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HomeMy WebLinkAbout12412-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z1205~ Date November ADDITION THIS CERTIFIES that the building ................................................ 2q&0 BAYSH01~E DR. GI~Et~NI~0R~ Location of Property/~s~ Ho] ....................... ~}r'o~*' ....................... County Tax Map No. 1000 Section 05~ .Block 0z~ .Lot lPt~CONIC BAY ES~A~ES .Filed Map No. ~ 124~ Subdivision conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... JIIAIt~ · 3 ......... 19.83- pursuant to which Building Permit No .... .q.24~.q 2~Z .......... dated ....J..u. 1..y..~.~. ................ 19...,85 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 ......... The certificate is issued to ...B.R.U..C.E...&..B.A..R.B.A..~...~.E.?R..U.C.C.I. ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ....N./.A. ................................... UNDERWRITERS CERTIFICATE NO, I~ENDING 2nd. floor non-habitable Building Inspector Rev. 1/81 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 12412 Z Permission is hereby granted to: ...... ~z~....).2~.F.~/~:..~, ............. ....... .................... . ,o ..... ~..~ ..~...~...~......~.~.~.~.~ .~..~...... .~.~.......~.~..~....~,?~,,~/. ./...~ ........ .. .~...C, ................................... d..:.-~.. ............ co~,~ Ta× Map ~o. ~000 S,~,~o~ ....C2..~ ...... S~o~ ....C::)..~ ...... Lot So...C~:~ ..... pursuant to application dated .... .C~.~.....~.~ ....................... , 192~.~ and approved by the Building Inspector. Fee $..~'~..~.. pERMiT INCLUDES APPROVAL ~.EMOV~ EXCESS I:ROk~TO ABO¥~- ??,~_~,SES REGR~ii~iG LOT ...... n.ivEWAY CONS~EUC IIU~ , cESSPUUU c~L~E CONSTEUcTION Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N,Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be 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 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 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 ] //$5.00~'/ 2. Certificate of occupancy on pre-existing dwelling ~r land use 3. Copy of certificate of occupancy $1.00 Date ....... New Building ............. Old or Pre-existing Building(Z,). ~..~ .... ~/Vacant Land ' Location of Property .~. ].~.C~. .................... . .'~..~/!$hr~'~' .~)c~.cJ. ~.~.~.~..~:~.. r.~' House NO, Street ' ' ' ~ " ........... Owner or Owners of Property ..... ~ ....................... County Tax Map No. I000 Section ....~.~ ........ Block .... .~ ......... Lot .... .~...~. ........ Subdivision . .~.C~.Q~.~.~..r~:~v~r . .~..5~.~.~.~.~. .....Filed Map No..I.~.~..L~ ..... Lot NO. !~.:~ .-.~! ~. ..... Permit No. J.~.~.).:~... Date of Permit ?ll.I.).~.-~....Applicant ,.~'O¢.~. 1- (~.gr~ Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. Underwriters Approval ........................ Planning Board Approval .................. ~.., ' Z Request for Temporary Certificate ..................... Final Certificate ....... - ......... - Fee Submitted $ ............................. Construction on above described building and permi'(me~s all app~cabte_.,co_des and regulations. Applicant .-~..~.-..(~_. ' .~J~C.c~ ..... ~. ?.~' Rev, 10-10-78 THE NEW YORK BOARD OF FIRE, UNDERWRITERS BUREAU OF ELECTRIC~ TY ~ THIS CERTIFIES THAT only the electrical equip~nent as described belo~ and int~duced by the applicant named on the able application ~umber in the premises of &~ the/ollo~'ng 'oc~t~on; ~ Basement ~ l,~ Fl. C 2nd F,. Sect,on Block I.o~ was examined on ~ ~7 ~ ~ and /ound to be in compliance wi~h the requirements of this Board. FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT DRYERS SYSTEMS NO. OF FEET E S E R V I NO. OF CC COND, J A W.G. NO OF HI LEG PER ~ OF CC COND, 1 1/0 OTHER APPARATUS: 1-G.F.I., 2--~:~e Deteo~ors.,Trac~ Li~t;~g: 18' O' 11 M~es. C A W, G, NO, OF N~UTRALS OF HI-LEG OF NEUTRAL 1/o Ted Cheshire, Jr., Co. Bc~ 255A, So,nd Averse Mattituck, N.Y. 1195~ GENERAL MANAGER Per _ This certificate must not be altered in any manner; return to the office of the Board if inco~rect, nspector~s may be identfed bv their credential ~~. FC~ff, [FIQA/E M~$O~BE;ALTERED JN AN~MANNER F~LD ~INSPECTION COMMENTS _. FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY FINAL (2nd) FORM.O., TOWN OF SOUTHOLD '~- "~'{ BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Disapproved a/c ..... _::_~, .