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HomeMy WebLinkAbout11846-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate O[ Occupancy THIS CERTIFIES that the building ................................................ Location of Property ... ~..7.5 0. .T.r.~,~,r~.'.s. . ~'.a.t,.h , . ~.a,~ ~. . .H.a.e. ~. 9.n' ...................... House Ho. Street Hem/et County Tax Map No. 1000 Section .. 3 ~- ........ Block . .]; ~ ........... Lot .. [. ~ ............. Subdivision ...... .X ........................ Filed Map No...X ...... Lot No....X .......... conforms substantially to the Application for Building Permit heretofore fried in this office dated ~ l~gtt ~ !;. 5. ,. ........... 198.2.. pursuant to which Building Permit No. ~..~ .8.4.6. Z. .............. dated .. 8.u. gu. ~.~..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 ......... .. N.~w. D.-.~ ~p.g ............................................................... The certificate is issued to ... 0'.o~t~. G.o~'.g~. sap. c]. [4sa?.~, Syr~..I~ ~y.J,],~..e ................... (owner. ;~c~.;~ ~.~ ~.~,~..~ of the aforesaid building. Suffolk County Department of Health Approval ... ,]-.i:-.S.Q .-~.0.,.. ] .1/.2.9./..8.2.,..~. 9.b.'q.... ~....~ .~.1.1a, UNDERWRITERS CERTIFICATE NO. 5.~0622 .............. i ........ ' ................... Building Inspector Rev. 1/81 11846 Per~nissJon is hereby g TOWH~ HALi' , sOuTH01~D, N~ ¥. ! BUILDIHGi~ (THIS PERM T MUST BE KEPT ON COMPLETION OF THE WORK AUTHORIZEDi ]Z ' bate ..,.~ UNTIL ~ULL at p~remise~ located at C~uflty T~x Map No. 1000 Section :...~:~.g:.:.~. BIoC~. ~... BuJ. ldlng Iospector. · /~.....~!kot N0. .(;:~...~ ......... ..;.., 1~...., and 'approved by the FORM NO. 6 TOWN OF $OUTHOLD Buiiding Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and subn~itted in duplicate to the Building lnspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate location of ali buildings, property lines, streets, and unusual natural or topogreohic 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 building~ and installa- tions, a certificate of Code compliance from the Architect or Enoineer responsible for the building. 5. Submit Planning Board approval of completed site plan requiremer~ts where applicable. B. For existing buildings {prior to April 1957), Non-conforming uses, or buildings a~d "pre-existing" land uses: 1. Accurate ~urvey of peoperty showing all prooerty lines, ~reets, 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. / C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date .. New Building ..... .~. ...... Old or Pre-existing Building(:~) ........ ~ ZV~cant Land I ?.~z.b ~ ~ , ' ......... ;' ' Locatlon of Property ............... .-'T.p~.. ?..n9 ..~ .,~ .~~,}~j .~ Hou~ No. . ...... : S~r~e[ Hamiet .................... . u, ... County Tax Map No 1000Section ... ~ } Block I ~ ....... Lot ..... .~ ......... Subdivision Filed MapNo Lot No ' PermitNo. ~l~ . Date of Permit ..~. ~.~.Applicant ..~2 ........ ~.~.~.9.~.. Health Dept Approval .~ ' ..................... Labor Dept. Approval ...................... Unde~riters Approval .... ~ ................ Planning Board Approval .................. R t f T y C tific ' eques or emporar er ate ..................... Final Certificate ..... - ......... S. ..................... · . .-. Construction on above described budding and er ~ :mmOT: THE NEW YORK BOARD'OF El,RE UNDERWRITERS BUREAU OF ELECTRIICI~ THIS C~J FIE5 THAT only the el, ical equipment ~ described belo~ and introduced by t~ ~ppl~ no~ed o~ the o~ application number in the premises of ~.~ ~..,i,,dd o. ~to~r ~ 8, 1982 and ~ound to be in con~pli~nce with the ~equlrements of this Board. FIXTURE OUTLETS DRYERS FIXTURES SWITCHES MOTORS APPLIANCE FEEDERS OVENS DISH WASHERS EXHAUST FANS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE OFHER This i, must not be altered in any manner; return to the C E of the I~oard )~ may be ANY MANNER. COPYq ISUlL~ING DEPARTMENTi T~$ ¢~P¥~?F FIELD INSPECTION FOUNDATION (lst) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATZON PER N. STATE ENERGY CODE FINAL JARTtCLE tS~ (Protection of Water) NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION PERMIT 'PERMI/ NO, UNDER THE ENVIRONMENTAL CONSERVATION LAW [ARTICLE 25, (Tidal Wetlands) ARTICLE 36, (Co,st~uction ill Flood Hazard Areas) PERMIT ISSUED TO I LO-C-AT~O~-O-F PROJE~T'(~c-tion c)~r stream, t-id'al Wotfahd, d~r~, buildins) COMMUNITY NAME (City~ Town, Village) COU~N ~'lt('~J'-~ JFIA COMMUNITY NO;' D*~ GENERAL CONDITIONS t. The permittee shah file in the office of the appropriate Regional Permil Administrator, a iloUce of inlention to commence work af least 48 hours in advance of the time of commencemenl and shah also notify him promptiy in writing of the cornpietion of the work. 2. The permitted work shall be subject to inspection by an authorized representative of the Department of Environmental Conservation who may order the work suspended if the public interest so requires. 