The URL can be used to link to this page

Home My WebLink About11879-zFORM NO. 4 TOWN OF SOUTHOLO BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ....... ~/[.26~7.... Date ............ . .. ....Ju~.3/..22. ....... . 1984... THIS CE13TIFIES that the building .......................................... ~dc~itio. n... Location of Property ..... .4.20 ............... .I~7 .ap~, .13d... ....... Mattituck House No, Street Ham/et County Tax Map No. 1000 Section ..... ~.~...Block ....... .4 ....... Lot ..... 3. 7 .......... Subdivision .............. ~ ............... Filed Map No .... ~f .... Lot No....x .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated August 25 19 IBZ pursuant to which Building Permit No 11.87.95 August 26 19 82 wasiss ed nd'conforms to all of the requireme ts dated ............................. , u , a n of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... f.a..m.il.y, room addition to existing dwelling. JOHN R. KLAGES & WIFE The certificate is issued to ............................... ~ .......................... (owner, 4e~cc~r.-tet~er~ of the aforesaid building. N/A Suffolk County Department of Ilealth Approval .......................................... N647655 UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 i PermissioQ is hereby granted to: TOWN O~ $OUT~01;~ BUILDING DEPARTMENI] TOWN ;H~LL BUILDIHG PE~IT~ (THIS PERMIT MUST BE KEPT 0N ~HE'P~E~is~S uNTiL COMPLETION OF THE WORK AUTHORIZED) ...... nt premises located at C0uhty-Tax Mop No. 1000 Section ~,,~.~........;. BIocl~ ~',.~..; .; Lot No.~.~.].,~..~7.. ......... I~. and :approvod by the pursuant ~o application dated , Bdil~lng Ihspector. Fee ;../..~ ............ Rev; 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ,~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitte~pH=ctc 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 featu res. 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 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 peoperty showing all property lines, streets, buildings and unusual naturaf 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. Certificateofoccupancyonpre-existingdwelling/landuse--?pe-E×±st±ng C.O. $15.00 3. Copv of certificate of occupancy $1.00 Vacant land C,O. $ 5.00 Date ............. f/. New Building ....... [. Old or Pre-existing Building ~ Vacant Land ......................... Location of Property House No. Street Hamlet Owner or Owners of Property ...¢~'~..( .¢~. ,"...~....~-~... ~...~4%/.~. (.-~. ................... County Tax Map No. 1000 Section I ~' ~ Block ~ Lot. ~-~ Subdivision ~ ' .Filed Map No.. ~. .... Lot No. Permit No./].ff..?. ?.?. Date of Permit ¢.~. ~ .Applicant...'~..~. /~ Health Dept. Approval ........................ Labor Dept. Approval ........................ .9.7 Underwriters Approva ............ P~anning Board Approva~ ...................... Request for Temporary Certific ..................... Final Certificate .. Fee Submitted $-~-.-~,' 0'0 . __~, ~stru~ti~n~a~v~ee~(;s~ri~be`dc~bu?~d~(~gLa/ndp~rmitme~sa~aJ2p~icab~e`e~c~e~and~ - ~ *~:~ ]//~- ~ regulation~ o cl 8' 1001165 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY, , 85 JOHN STREET, NEW YORK. NEW YORK 10038 ~ate Jume ].3, 1~$4 261170/84 N 647655 "r~llS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of gol'~ I(lages~ ~)uth Side Kt~,,tu,s l~roa, d~ O~.e Ju~e Lane~ ~Lattituck, N.Y. i,, the following Iocatlo.~ [] Basement ~ 1st Fl. [] ~,,d 1,7. Section Block Lot was examined on JLIXI~ 4 ;~ ~9~ and found to be in compliance with the requiretnents of this Board. FIXTURE OUTLETS DRYERS SWITCHES FIXTURES RANGES OVENS EXHAUST FANS 7 4 3 FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERs MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE OTHER APPARATUS: S E R V I C E NO, OF CC COND. A W+ G. NO OF HI.LEG OF HI-LEG NO. OF NEUTRALS A W, G. OF NEUTRAL tbwerd Dillingham ~ain Road Laurel, No¥, 11948 ~ This certificate must not be altered in any manner; return to the office of the'Board if i~correct. Inspectors may be identified by the~ FOR ' OF CERTIF C MANNER, ION "DATE COMMENTS., (1st) (2nd) :R N. Y. :RGY COv ADDITIONAL M~ENTS: 1. FOUNDATION FOUNDATION 2. ROUGH FRAME & PLU~ 3. INSULATION PER STATE EN qODE FINAL FORM NO, 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c ..................... Application No. r,~.?..,.