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HomeMy WebLinkAbout12445-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy z I 4.8.0.0 Date ).u.~. u..s.~ ~3.: 19.aA THIS CERTIFIES that the building Inground swimming pdol,deck & fence Location of Property ....................................... House No. Street Hamlet County Tax Map No. 1000 Section ... ~ ~ ...... Block ..... Q6 ........ Lot .. ~... 1,1 .......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated June 27 19 .8.3. pursuant to which Building Permit No 12445Z dated ... ?.u.l.y...2.7., ................ 19 .S.3., 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 ......... Robert G L a.u.r ig u e t. The certificate is issued to .............. ... ............................. .. .. . . . .. . {owner, ~9~F~x ~;~i~l~x x of the aforesaid building. N/A Suffolk County Department of Health Approval .......................................... N610871 UNDERWRITERS CERTIFICATE NO .................................................. Rev. 1/81 FOF, M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PEIU~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 12445 Z Permission is hereby granted to:,// ..... z~..:.....~..z/. ./~..~:..~...../. .~"~. ....... ..,~.×....~:<./... ..................................... ...... zY zzz..,.Z. . . . . ,o .......... ~ .................... ~ .......... /..~..~'~.~ .............. ;~z~.z,~.~....~.., .............. ..... .'T. ~.. ....... i'E.7.-.T.... . ...../... .......................... ....................................................................................................... County Tax Map No. 1000 Section ...... ./~..,. ......Block ...... .(~...~.. ..... Lot No..(~....0...~...,.././.., pursuant ,o application dated ........ ~..~--~...~.~......~..~.. ................. , 19.Z.~,., and approved by the Building Inspector. Fee $.../.~....,~..~ ..... Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted m ~ 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 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 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. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of pz~operty 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 2. Certificate of occupancy on pre-existing dwelling $15.0 0 3. Copy of certificate of occupancy $1.00 5.Updated C.O. $15.00 Date ....................... NewCons truc%ion..~.... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ~., House No. Street Ham/et Owner or Owners of Property ...................................... County Tax Map No. 1000 Section ....... [~..~... Block ......... ~. .... Lot ..... al:Il ...... Subdivision ................................. Filed Map No ........... Lot No .............. Permit NO. ~, .q~.~.~'$'~ .Z'D 7/ .3.................................. ·.. ate of Permit ........ Applicant Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate .... ~ ............... Fee Submitted $ ..... ~ .... . .~'~...1.~. ?-~ ] ........ Construction on above described building and permit meets ali al~'l~cable codes and regulations. Applicant. .~,~. ............ Rev, lO-10.7a 1000663 THE NEW YORK BOARD OF FIRE UND RWR.ITERS BUREAU OF ELECTRICITY 05 JOHN STREET, NEW YORK, NEW YORK THIS CERTIFIES THAT onJy the electrical equ*pment ~ described below and int~duc~ by t~ appJ~eant named on the abo~e application nu tuber in the prem~zes of ~b~e L. ~raqmt~ Alois ~. Crop ~n~la Rd., ~tti~, N.Y. ~.~ ~x.,n~.~d o. J~y 21 , ~98~ and found to be in corr[pliance with the r~quirements of this Board. s~x~ua~ s;x;uaas aAN~SS eVaNS raSH WASHaaS aXH~UST SANS OUTLETS 1 DRYERS S E R 'V I C NO OFpE~C~COND. A.W.G. NO OF HI-LE~ A W.G. OF CC COND, OF HI-LEG OTHER APPARATUS: 1-G.F.i. (Swima~ Pool) This certificate covers conplian~e ag the date Of irm~ction only. Becaus~ of t~ua], environments it is advisable to have frequeng'test and/or repairs ~mde by a qua].i,t,~ed p~rson. AW, G, OF NEUTRAL Glenn R. Bradley F~rton Ave. RED Mattituck, N.Y., 11952 LIC. #1227 This certificate must not be altered in any manner; return to the office of the Board if'incorrect. Inspectc~irs IG DEl '~ THIS COPY 01~ CEflTIF may by their credentials. MANNER. FIELD INSPECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY FINAL COMMENTS ADDITIONAL COMMENTS: 765-z8o::, BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [] FOUNDATION 2ND [/~I:ATION []FRAMING ~] FINAL REMARKS: ,,, (~ ~ DATE (~/~INSPEC'rOR ~x:~/r"~"~/~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined· .