) Estimated Cost ............ ~ -, _ (to be paid on filing this application) ;. If dwelling, '~ number of dwelh~g units .............. Nmnber of dwelling units on each floor..~' . ........ I~ ~r~;}~c;r;r'n~i'~ed o~cu ;ancy spe~y ~ature and ex(ent of eac~ t~'pe ;. , of use ............... Height .... ~: ...... N{unber of Stories ..... { .................................. Dimensions of same structure]with alt< rations or additions: Front Rear ' Depth .................. ~ ....He ~t ...................... Number of Stories ................... ~. Dimensions of entire new construction? Front ......... c ..... ~ea~ ..... ~ ..... v.. Depth ............ Height .............. ~r o~ ....... /dj... 3.~ .... ?~ q.~ ....... ,..~ ......... ). Szeof ot Front ~., . .~/O Rear . [~ ~ ~*h /~ ). Date ..... ,,,- .,.o'... ............ Nsme of Fomler Owner . .~.. 1. Zone or use district in which premises hre situated..~D6~.m O. ~ .~.O~.~. ........ [: L Doe~ propos.d~ Constructio0 violate an~ zoning law, ordinance or regulation: .... ~. ~ .......... ................ ~ ..... I. Will lot be re~radea ...~.%.,.~...l. .............. Will exc[ss fill be removed from premises: (~. Nt L Na ne of Owner of pre n scs ~/~e~., .~ 'o.]~. AddressO~fD ~ ~Ph~na Wa ' Name of Architect . ~.~ · Address ................ Phone No. Name of Contractor .B~,~.~,'~. ~[~ ..... Address ~F ........ Phone No. ~'.~ .... PLOT DIAGRAM ~' Locato clearly, ~d distinctly ~1 build gs, whether existing or proposed, and, indicate ~1 set-back d~ensions fron roperty hnes. Gi~e street and block numbdr or description according to deed, and show street nines and indicate whethe rATE OF NEW YORK. OUNTY OF_. ,~0 ~{¥,)~1~ .' S.S I ' , ....... :. ~ ~..~.'.. ~.' 7. ~~ ...;. being duly sworn, deposes and says that he is the applic~nl (Nanie of nc v dual si~ni~g contract) ~ove named. e is the ~ ' , (Contracto~corporate officer, etc.) r said Owner or own'e~, m~d is duly autht ~zed to Oerform~or have performed the sa d work and to n~e and file fl~i~ .>pl]ca[[~, tim(all st,}tym~nts con, tamed tr tlns apphcanon are true to the best of his knowledge and belief; and that the or~ wm ue permrmed m tlm mare er set fo'th h~ the application filed therewith. .worn to before me this ~ . ~,..~' ....... ............. . ............ . ......