3. As a condition of the issuance of this permit, the applicant has ac- · cepted expressly, by the execulion of the application, the full legal respon-', sibility for all damages, direct or indirect, of whatever nature, and by whom- ever suffered~ arising out of the project described herein and has agreed to mdemnify and save harmless the State from suits, actions, damages and cosls of every name and description resulting from the said project. ~ork herein authorized. 95-20-4 (9/75) PERMIT EXPIRATION DATE 8. That the State of New York shall in no case be liable for any damage or injury to the structure or work herein authorized which may be ~aused by or result from ftiture operation~ undertaken by the State for the conservation or improvement of navigation, or for other purposes, and no claim or right to compensation shall accrue from any such damage. (SEE REVERSE SIDE) SP£CIhL CONDITIONS 40, FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Disapproved a/c ...... ]'~..-~. · ........... ~ ......... / APPLICATION FOR BUILDING PERMIT Application No.../'./~..~C/. ·~*. ........ 19 Y INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted ~._ t:5~!i._:d_~ 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 issue a Building Permit to the applicant. Such permit shall be kept on the promises 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, Jkkr removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, bu/~in,~ code, housin~ code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary i/fi~pe,cXipns. ?..d. x ............ 0Vl~iling address 9f applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ... Cg,.T . ?:*. .............................................................. (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 7icense No ..... . .'7~..*~~~ .......... Electrician s License No ....:~~. Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax ~p No. t 000 Section ........ ~, J ....... Block ........ /..~. ....... Lot .... 1 ..O~. .......... 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 b~C ct ~ ! b. Intended use and occupancy . .. .ff..e.t,c~ .... .~..o.~?. ~. 10. 11. 12. 13. 'pli ) Nature of work (check which ap cable: New Building .......... Addition .......... Alteration .......... Repair Removal Demolition Other Work ' Fee .~..o~..~.. ~ (Description) Estimated Cost ..... /. <.~ .>.O...~. ..................................................... (to be paid on filing this application) If dwelling, number of dwelling units ..... .~ ......... 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 of use ..................... Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Nun~ber of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear Depth ...................... Height ...................... Number of Stories ..................... Dimensions ~o~ new construction: Front...~. ~. ....... Rea[ .... ~.. 9. ~... Depth ...~. ~ ....... Height .o~.O. ~ ..... Number of Stories ..... /.~.. i ........................................ Size of lot: Front ..... ~. 2 . ..... Rear ..... ~.~. ~.. ........... Depth ./..57...: .'7'7.....~.~ ..... Date o,f Purchase .... ~ , . . N~me of Former Owner ............................ hp Zone Or use district in whic romises are situated .... l.V~..~ ........................................ Does proposed construction violate any zoning law, ordinance or regulation: ...~.o. ...................... Will lot be regraded ....~,...: ................... Will excess fill be removed fr?,m premises: Yes Name of Owner of premises .So. &~. ~--~t~q ..... Address ./~..X..~?.~.. ~ ~.~,e.t~?Phone No...~.~. ~.. ~,~ .Ff,... Name of Architect ......... ~ ................. Address ................... Phone No ................ Name of Contractor ./~ .,J~..o..~?.~ ~.~ ............ Address .~..~ p.o...~.o.o/,! .v/V/?~,,' ~h' one No..~.g ~-7/./..~.ff.. PLOT DIAGRAM Locate clearly and distinctly all 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. ~ : ,% COUNT~ ~ ~.~/,~.,~_.~:,~Y O~ ...~~'~ . ,._.. being duly sworn, deposes and says that he is the applicant above n~~dual ~fiing c°ntract) He is the ......................................................................................... _...._~Contract~ent, corporate officer, etc.) of said owner or owners,'~'" ' ' -~"- ~'a~ is duly aut~m or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this . _ SUFFOLK C0. HEALTH 13~WI'. A~'r~OVAL ____ = ~' H.$. NO. , : ( ~IDE~[) ~T~T~NT ~ INTENT /: ~ T~ WATER ~Y AND ~AGE DI~AL  ~E~ F~ THIS E~IDENCE WILL . ~ .' .' ~! -- ' ~ ~ ~ ~K COUNTY O~. O~ H~ALTH -i'~ .a .. _ ~ ~~///; .] ~ /~NO~ ' - ~ 2 ! ~ERVICE~ -- FOR APPROVAL OF ~Fg ~. TAX MO ~$1GNATION: ,¢ '~9~ '.~' ~-. ' ,~5'~' / / ~0~ C0~tTY HEALTfI DEPART~4ENT ~ ~. l..*~ I.-~'* ~) LICEN~D LAND 5~[Y~5 ~N~RT NEW YO~ L, N~ SUI~FoLK CO, H£ALT'~I' D£PT i" H:$. NO. .......... (:ONFORI~,,.~O THE STANE~ARDs Or THE C~,O~PT'. ~ HEALTH SERVICES COUNTY '~/P~:, OF HEALT~ SERVICES ~ FOR ~APPRO~VAL OF CO~TEUCTION ~LY 'xx. /7 SUFFOLK CO. HEALTH DEPT. APPROVAL H, S. NO. STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO. DEPT. OF HEALTH SERVICES. SUFFOLK COUNTY DEPT, OF HEALTH SERVICES -- fOR APPROVAL OF CONSTR UCTIOI~ ADDRESS: USE IS U~tLAWFUL Wi¥t~GUI' CEI~T~EiCATE OF OCCUPANCY APPROY=D AS ~OT]E~ N O~N G ~EPARTME~ THE REQUIREME~S OF THE N. STATE CONSTRUCTION & CODES. NOT RESPONSIBLE FOR /7:?'