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HomeMy WebLinkAbout12009-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z13726 Date August 7 .,l~5- one-family dwelling. THIS CERTIFIES that the building ................................................ Location of Property 45300 Main Rd. Peconic House No, Street Ham/et County Tax Map No. 1000 Section 7 5 ...Block 6 .Lot 9 Subdivision ...... x ., .Filed Map No. x .Lot No. x conforms substantially to the Application for Building Permit heretofore filed in this office dated October 29 19 .82. pursuant to which Building Permit No. 12009Z dated ........ N.o..v.e..m~.e..r..9. ........ 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 ......... One-family dwelling. The certificate is issued to p.O.R..O~.H.Y.&.. ,S.A.L.V.b.T.O.R.E,. .......................... (owner'z/F~g~a~t of the aforesaid building. Suffolk County Department of Health Approval .............. 1.2. r .S.O.-.1. 2. .3 .................. UNDERWRITERS CERTIFICATE NO ............ N624197 Building Inspector Rev. 1/81 TOWN OF $Ou'rHoI~D · BUILDING DEpARTMEN*~ TOWN HALL ' SOUTHOLD, N. Y. NV BUILDING PERMIT UNTIL I~ULL COMPLETION OF THE WORK AUTHORIZED) t ooo z oo,, .... ~./m..~..F....,.~:.~i..:: ....... .,...~.~o~; ,o .......... ..... ~ ........ ~ . ~. .......... ; ................................................................... ?....;,....~,....,~ ...... ,t....; .......................... ~, ~",,,":,.~,.~ o,. ~~o.:....Z~z~.,:: ...... ~...: .......................... ................ .............................................................. : .......... :'....;;...? .............. ~~.~.c. ~,~ ~.~ ,o. ,000 ~,,,o.~z~..:. ,,,~ ;~.6..; ...... ~,,o. :.~e.~ ....... " ~ ~end approv~ by the pumu~nt ~o appIicotlon dot~ ..... ~'~'"~r'". ~9. BUilding I~spector ~ Pr~RMIT: INCLUDES APPROVAL TO [(EMOVE EXCESS FILL FROM:iABOVE: ;PREMISES BY.z/ REGRADING LOT DRIVEWAY CONSTRUCTION ¢6SS~O©t. ·CONS ~RUCTIO~ CELLAR CQNSTRUCTION OTHER Rev ~/3o/~o FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southotd, 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 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 or Engineer responsible for tim 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 p~operty 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. Fees: 1. Certificate of occupancv $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 $15.00 Date March lO.,]OPg. New Building .... ×.x.~. A .... Old orPre-ex~stm u~ ng ............ Vacant Land ............. .... p,^~o,,, L~5300 ,,air toad; ~,,; y 11971. . , House No. Street Ham/et D thy balcato~' )i 'hi' ' Owner or Owners of Property nco ~ e . ~, :t Da County Tax Map No, 1000 Section 07~ Block ~ Lot ~ ,~.~ © Subdivision ................................. Filed Map No ........... Lot No .............. Permit No.1.;(q0. 9 ..... Date of Permit .~.~,~. !¢74..Applicant .;').o.~..o.~.h.~... ,~ .S;~y.~ t., .o.r?..[14..b.Q~ ¥:"! Health Dept. Approval ........................ Labor Dept. Approval ...................... Underwriters Approval ~ .~). ~ L~... .. t~. . . . . . . . .q "l~.~,.,.Planning Board Approval Request for Temporary CertificaLe ..................... Final Certificate .. ~'~L%,~ ............ Fee Submitted $ ...................... Construction on above described building and permit meets all applicable codes and,regulations. : ....... '~,, ~'-O, ~L~( ~0 Applicant . Rev. 10-10-78 I~O0SO~ THE NEW YORK 'BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 TI-lIB CERTIFIES TNAT only the electrical equipment as escr'bed elo and i trod e by · . N¢)V~Z~ J.4~ 1~ a.dfoundtobei,tcompli.ncewlththerequirementsofthlsBoard. DRYERS FURNACE MOTORS FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E NO O1~ E R~C,~C~_D'[ OTHER APPARATUS: Defects ~ved as per o~m ~er of 4-.21-~83. R V I C E A.W G, '40, OF NEUTRALS A.W.G. OF HI-LEG P. Ol ~ 907 This certificate must not be aJtered in any manner; return to the office of the Board if incorrect. BU LDING DEPARTMENT, THIS ( GENERAL may be ide~tified by their AANNER. FIELD INSPEjJTIO~ FOUNDATION (1st) FOUNDATION (2nd) COMMENTS ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY G,ODE FINAL AIDITIONAL COMMENTS: 7G5-~.802 BUILDING~ DEI~', INSPECTION FOUNDATION 1ST ~ ] ROUGH 'PLBG. FOUNDATION 2ND ~ ~ INSULATION ~ FRAMING ~ ]FINAL ~ FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL File No ................................ Date ...................... 19 . To ~/. ~. ~/.o. ~. ~ . . ~.,'. .C~,.~. .~. . . ~ ~/ ~ //e~ . . .~ ~ ...... . PLEASE TAKE NOTICE that your application dated ......... C~.. ~. ~..., 19... House No, Street / HaMlet co.~ty Wa~ M~ .o. ~000 S~¢t~o... ~f&~ .... mo~ .............. ~t .~ ........ Subdivision ................. Filed Map No ................. Lot ~o .................. '"/ ~~~' ........................... ~7 .................... RVI~O $9Z. oo "~ ' ' fi~rm lo the ~anltard cf dm ~hd~oik '\ I FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:3 Disapproved a/c ..... :--..-:7'. ............................. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No./~..~...0..7 ...... a. This application must be completely filled in by typewriter or in ink and submitted 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 issued 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 building 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'O' ~' ' '~(' ' ' '~' ' '~" ' '~-e' ' ' ' '; ~ .~.' .~.' .'~owner of premises '~)' ! (s t eta roll or t t ) tf applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... elmnber's License No ......................... '~.~c i'.F¢ C)[~c~ ~ C.t, vc~.'~ ' ' ' ........ ...... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ...................................... [ ..... I~;;1;t '1' ..................... House Number Street p~. ~,, <:~ County Tax Map No. t000 Section ...O.~ ~ ...... Block .... ~ ............ Lot ................... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ~...o.~,..r~......~.. ~.~. .......................................... b. Intended use and occupancy i..~ ..O. .... ¢ .6. I · ~-~ ~.~..~. ..... ~..O..m.~. 3. Nature of work (check which agplicable): New Building .. . Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... 4, Lst~mated Cost ....... ] ......................... Fee ........................... / (to be paid on filing this application) 5. If dwelling, number of dwel~i~g iunits ............... Number ~f dwelling units on each floor ................ If garage, number of cars .~ .; ................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .... .................. 7. r)imensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dirnensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... i. · Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot Front ........... ' Rear ............... De~th ...................... Date of Purchase 10. , ~ ........ i ............... ~_2~}n ~_f F°rmer Owner .......... .~ ................. 11. Zone or use distri, et in which premises are situated .... /77. .... .°..~. i~.. H ;,...:,~, ..... !. ................. 12, Does proposed construction vic!ate any zoning law, ordinance or regulation.....~...Q ............ -- ...... 13. Will lot be regraded ........ .,. ~ ....... ~. ....... Will excess fill be removed from premises:_ ~ , N_,q,_ 14. Name ofOwnerofpr, epaises .~f..~." .C-?~.~...t,)~...~. Address ............. PhoneNo Name of Architect ~..~.'f-~. ~ .~5~ ............... Address ................... Phone No ................ Name of Contractor . ~. ~ ./~. '..~ ............... Address ........... Phone No PLOT DIAGRAM Locate clearly and distinctly alll buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATL OF NEW,YORK. -- COUNTY,,,._~__/, . ,' .-'"'-?,~ __OF .~.-~?../..~....~ ~]S, , · .~'..'~,'[re..~'.?.l.~?~.?-.... J~..'.'~'/.~..l.r( .~..~..'..~. ......... being duly sworn, deposes and says that he is the applicant . (Name of individual signing contract) above named. He is the . ~ ? o (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authoflzed to perform or have perfo~ed the said work and to m~e and file this application; that ail statements contained ~ this application am true to the best of his knowledge and belief; ~d that the work will be perfomed in ~e m~ne~ set forth in the application filed therewith. Sworn t0 before me this ......... ,~.~ ......... day of;..~~ ...... 19 ~ :~ Ua* 52-$125850, S~ ~. 1~ (Signature of applicant) .............. ><_, :, x....,<-: ..... - (~o~ :,! If copper tubing u!ied for water distributi~ig sys~e~; piping ~hall ~e of types K or ~. on ~i If copper lubing is for water distributing be types K or L only ~ ~a~aado N£ALTtt $~RVICES O i s4-. IOOf'D, ! o 95./0 Il./I .5'Z .~ 0 Tl'+te No. TI28{-2'30I ~z 7 9-6 .~ ti. lO'-4t