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HomeMy WebLinkAbout11680-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.Z. 1..1.3.1.~. .......... Date ...... ~.o.v.e..m.b.ey...~.3 .............. 19 .8.2. THIS CERTIFIES that the building ................................................ Location of Property 9985 G~'eat; Pecontc Bait Boul®v&~'d Laud'el House No. Street Hamlet County Tax Map No. 1000 Section ...1.2.~ ...... Block .. 0.2 ........... Lot.. p.a?. ~...of..O..1 ~.. Minor Subdivision Marilyn C. Hick®y ...Pttetr~llff'No. 270 .Lot No. 2 conforms substantially to the Application for Building Permit heretofore fled in tiffs office dated ...A.p..r.i.1..3..0 ......... , 19~..2. pursuant to which Building Permit No...1.1.6..8.0..Z. ........... dated .... M.a. ~-..2.0. ................. 19.8..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 ......... ...:..pr.~?. ~..~.e..o. ~. :.-.r.~?..~.~. q.,?.~.~..Ln.~.,. ......................................... The certificate is issued to John I~. I Susan H. Fallon (o wrier../,mae.er .mmnz)- of the aforesaid building. Suffolk County Department o f Health Approval . 1..2 .-.~.0. -..3.2.,.. 1..1 ./ .1. 2. /. .8 .2 . ,.. R..o.b.~ :..l....V...i .1 .la., P. ~. UNDERWRITERS CERTIFICATE NO.. I~ 580;? 11 Buildins'IfflI~ctor TOWN BUILDING TOWN HALL SOUTHOLD, N~ Y. BUILDING PERMIT '~ (THIS PERMIT MUST BE KEPT ON TH,E'PP,~IS~S UNTIL F~LL COMPLETION OF THE WORK AUTHORIZED) N~°. 1~1680 Z Date ...?~.~.,....~ ............... , 19.. Perr~i$~ioW i~ h~mby omnt~d to: .. ~~.~_~...~.~,. ~o.,....C~. .~T: ...... ~.~...,...~.~ .; .............. ...... ~ ....... ~.~.~ ...... . ~ .... ~, ....... ,...,....~ ............. ~ .......................... Cou6ty Ta~< Map No. 1000 Section pursuant fo application dated Bui!~lng I~spector. Fee ~ ~,~... and pproved by the FORM NO. B TOWN OF SOUI'HOLD l~ui~d[ng Departmen'~ Town Hall Southold, N.Y. ~11@71 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions A. This application must be filled in typewriter OR ink, and subr~ tted in duplicate to the Building lnspec- 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 topograohic features. 2. Final approval of Heaith Dept. of ~vater supply and sewerage disposai--(S-9 form or equal), 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buiiding~ 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. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate sur~ey of peoperty showing all property lines, streets, buildings and unusual natural or topograph ic 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 info/ma- tion required to prepare a certificate. / Co Fees: 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 New Building ........... Old or Pre-existing Building(%) ........ =/Vacant Land Location of Property ~'~..'¢'~- .~:, ~ ...... Hou~ No, S~ree~ Owner or Owners of Proper -~, County Tax Map No..1000 Section .. ¢.~.~ ........ Block . .~.~,. Lot SubdJwsion ....... ~' led Map'No, ~ ~ .Lot No. Hea~th Dept Approval '~' · · Labor De ~ A' rov ....... ~ ............ Request for Temporary Certificate .... ' ................. Final Certificate .... Fee Submitted S ~ Construction on above described building and per~[~ meets all a ...... ' pp~cao~e~:odes and regu ations THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~-- n~ 0cEobe= 2,0, 19~JOHN STREET. NEW YORK, NEW,YORK IOO~8 a.~e .~pplic,,tio. ~o. o./"e 178517-82 N THIS CERTIFIES THAT only the electrical equipment as descried ~elow end introduced by t~ applicant numed on the a~ove application number in the premises of Jo~ Fall~, N/S Pec~ ~y Bi~ ~ay & S~s~, ~tCi~, N.Y. in the following locatio,; ~ Basement ~ Izt FI. ~ 2nd FL Sectlo,, Block Lot was examined on ~tO~ ~4, 1982 and found to be in compliance with thc requirements of this Board. FIXTURE OUTLETS SWITCHES 45 31 DRYERS FIXTURES RANGES OVENS EXHAUST FANS NCANDESCENT ~LUOR~SCENT ,6,5 MULTI-OUTLET SYSTEMS NO. OF FEET OTHER APPARATUS: Motors, 1-1HP E R V I C E A. WG OF CC. LaND 2/0 NO OF HI~LEO Op HI-LEG tNO O~EUTRALS AW, G, OF NEUTRAL 2/0 L. A. Elec[ric Inc. 23 Valley Ease Moriches, N.Y., 11940 L~. #224o-z This 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 B~UILDING DEPARTMENT. THIS COPY OF c{.TJFI~Afl!~ ~/l~[lST NO~ ~ 'ALTERED IN ANY MANNER. COMMENTS FIELD INS~ECTXON 1. FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C,ODE 4. FINAL BUILDING DEPARTMENT'' TOWN HALL SOUTHOLD, FLY. 11971 D~. app roved ~/c .......................... APPLIOATIO~ FOB BUILDIN~ PERMIT Date ..ff. .............. 