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HomeMy WebLinkAbout12083-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No .... ~Z.q. 6..5.7.9 ....... Date ...... July q ., 19 .8.6. THIS CERTIFIES that the building., g.a?.a.~ .e..8,.. b..p.e?.z.e..~.a.y..a..~.cl.~t:$9.n .............. Location of Property .... ~ 5 9 ............. ~.a.k..e.s.~.d.e.. p.v... .... S o u t h o 1 cl House No. Street Hamlet County Tax Map No. 1000 Section ..... ~ 9 .....Block .......... 3. ....Lot ....... .5 ......... Subdivision...O.e.d.a. ?. .B.c. a. .c .h..~. a. ?.lc .......... Filed Map No ..... 9. 0...Lot No ....... 5. 7. ..... conforms substantially to the Application for Building Permit heretofore t-fled in this office dated · .D.e..c .e.m.b.e..r..9. ....... , 19.8 .2. pursuant to which Building Permit No... 1. 2. .0.8.3.Z. ............ dated .... ./? .e.c.e.m..b.e?..2. ? ........... 198. .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 ......... .... .~.a.v.a.g.e..a.n..d..b.v.e.e..z.ey.a. Xr..a.~.4 ~.~3.qn...~9..a..n..e.x. ~..s.~.~.n.~..d.w.e. ~..~ 3.n.¥: ........... The certificate is issued to ROGER & VIRGINIP/ CORNELL (ownor, ~Y~ of the aforesaid building. Suffolk County Department of Health Approval .................. ~ ./? ..................... UNDERWRITERS CERTIFICATE NO ......................... ~ ~( .59.9.6. 5. ................. Rev. 1/81 Building Inspector BUILDING D~PARTME TQ~N HALL SOUTHOLD, bi. Y. BUILDIbiG PEEN IT ~ (THIS PERMIT MUST:BE KEPT ON THE PREMISES UNTIJ~ ED) i~ COMPLETION OF THE WORK AUTHORIZ ,: ~ FULL N9 12083 Z ~ate ....... ~- ................. ~. ............................. , PermisSion is hereby granted ~ / _~,. X/j' ~ -- ~ ,, ./~ 'Of premiss I~ot~ at pu~uan~ to application dat~ ............................... ................ ~ ......... 19.~.....,, and appr~ by the B~ildlng: Inspector. Fee $...,~ ................... ;~: Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted m ~ 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-IS-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 p~'~operty showing all property lines, streets, buildings and unusual natural or topograph ic featu res, 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 3, Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. Updated C.O. $15.00 ~ew Building ............. Old or Pre-existing Building ............ Vacant Land ......... . .... Location of Property ~SC) House No. Street Ham/et Owner or Owners of Property .. County Tax Map No. 1000 Section $15.00 Subdivision ................................. Filed Map No ........... Lot No .............. PermitNo ........... Oate of Permit .tv.l..~..Applicant... eC.....,~_....? [~J~. ..,....~r ~'~ ... Health Dept. Approval', ....................... Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ... ~ .................... Fee Submitted $ ............... Construction on above described building and ~ermit meets all ap_jplicable codes and regulations. ~' ~F~ ~-'1/~[ ,'~~q' Applicant . .~..~ . . .~ ........................ THE NEW YORK BOARD OF FIRE UNDERWRITERS  BUREAU OF ELECTRICITY '~ 85 JOHN STREET, NEW YORK, NEW ~[~,~8 ~ Pay 22~ ).9~6 THIS CERTIFIES THAT ' only the electric~g~t ~E~ b~a~,~~p~d ~he above application number i~ the prendses of in the following location; RXTURE OUTLETS DRYERS 1986 I ~ FIXTURES MOTORS 2nd FI. ; Section Block a~tcI found to be in compliance with the require.~ertts of this Bo~d. Lot RANGES OVENS EXHAUST FANS OF CC, COND 50 Cedaz ~e. ac, h Road This certificate must not be aJtered in any manner; return to the office of the Board if incorrect. Inspectors GENEI~AL MA NA~,F~ ~ Per-~ be b~, their credentials. l" I' ~;-L D "~,N S PRCT T ON COMMI,NIo FOUNDATION (2nd) ROUGH FRAME & PLUMBING 3. INSULATION PER N. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-180;~ Examine~ '7~.. ¢....dY..., Approved~...~. .~.,. Disapproved a/c ............... '. ^ppncation No./C~: .~.~ ....... APPLICATION FOR BUILDING PERIVlIT Date ......... INSTRUCTIONS 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 necessaw,,,~spectio,~. ,/7 ,,-? ................... (,Signature of applicant, or name, if a corporation) .