HomeMy WebLinkAbout11713-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No..Z. 33.6.9.? ......... Date ..... .~.a.7..3. J ..................... 19 .8.3.
THIS CERTIFIES that the building addi~c±°r~
Location of Propertynoose"~'9 5 .~ .~vo. Oyst e~.. 2Poncl .lSa~o .... 's't/e;i ......... Or .~on~. .......
County Tax Map No. 1000 Section . .0.2.? ....... Block .... O. fl.. ......... Lot...0.0..2 ...........
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
Flay 24 19 ~2 pursuant to which Building Permit No. q'37'137,
dated .... .~.m. ~.e...~ ................. 19 ~.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 .........
..... An...<~.%~..~.o.n., .~.o..e.z. $.s.~. a .ct? .z.z.~ ....................................
The certificate is issued to . .R. ql¢..e.z'.~..~.....R.e.e.¥.e..~.: ....... ............................
(owner,/e$$ae or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval ..........................................
N 586q~6
UNDBRWRITBRS CBRTIFICATB NO
Building Inspector
Rev. 1/81
(THIS PERMIT, MU
COMPLETION (
~171'3 Z
;T BE KE~T ON;
a~ piemise~ located
Map; No, 1000 ,~ecti n
p~;la~t ;o application dated
I~spector.
3LL
~pproved by the
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must he 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 llnes, 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 instaIla-
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~exist!ng~"
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 ~r 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 ~r land use $/s-/$5,00
3. Copy of certificate of occupancy $1.00
Date
New Building .,Cr¢~../¢~.z9,. Old or Pre-existing Buildin,g(Z). ~ ~Vacant Land ....... . .....
House No, Street Hamlet
Owner or Owners of Property
County Tax Map No. 1000 Section ............... Block ............... Lot ................
Subdivision ................................. Filed Map NO ........... Lot No ..............
Permit No. //~.7/z~,~' Date of Permit ~_~..~. ~. ~...Applicant "~..~;.'~_~_/~..~,,~... ~"~ .....
Health Dept. Approval ........................ Labor Dept. Approval .........................
Underwriters Approval ........................ Planning Board Approval ..................
Request for Temporary Certificate ..................... Final Certificate ........
Fee Submitted $ .............................
Construction on above described bu ildi~e/~s,~ab~_,,,,~ ~//', ,--,~¢,~'~' ' ~ and regu latio~s.
FIELD INS['ECTI~N
FOUNDATION
FOUNDATION
(1st
(2nd
ROUGH FRAME &
FLUMBING
INSULATION PER
STATE ENEROY
qOD
FINAL
1000773
THE NEW YORK BOARD OF
B~ JOHN STREET, NEW YORK, N~W~YORK 1OOaB
..re December 9, 1982
THIS CERTIFIES THAT N $ 8 6 ! 4 6
only the electrical equipment as described belotv and introduced by the applican{ na~*ed on the a~o~e application number in the premises of
~berc ~eves Jr., ~st~ P~d ~, ~t, N.~.
n thefollow~ng Iocat~ott; [] Basernent ~ 1st FI.
~.sexa~.i.~do. December 6, 1982
FIXTURE FIXTURES
OUTLETS
5 5 7 5
DRYERS FURNACE FUTURE APPLIANCE FEEDERS
[] 2nd FI. ' ~ Section Block
and found to be in cor~;pli~nce with the ~equirements of this Board.
Lot
MULTI-OUTLET DIMMERS
SYSTEMS
NO. OF FEET
SERVICE DISCONNECT
OTHER APPARATUS:
2-O.F.I;
1-150 amp. Transfer Switch
R ~!V I C E
NO. OF HI-LE( I A W. G. ~ A, W G
1/0 1/0
Orient, N.Y,, 11957
THIS
MANNER.
~09,00'
,(
FORM NO. 1
TOWN OF SOUTHO,LD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
. . .... , ,':e'%erm,t /. ?.Z. .:.--f'
Disapproved a/c .... 77..-:. :~ .....
