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HomeMy WebLinkAbout11854-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall 5outhold, N.Y. Certificate Of Occupancy No ........ g.~.&4 ~.7... Date ......... .M.~.y..2. J ................. 19.8.6. THIS CERTIFIES that the building ........ fi.rig .r 9.u.r~d,, &w.~.r0~ $.n.~. p 9.o.1. ............. Location of Property ...555 ................. /t.l.v.~.'.~..b~.n.e. ........... C.u..tg.h. qg.u.e .... House No. Street Hamlet County Tax Map No. 1000 Section .... 1 99 .....Block ....... .1 .......Lot .... 2.~ ........... Subdivision ............. g ................. Filed Map No...X. ..... Lot No ...... X. ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ·. g !ag~ ~ ~. B ........... 19 ~3.2. pursuant to which Building Permit No... ]..1.8.5.6. Z. ............ dated ..... kug~ ~.~,..l ~3 ............ 19 ~37., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ·.. Iz~g~ ouz~d. ~q.~.mm$~g .p Q.o.1. ................................................... The certificate is issued to .............. ~T.Q~g~..&. ~l&l~g...H~I.qB. ~ .E ....................... (owner, ~e~K ~a~ of the aforesaid buildiug. Suffolk County Department of Health Approval ............ SAg. .......................... -UNDERWRITERS CERTIFICATE NO .................. lq 5.7.6.~ 5 ? ........................ Building Inspector Rev, 1/81 FOR~ SO. e~ T OW ,OF BUILDING DEPARTMENT~ TOWN HALL BUILDING FE~I~ (THIS PERMIT~MUST BE KEPT ON THE P~E~IS COMPL~ION OF THE WORK AUTHORIZED) No. 11854 Z Date Per~nission is hereby granted to: uNTIL ULL at premises located at .~,...~.*~ .............. Couhty Tc~X Map No: 1000 'Section L~./.~....~;.......~.; 'Block :~...(~ ~.~. .......... ~ L~, No....~.~.~ ..... pursuant tO application dated ...~~..'.~L;.~;...;;....:, 19.~and ~approved by the Building Ihspector. ~ l~ctor R ~ ~ ev. 6 /30/80 ~ ~ ~ ~ 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 submitted in duplicate to the Building lnspec- tot with the following; for new buildings or new use: 1o 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 olectrical 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 ~oard,approva 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. Fees: 2. Certificate of occupancy on p~6-~xisting dwelling op land u se'~'/,~' 5.00 3. Copy of certificate of occupancy $1.00 Date .. New Building ............. Old or Pre-existing BuUding(X) ......... ~ ZVacant Land ............ Location of Property . . ~. ~0'~, . . ~ ~/4~.~ ~. , ~. ~ .~ ~, ..... C(2 ~. C.t'J O ~ ~.~ . . ='. .Street Jou~ No, ' ''.'.'--t' Ham/et Owner or Owners of Property ..... ~ ._.. [eq County Tax Map No. 1000 Section ............ Block ... .~ { Lot .... Subdivision ................................. Filed Map No .... ~ ...... Lot No .... ~. ........ Permit No. .1( ~ ~. Dato of Permit }['O/}~Applicant '~{m ~[ G.~ . Health Dept. Approval .~. ..... ~ ......... Labor Dept. Approval ........... ,.. Unde~ritersApproval ~~7 . .Planning Board Approval %~. .~., Request for Temporary Certificate ..................... Final Certificate ................. .... Construction on above described building and ~ermirmeets/I acp~cabl~odes and regulations. ................................ TO~FN OF SOUT~OLD OFFICE OF BUILDING L SPECTOR · N P.O. BOX 728 TOWN HALL $OUTHOLD, N.Y. 11971 TEL. 765-I 802 ~li f!?~' ........ "~'' ~ APR 2 3 1986 P .T,his is to advise you that the = c' ,l,, - - ,. ~. ~ ~-~X -u complebed and ~ .ln~ inspect!on na~ ~ has noz~--been done. In o~deu to comp!ere this file, it is necessary that a Ce. t-~lcate of Occqpancy be issued Please fill out ~h~ enclosed ~oum(s), return same to the above office with a check fop $5.00 payable to the Town of Southold. Please ' indicate to whom the CePtificate of Occupancy is to be mailed, and auman~e with this office fo~ an inspecEion date. Thank you for youP prompt attention. VL;ec Enclosures Very truly yours~ Victor Lessard Administr~ tor 1000344 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ B5 JOHN STREET, NEW YORK, NEW YORK ,O03e .a,e August 26, 1982 181661-82 ~pplieet,o.~o. onfile N574257 THIS CERTIFIES THAT only tko electrical equipment as described below and ~ntroduced by the applicant ~med on the above application number in the prernises of ~. ~, 555 ~v,~ in the/ollowing locationi ~ Basement ~ 1st Fl. ~ 2nd FL ~CSi~ Section Block Lot ~.~ .~..a,,od o. ~t 23, 1982 ..d /o..d to be in complla,,¢e with the requirements of tkls Board. FIXTURE FIXTURES RANGES OVENS EXHAUST FANS DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT OTHER APPARATUS: 1-G.F.I. Rec. S E R V I C E NO OF Hi-lEG A W.G. OF NEUTRAL JoFA' HI-LEGW' O. NO, OF NEUTRALS ~ff~ml) _1~ ee~tificate covers compliance a~he da~e of Jampeccion only. use o %mamual emrlror~ ~a~lCs it is advisable to have frequent test: amd/or repairs mad~ by a qualified person. I~ Th,s certificate must not ~e o',ered ,n an manner ret P,r iii ' - COPY FOR BUlL]DING DEPARTMENT. THIS cOpy OF CERT~I ATE~ /TERED ~M~A?NER. FIELD INSPECTION FOUNDATION (1st) FOUNDATION (2nd} ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY COMMENTS FINAL ADDITIONAL COMMENTS TOWN OF SOUTNOLD BUILDING D£PARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exo ned ~..~ ............. , ]9~ ' ~ ~pplication No. ~/~ ............ ~lT2ved ~_.~ .............. ~ -' 1~ ~ormit ~o....~.~~ ...... ........................................ .................. .................... ../ .................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Dote ..~..:......