19. INST RUCTIONS 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 sire or areas, and giviug a detailed description of layout of property must be drawn on the diagram which is part o~this cation. c. The work covered by this application 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 pen 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 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 'of 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 The applicant agrees to comply with all applicable laws, ordinances, building code, bonding code, and regulations, and admit authorized inspectors on premises and in buildings for necessarv.:~Ispections. ,, (Signature of applicant,/~r name, if a corporation) " ,- (Mailing address of applicant) 1/'-~ State whether applicant is owner, lessee, agent, architect, engineer, general coutracror, electr/cian, plumber or build /2 -,-:-- ........ ................................................... , .................. . ...... ,~,~ ,, e o r o , ,' n e ~ o ~ l, r ~ m ~se s-- .................... ?://p. ~ ?.//.,.~.~ ~-7 ~ ' .~. (./.4 <./. . .............................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly attthorized officer. (Name and title of corporate officer) Builders License No....-~O..b. Electrician's License No.' .... Other Trade's License No ...................... 1. Location of land on which proposed xvork wil! be done ............................................... House Number StreeL Hamlet ...... ~ Map No .............. (Name) mut~ ~xt~tmg use and occupancy of premises a~d intended u~ and ~dc~p~ne~ ~f p~D~osed construction: [. X<...? ~.,~.~a ,,, ~ o,~,2,~ ...-p.c.~ Nature of work (check whicl, ~pplicabl Repair .............. Removal .. 4 Estimated Cost . ,~.0./.~.o? ' , .... S, Ifdwclhng, munbcr ofdwelhng umts ~f~grage, number of c~rs . .. If business, commercial or mixed occt 7, Dimensions H~i~ht ............... Nt tuber Dimensions of same ~tmcture Depth .................. .... He ~. Dimensions of entire n~,,v construction Height ............... Nthnber or 9. Size of lot: Front ..... /.~; .... '... ~0. Dat~ df Purchase ......... ~ ..... ti. Zone or ~2. Does propo~fl construction vmlate anl Il lot be r*o, ad-d ...~_. ..... 14. Name of Owner of premises -! } amc of Archi:e~t ....... locate clearly ~d distinctly ~I build~ property hnes. Give street aud block numb~ ~aterior or corner lot. ): New Building .......... Addition .......... Alteration ........ ........... Demolition .............. Other Work ............. ~. ,. ,~..e .~. ~_.' (Description) .................... Fcc . .. ~ .............. ~ ......... (to bc paid on filing this application) ;~Q~I'[f~ Number of dwelling units on each floor .............. ancy, spec~y nature and extent or,ach type of use ................... Front ............... Rear .............. Depth 5Stories ....................................................... rations or additions: Front ................. Rear ............... .... Numk~r of Stories ........... t . , Re ........ Depth ~/...Y.~ stoaes ...~..~...~ ...................................... ...... Rear .... [.[.¢/ ............ Depth .~Q~ ............ Num~ of Fom~er Owner .......................... re situated... ~., ............................ ).. ................ zonhag law, ordinance or regulation: . .~ ........ 5 ............ .......... ~d/{Will excess fill be removed from prem~s=s: Yea f? .................. .......... · .. Address .................. Phone No ............... 7 ........... Address .................. Phone No ............... PLOT DIAGRAM '" ngs, whether existing or proposed, and, indicate all set-back dimensions fro: r or description according to deed, and show street names and indicate wheth, ~TA'TE OF NEW VrI~rtK.., ,-'// ' (Nanie oflndMdua-'l signh~g cm above named. rte ~s the ............... o'f said dwner or own'en, and is d.ulv auth a/~plicatiog?~at all statements coOtained i W'ork will b~ performed in the man{~cr set fc ~worn to before me tiffs tra~ ......... being duly sworn, deposes and says that he is the applicm--_ (Contractor, agent, corporate officer, etc.) ~r/zed to perform or have performed thc said work and to make and file th this application are true to the best of his knowledge and belief; and that tll rth h~ the application filedt~".ercw~th.' SUFFOLK'CO. HEALTH DEPT. APPROVAL H.S. NO, //- SO-lO O) C~FO~ T© THE STANDAR~ OF THE SUFFOLK COUNTY DEPT. OF HEALTH ~, ~, ~ . ~. , , ., ~ ,~ wuo ~u~ cctv. , ....... ~. . .. ........ :: i . "~ SUFFOLK CO. HEALTH DEPT. APPROVAL - + ~ STATEMENT OF INTENT -'e ~ THE WATER SU~LY AND SEWAGE DI~AL LICENSED LAND ~RVE~ORS SUFFOLK CO. HEALTH DEPT. AF~'ROVAL ~.~ I SY~E~ F~ TH~ ~ESI~NC~ WILL ' CONFORM TO THE STA~A~ ~ THE 7' -'~ ~ ~ ~FFOLK COUNTY DE~. OF HEALTH -~ ,. ~ - ~ ~ ~ SERVICES -- FOR APPROVAL OF ~ ~E ~ ~H~ 0 '~' ~ ~ ' CONSTRUCT~N ONLY LICENSED L~D ~RVEYORS GREEN~RT NEW YORK OCCUPANCY OR USE IS UNLAWFUL, Wll'~1' CERTJFICAE OF OCCUPANCY U LDIN~ DEPARTME 9 AM TO 4 PM, FOR THE ~ FOUNDATION ;L TW~ POURE~ CQNCR~E, ' '~ ' SUCTION : FINAL r CO~TRUCTIO~ MUST cOMPE'~E FO~ C~ O.' '~ONSTRU~TION SHALl- 'ME~ R. tREMENTS OF ~H~ 'CONSTRUCTION & ENERG~: 'RESPONS' NOT IBLE' FOR , CONSTRUCTION ERRORS :.:~,:. ":v' " '( ~' ~.',;: :::' .:, ~:i'" Phone 477-0400 ~ Main ,Road GREENPORT~ N.Y. ! 1944 Plmne 477-0400 Phone 477-0400 Main Road GREENPORT, N.Y. 11 q~44 -?Vt/o' i 'i