~e¥.d(~./..fe(~?~.e~.,.~W., ~:,.//~. ?l ........ (Mailing address of a~pplicant) State wliether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· · .CY.~.~.~< ...................................................................................... Nameofownerofpremises ..~%)~.,~.~-)~/d~ (7-0/2~A/ce'~ ~ ~///~-~ Z C~6;~/~'/~-~/'- .......... :..&~. ....... -; fA VA4 ................................. (a~ on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Plumber's License No .......... . .~/.~..~, .. ,/ Other Trade's License No ................. ./. 1. Location of land on which proposed work will be done .................................................. ...4:.o. ................ .:. .~. ~(~: :. /p. .:. , . .~ ............. ~.?: :~ ?>. h + . ,4.,. (~/, .......... Honse Number Street (~)9~ Hamlet , County Tax Map No 1000~Section ~..~-~.. ?.~.. Block ..... .Q 3 ......... Lot ~.. Subdivision ~. ~A:.../.~-~ .".~....¢.'.6~, .~.. ..... Filed Map No. p.O. ........... L'ot ...'M.. 7 ........ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. ~×isting rise and occupancy ......................................................... b. Intended use and occupancy .. ~.-~..~.~...~.~.~'. .............................................. 3. Nature of work (check which applicable): New Building ...... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... 4. Estimated Cost .......... , ................................................... ~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ 6. If business, commercial or mixed o6eupancy, specify natffre and extent of each type of use .............. 7. D~mensmns of existing structures, ff any: Front. ./ ...... Rear . D pth . oq~-./. Height ............... Numbe( of Stories ./.~ ................................................ Dimensions of same structure with alterations or additions: Front ... & .q .t ......... Re~r._E.' .~ .~./. ........... Depth...:. ~_.~.~r. / ... Height ..................... Number of Stories. 1~_.~ 8. Dimensions of entire new construction: Front/:q.~ .4~d-C~/~'7.,... Rear ............... Depth ............... Height ............ Number[of Stories .~:-,r./'?,~5~ .~,~7 ...................................... 11. Zone or use district in Which {)remis~s are situated/~SeX5't'~2~'~4JT../.~?-~.-~ ........ q. ....... ................. 12. Does proposed construction violate any zoning law, ordinance or regulation/~/~. ..... ] ..... 13. Will lot be regraded ............ 5' r. ....... ~ ..... Will excess fill be~emoved from premises. Yes Name of Architect ............. i ............. Address ................... Phone No ................ Name of Contractor ............ i ............. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whet,her existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block num6er or description according to deed, and show street names and ~dicate whether interior or corner lot. ...__.. STATE OF NE~.. ~ S S cov v oF .... · above named. He is the .............. ~ . .. . ... ........................................................ (Contractor, agent, corporate officer, etc.) of said owner or ownem, ~d is duly authorized to perform or have perfo~ed the ~id work ~d to m~e ~d file this application; that all statements contained ~ ~is application are true to the best or, knowledge and belief; and that the work will be perfomed in the m~ner set for~ in the application filed therewith. Sworn to befo~ me this ......... Y. County~~. .. ..... ........ ~o~ V0r~ (Signature of applic~t) AP~©~D ~$ NOTED 7654802 '2 A,M TO ~ PM FOR THE FOLLO'/WN~ ;h;c?FC-T~ONS: ]' FOI'Jh!'~AT~F~ '- '[WO REQUIRED FOR PCUR':O CONCRETE 2. ROUGH -, FRAMINC & PLUMBING 4. FINAL - PON:%[UCTION MUST BE COM?L,ETE FOR C. O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N. ~ATE CONSTRucTION & ENERGy ~DES. NOT RESPONSIBLE FOR DESIGN O~ CONSTRUCTION , f FLOOR PLAN GAR, AG-C~' LAU~Dr.~Y ROOM LAKE $1P~ s"'&" > 3///', / .._ / --; PAT/O