~,. .................... , 19.,~..~..... o. This application must be completely filled in by typewriter o~ 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 o~ areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. 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 perh~it 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 Occupor. cy shell 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 app~nt, or name, if o corporation) ...... [A~l~ress"~'~ '~g~f) ................ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (Name and title of corporate officer) Builder's Licens~ No. Plumber's License No ............... ~ ............................ Electrician's' License No..../.../..~)..../...Q...~... .................. Other Trade's License No .......... ,.~..: ........................... / FROM ABOVE PREMISES REGRADING LOT CONS UCT,ON CONS'r UCT O _ lOU Subdivision Location of land on which proposed work_will be done. Map No.: ................................ .~ ...... Lot No ......................... Street and Number ...... .~...~. ............. .~/. ,/'.,~..~/l~.....~z~..~.. .......................... /~..~....~....~..,,,~.~. .................. ~ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use ond occupancy .............. x~..,~..~..~.~-... ........................... ,~ ................................................. b. Intended use and occupancy .~,~.x~...~..~....,.~.~..~4.~.,~...,.,~.~..~.<~.~..,d'~'~'.,..~..,~..~ ............. County Tax Map No. Dist. 1000 Section /~] ~ Block ~/ Lot 3. Nature of work (check which applicable): New Building.. ................. Addition .......... Alteration ................. Repair .............. v;' Removal .. ................ Demolitior. .................... Other Work ................................................. .... ~, ~_._,~_~2~.. ~ /~. '/~ (Description) 4. Estimated Cost .~.~.~ ....... ~ ................................... Fee .../.~ ............................................................................... ~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ........................ :..Number of dwelling units on each flor ............................ f garage, number of cars ........ t .................................................................................................................................... 6. If business, commercial or m~xed occupancy, speci~ nature and extent of each ~pe of u~ ............................ 7. Dimensions of existi,ng structures, If any: Front ............................ D~ar ................................ Dep~ .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure ~ th alte[ations or additions: Front .................................... Rear ............................ Depth ................................. Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number 0f Stories ...................................................................................................................... 9. Size of lot: Front .................... .................................... R~r .......................................... Depth ................................ 10. Date of Purchase .................... ~ ................................... Name of Former ~ner ........................................................ 11. Zone or use district in which premises are situated ...................................................... .~ ...................................... 12. Does proposed construction violbte any z~ing law, ordinance or ~ulatlon: ......... 4u.~ ........................................ 13. Will lot be regraded ....~.~ .......... ~ill exce~ fill be removed from promises: (~es ( ) No / o~ ~ , ~Z (E, . . ..... :~.~.~ ~. ~e o~ O~.e, o~,r,~,~,~...,....S~.Y~ ................... ~r..~ .................... ~. Name of Architect .................. ~[: ........ ~ ......................... hddre~ ................................ Ph~e No ....................... . ~m~ o~ Con,~,o~.~ ................................ ~,,, ~ ........... , ........... ,~ ,o..~.~ ..... ' ; ~ PLOT DIAG~M ~~' Locate Clearly and distinctly all buildings, whether existing or proposed, and indicate all ~t~k dimensions from prope~y lines. Give street and blocl number or description according to de~, and show strut ~mas and indicate Whether interior or corner lot. STATE OF NEW )~,ORK.~.-% j/~ I SjS ~. COUNTY OF ...~4~..~.~.~.D ...... ~' ). ( ~ /, .................................... ~Z~/~:.....~~ .......... being duly sworn, d~oses and says t~t he is the applicon, [Nome of i~ividual signipg contfac~ above named. . ; . / , . ..; ............. ~.~ . .. ..................... ~e is the ........................................ ...... ,..,.~ ......... ~': ..... , : (Contractor~e~t, corporate othcer, etc.) of Said owner or owners and is duly authorized to perform or hove performed the said work and to ~ke and file this app ication; that all statements :contained in ,th~pp~io~ a? tru~ to. ~? besS.of ht~edge and belief;, and that the,work will be performed in the manner set f~h in the ~pficati~ tiled merew~m.~ Swor~0re me this / ~ ~ ~ ~' 2' ~ ........ · / "// Notaw Pubhc,,lic, ....~ ..... ..~ ~... Coun~ ..~..-..: ....... ~: ....................... , p~. c. w~. ' ' ' ' ;, No. ~2.~12312 - / ~ SECTION OTE~. ..... WALKS TO 8£ SMOOTH- NON SKID TYPE, SLOPED AWAY FROM POOL. WATER DISPOSAL SHALL BE LIMITED TO OWNE'R'$ PRO__PER_T~Y TO SUi. T LOCAL REGULATIONS FiBERGt. Ae~t MOULDED I PIECE OPTIONAL STEP TYPE I. TY,.~PICA.L W__A LL SECT1_ OPTIONAL STEP TYPE 2.