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Application No.////Z/.~'~
INSTRUCTIONS
a. This application must be completely filled in by typewriter or 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
or areas, and gSving 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 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 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, builOing code, housing code, and regulations, and to
admit authorized inspectors on premises and in buildings for necejsa~ !~s~p~)ztion~
-- 7'7t~->e0 ~ 21~ '7~-~ ~ (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 owner of premisesr'~O, b~-a~"~. · ~.,~.,~- .~e.5./;~12--..oe./,O.,~.e~...~. ~...,1-$/~ l e~. Z-.~..~e .~.e-.$'. ....... (as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No ...... ,~.~.~ ..............
Plumber's License No .........................
Electrician's License No ....
Other Trade's License No ......................
1. Location of land on which proposed work will be done ..................................................
........ 7. .............. ...... .......................
House Number Street Hamlet
County TaxMapNo. 1000 Section ....~O~..~.~. ........ Block ' ~/. Lot..~...~...'~.. .........
Subdivision ....... ~,~..~5~.O,.~..~. ................ 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 .... ' .....~ c&,'.~.~ ~ C.~..4.[.~F.~ ~. O~ .... : ............................
b. Intended use and occupancy ....... ,/,x7~.$.o~.C: o.c e~...~. 4 .c2,...,c~..{~: .......: ..............
9.
10.
11.
12.
I3.
14.
/
Nature of work (check which applicable): New Bu/ldin§ .......... AdcUtlon . .[--/~.,. ,'~tteratxon
Repair .............. Removal .............. Demolition .............. Other Work ...............
Estimated Cost ~..~.~... ee~./('...~--.. ~O,e/ ~ ~ (Descript. ion)
~ (to be paid on filing this application)
If dwelling, number of dwelling uhits ............... Number o f dwelling units on each floor ................
If garage, number of cars ..... 3Z~ .................................................................
If business, commercial or mixed!occupancy, specify nature and extent of each type of use ............ 5' '
·. Rear . ~?-.~..~ ....... Depth.. ~ ........
DJmens~ons of ex~s, hng structures, if any: Front... ~'~... ~... ~ ~
Height .... /5. d'. ....... Number of Stories ........................................................
Dimensions of same structure with alterations or additions: Front ...~,5'f.~'f: ...... Rear .... 2~7. ~. ~./.~ .......
Depth ....... ~'.0 ........... . Height ..... /.ff. ..../ ......... Number of S~tones ............. y ........
Dimensions
of entire
new constrqction: Front .... ,/.~5' ....... Rear .... ~'.~ ....... Depth .. ~.O .....
Height ............... Numbor of Stories ............... j ........................................
Size of lot Front ...... ./.4:.~: .......... Rear .... /O.~7. ............ Depth ../.,,~.O ...............
Date of Purchase ........... i ................. Name of Former Owner .............................
Zone or use district in which premises are situated.. ,~. ¢6'./.*fe.,,,~m ./ ....................................
Does proposed construction violate any zoning law, ordinance or regulation: ..: .............................
Will lot be regraded ....... /<}i~o ................. Will excess fill be removed from premises: .Yes ~
Name of Owner of premises . ~.~. /?ee~c.~: ~,.. Address . ~./v~.~-e.~.~tor-4/J~ ~ ePhone No ~ .~. 3'.. ?..~./.7 ....
Name of Architect ........... . ............... Address ................... Phone No ................
Nmne 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 st~ eot and block r umber or description according to deed, and show street names and indicate whether
interior or corner lot.
TATE OF
COUNTY,
above named·
signing )
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 dul? authorized to perform or have performed the said work and to make and file this
application; that all statements cont~ .ined in this application are true to the best of his knowledge and belief; and that the
work will be performed in the manne'r set forth in the application filed therewith.
Sworn to before me this
AFP/R~Y~D AS NOTED~
~-180~ 9 AM TO 4 PM FOR THE
¢~LLOWING IN~ECTIONS:
1. FOU~DATION - ~0 REQUIRED
3, INSU~TION
4. FINAL - CO~TRUCTION MUST
BE COMPLETE FOR C.O.
ALL EONSTRUCTION SHALL Mbb~
THE REQUIREMENTS OF ~E N.Y.
STATE CONSTRUCTION & ENERGY
CODES, NOT RESPONSIBLE FOR
DESIGN OR CONS~UCTION ERRORS.
OCCUPANCY OR
USE IS UNLAWFUL
WITHOUT CERTIFICATE
OF 'OCCUPANCY
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