~.. ................. " iicii~&'I~3~itg~i ........ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No.../6~....~./..~.~. ...... 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 necessary inspections· . (Signature of applicant, or name, if a corporation) t .............. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. ·. ..................................................................................... Name of owner of premises .~..~.~.F..O.C.C..i ./..~. c. 9.(<.~...~.tq..~..B.O,..~-.~.O...Fg:.. .................................... (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. :~¢rnf~o~oqdT'. ........... Plumber's License No....~. ~.~. ~..¢ .............. Electrician's License No..~.~.....~.2 .............. Other Trade's License No..~. 9k~©.~. :...~.c.~?.~. ~. Location of land on which proposed work will be done.. ' . .: ......................................... ·. ......................... c4 House Number County Tax Map No. 1000 Section .... ~..~ ........... Block ....~ ............. Lot..~..~. .............. Subdivision. ¢~i~4. q-~. ........... Filed Map No. ./I.~ ........ Lot . I[~- I~ .... ( State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . .~. ¢~.; .c[~.~q.c~¢~. ........................................................ b. Intended use and OCcupancy .~. ¢~.~.e~. ~.c..¢<. .................................................... 3. Natureiofwork (check which applicable): New Building .......... Addition .... .)(. .... Alteration ..~. ....... Repair .............. Rem6val .............. Demolition .............. Other Work ............... (Description) 4. Estimated Cost/~ot~ro~ r~.e~Co~ .......... ..~.~ ........... F ~ ....................... (to be paid on filing this application) ~5~-. If dwel!ing, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars ..... i ................................................................... -6w-. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... ' 7. 'Dimensions of existing structure~, if any: Front ............... Rear ............... Depth Height ............... Number of Stories ........................................................ Dimensions of same structure w~th alterations or additions: Front ................. Rear .................. Depth .................... :.. Height ...................... Number of Stories -St--. Dimensions of entire new construction.. Fr6nt ............... Rear ............... Depth ............... Height ............... Num:ber of Stories ........................................................ 10., Date of Purchase ./~p.6l. I.q,l.0t~ 3 ........... Name of Former Owner .Li.t.li. qa9..C~.'~..*..~?..~. ?....k'.~..0.eqi. 11. Zone or use district in winch promises are situated../q 7. ~q.O) .d.e434:.i.a,.! ................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..No. ............................ 13. Will lot be regraded . .N.q. ',~,-'i .... ~' · i · · ·: ~ ...... Will excess fill be renlqved.frotll~premises: X Yes No 14. Name of Owner of pr~emisesC'e~rpr.-cfit ~.a.r.h¢~?.Df..o~.~ Address .~) .C~e.q~'~., .~,.Neo)~r~ '~hone No 5 Name of Architect .(Z.,.~.cp.j .5.~.~.~..~ ....... Address;~q;~ .~...~{o.n~ .~.~e.~.f~-..?..~.s~one No.q.g.~7.~.?..;~.. ..... Name of Contractor .~me~>v4~.ne~Z.. .............. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from to deed, and show street names and indicate whether property lines. Give street and block number or description according interior or corner lot. STATE OF NEW YORK, COUNTY OF ..... S.S ............................. .................... being duly kworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ' i (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 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 ..... ~/ ~ day of ......... Notaw.l}ublic, ~, ................ .~..~.~.' .~ (¢ ..... Cotlnty ~r m-~- jr ~i~ I~, 8mt~l ~N,Y; ......... /' ) // #52,.4521061-8uffolk Coup*~/ , (Signature of applicant) ~',¢.FO" ii, Y icj,'- o~ Wges ~ NOTIFY UU~L~ '-~M FOR , FOLLOW ' ~,,m REQU RED --- ~ ROUGH - F~MING & pLUMBING 4.FINAL * coNSTRUCTION MUST BE CoMPLeTE FOR C, O. r L coNSTRUCTiON SHALL ,STAT ,,~ oESPONSIBLE DESIGN OR Cg ~XISTI~G ~. ZZd' ,,.~:' T TF j NEW // ~Prr~ L L r/,~.,,= FO" T I