&./..~.. ~.~.Z.., 19Zd Approved . .~.~. L~./(..~./.., l~d Permit No. L~¢~7~ (Building Inspector) ~PPL~GATIO~ ~0~ B~ILD~G PE~T INSTRUCTIONS Application No./d~..~.~.-'. ...... Date..:~I .7. .......... 19ff.3 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 Budding 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 budding 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. .... ff.: .... ...... (Signature of applicant, or name, if a corporation) .... x~,x. ~3..>,:....~..,e...7~..,....,v.~..././..~..~. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................. /3..c,z .,,..~.¢.,~ ................................................ Name of owner of premises..~:.. ~-xZt~ .~..~./.'.~./~..~. · .T-.-. .......................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. title of c~er) .... ' '~('(~ e and ) ' /"~.~'~r~. Builder's License No ..... /.~. ................. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... l..o/5 AA/JQ' S .......... 1. Location of land on which proposed work will be done. RO.'./~..'.. · .~¥6 ..... t?.o,~... ..... A.~/~ .... ~ ~ ........... ~.~.~.~re.~.~ .... ~ ...... House Number Street Hamlet County Tax ~ap No. 1000 Section .... ]~. ........ Block...~.~ .......... Lot~.~.'. [.( ........ Subdivision ................ (~'a~) ................ ~ ~o. . I.t. ~ ........ rot...¢ .......... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... ~C~... ~.~.~ ~...~4.~ .................... ~/~ o o ~ .... ~e~ q. ~..;. ....... b. Intended use and occupancy ./~d~0~ ................ ~.'. ..... 3. Natur6 of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work .~..0~.~.,fO.. ~.. 0.~.~. ~ 1..~~ (Description) 4. Estimated Cost ................. ~....(~.e~ o.o .,~..~ ..... Fe ................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number o f dwelling units on each floor ................ If garage, number of cars ........................................................................ 6. If business, commercial or mixed occupancy, specffy nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure w!th alterations or additions: Front ................. Rear .................. Depth .................... i · Height ...................... Number of Stories ...................... 8. Dimensions of entire new const/uction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ Size of lot: Front ........... ........... Rear ...................... Depth ...................... Date of Purchase ........... .................. Name of Former Owner ............................. Zone or use district in which premises are situated ..................................................... Does proposed construction vioiate any zoning law, ordinance or regulation: ................................ Will lot be regraded ........ ,., .......... '. ,, ......Will excess fill be removed from premises: Yes No NameofOwnerofpremises ,~. ~.,f~/J~./~'..~'~.7~ddress PhoneNo Name Of Architect .......... ' ...., .......... Address ................... Phone No ................ Name of Contractor . ~. ~'~' ./4:.Z.~..-~..J.o. ...... '°-r'i//:f-d4ddress .... ./~...'~. '..?L77..: .... Phone No..2-?.8'.'7 ?..47..-~... 10. 11. 13. 14. PLOT DIAGRAM Locate iclearly and distinctly all! buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block inumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NE~RK, . .~ S S COUNTY OF.~. i ' ~ , (Name of individual signing contract) above named. ~ He is the /3 U/'~..~. Z~.. (Contractor, agent, corporate officer, etc.) of saki 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 ....... NotaE/Public ............... i. · ...~_ f~lu_ll ~' ',~ --~' (SignatUre of applicant) i~'r~RY PUBLrC, ~t~ ~ of N~ Yel~ No, 52-8125850, ~ folk Cou~/~ form Ex?res March 30, I9,~ FOOT [20BE2T t EN i-_ MATT/ TOWN 01:' ~,,",' /~$o ? ? 268 25 ~ hi. -tUIz,GLJET SCALE' ~= - '; ""' ,'T,HE. tj,5. LIFE. "~- ' I~O1~ I,~:il~ VAN T _~_L. P.C. LICENSED LAND SURVEYORS GR EENPORT NEW YORK SUFFOLK CO HEALTH DEPT APPROVAL H S NO ,S; ,~ ~ E_[~__E N_T_O_F_ LNTEN_T THE WATER SUPPLY AND SEWAGE DISPOSA, c,¥ STFMS FOR THIS RESIDENCE WILL r'ONFORM TO THE STANDARDS OF THE. SUFFOLK CO DEPT. OF HEALTH SERVICES. APPLICANT "~S l I F ~'©! K COUNTY DEPT OF HE :~IE ~ V I~-ES FOR; APPROVAL OF CONSTRUCTION ONLY DATE' __ M S ~'EF NO ........................ ,:-2~OVED TEST HOLE ! STAMP 5:, A. F4 ro '¥ 14'