~..~. ........ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted.~ to the Building Inspector, with 3 sets ot~ 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 wi/1 issue 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 [o 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 nec? ~y i~cti~ ~/~ ................ J / (Signature of~p~pli~al~f/6r name, if a corporation) (Mailing address of applicant)///~Cff~.~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .~..~...tt2t~.....~.....~..~../~...C~...~..~../~../fi.~.. ................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate o~f~er) , , Plumber s License No .... ~...~......~./~..g-~..~..~ Electrician s License No. ~.~ Other Trades License No..~*.. Location of land on which proposed work will be done. ~, .~ Z...~Q ~..~T ~ ...................... House Number Street Hamlet County Tax Map No. 1000 Section...[.~ ......... Block .... ¢ ........... Lot..~.~ ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .. ~/~ ~... 7.~.... ........................................... b. Intended use and occupancy . ~.~[ ~ ~¢.~.. 7. ~ ..................................... o 113. 14. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Rem6val .............. Demolition .............. Other Work ............... '~''~ : "~..d'/.~'~,' ~ (Description) Estimated Cost.. :. ...................... Vee ............................. (to be paid on filing this application) If dwelling, number of dwellinglunits. ....... /. ...... Number of dwelling units on each floor ................ If garage, number of cars .... ~ ...... [ ........................................................... If .... business, commercial or mixed, occupancy,, specify nature/and., extent of each type/_ ofo..use ......... .~' ' ~ t' · · · Dlmensmns of ex]st~n~ structures, if any: Front... ~..,~... 7 .Q... Rear . .~. ~ . .':-. ..... Depth . ,~..... 7 ....... Height . . ./~. f.-. P..' ....Number of Stories ........ /. ...... Dimensions of same structure wlth alterations or additions: Front .~..~. ...... Rear. i~..~7..~ i~7 O :; ~.'- o" ! '~ht d ~ '- o" ./ I)epth ................. ,.. Hel ................... Number of Stories ............. Dimensions of entire new construction: Front ............... Rear ............... Depth .............. Height ............... Nulgber 9f Stones ......... } ~ ~,. ~ ...., ......................... ~,. ......... Size of lot. Front ...................... Rear ...................... Depth . : ............ Date Of Purchase .......... ~ .................. Name of Former Owner ............................. Zone 6r use district in which pr~mises are situated ......................... A;¢, ......................... Does proposed construction viOlate any zoning law, ordinance or regulation: ..../~...~ ......................... .Will lot be regraded ......~ :7,. "' )'~ ~': ~'~-~d' ' ' ' Will ~x, gejs fill b_e, re,m?~d from premises: marne of Owner of premises ,V.o, .~....... ~ ...... Address~...tr'~..r. ~..~,'~.~. < .~.~...'~Phone No.~. ? .~.-."5~..~/.... Name of Architect Address Phone No Name of Contractor ~.' .~,- ' Address Phone No PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and blocklnumber or description according to deed, and show street names and indicate whether interior or corner lot. . ~ / STATE OF NEW YORK,/..j,. COUNTY OF .~. '{,(p"; .,~{9 ......... ........ .... .... ...... (Name of individual signing contract) , above named, i ...'.. being duly sworn, deposes and says that he is the applicant He is the ................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this applicationi that all statements contMned in this application are true to the best of his knowledge and belief; and that the work will be performed in the mann{r set forth in the application filed therewith. Sworn to before me this ~ ......................... day o! Notav ror~ ,I jul AFP~OVZD AS NOTED ~ DATE:~B.P. ~//~-~-~-~ J ~' BY: ~,..,T I F'Y gUILDING .... 765-1802 9 AM TO 4 pM ~w~ '"~ FOLLOWING iNSPECTIONS: 1. FOUNDATION - ~O REQUIRED FOR pOURED cONCRETE ~. ROUGH - FRA~[NG & pLU~BING 3. INSULATION 4. ~INAL - Coh~T~UCTION ~UST BE Cnh&pI FTE FOR C, O, ALL CONST~'~CTION 5HALL THE R~OUIpEMENTS OF THE STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. F. ~IST~ G G~,EA &-E