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HomeMy WebLinkAbout12480-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificnte Of Occupancy No...Z.1.3.2. l .4 ......... Date .... ?.e.~ r..u.a.~.y...~ .5 ................19.8.5. THIS CERTIFIES that the building C..o.m.b.~ n..e..~?, o.. ?.x.J:. s..~.5.n.g..d?.e. 1..1.i.n. gs.. ~.n.~.o...o.n.e.. fam±ly dwelling. Location of Property 6105 Wickham Ave Mattituck ..... h~d~b ~'o: ....................... 'S't/e~i ....................... Hamlot County Tax Map No. 1000 Section . J.q ? ....... Block ....~. .......... Lot ..... .2..2. ....... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... ~.u.l.y...25 ......... ,19 .8.3. pursuant to which Building Permit No .... J .2.4.~..0 .Z ........... dated ... 6 .u gas. ~. ~ ................ 19 .8.3., 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 ......... .... .c.o.m.b. $.~.%. ~..~.o..q x..~.s.~.~n, g..d.v.~ .e $.Z.~.n. ~.s..a.n..d..m.q ~..e..a...o.n.e..~..a.mA~.y...~.~.e. % .A~.~.~:. The certificate is issued to JAMES & SANDRA BROCKBANK (owner, ~e~ ~ ~.e~ X X of the aforesaid building. Suffolk County Department of Health Approval ..... ] .3 :-.S.O. 7.1.0.6. .......................... UNDERWRITERS CERTIFICATE NO ............. ~ N ~5.q 99 B ............................ Building Inspector Rev. 1/81 FO~ NO, ~ 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? 12~80 Z Permission is hereby grantec~to: . r-~ ~ -- ...~_~,~.~:?..~:..~..~?~...~~ ~- ..... ~.._~../..m...~l.a ....................................... ..... .~...~ ............ ~ ....... L./.~x.:... '~ ................................................... :'":'"'" .................. ' ...... '1'"':; ............... ....................... ......................... at premises located at ....~q.../.~.~ ....... .,.~..,.i~..~...~....~.;........~...~~ .......... County Tax Map No. 1000 Sectior~ ...... L..~.'..~] ....... Block ....... ..L/. ........... Lot No .......~...:..~.~ ...... opp~,cmt~on dated .... ~ ..........~.,..~..~,, ..................... , 19.,~..,'~ ond opproved by the Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall 8outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspech tar 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 p~'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 $15.00 3. Copy of certificate of occupancy $1.00 New Building . '7 ''~ '~ ..... Old or Pre-existing Building ............ Vacant Land ............. House No. -' Strobt Hamlet Owner or Owners of Prope~y . ~ ~,~ ~, ~... .C(% ................... County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ I~b~t~~ .................... Underwriters Approval ........................ P -' , L ...................... · ' ~ ..................... Final Certificate ....................... Fee Submitted $ ........... Construction on above described building and permit meets all applicable codes and regulations. Applicant .... ;., ' . ........... e.o z THE NEW YORK BOARD OF FIRE UNDERWRITERS 1001190 ~.te ~ ~.3, ~.~ *,,,,ica,on No.o,,file ~4~s~-~ N 654998 in the following location; ~ Basement ~ 1st FI. [] 2nd Fl. Section Block Lot was exatnlned on J:~ ~C,~J;~' 1~ ~ ~1.~ and found to be in compliance with tke require.tents of this Board. FIXTURE OUT[ETS rECEPTACLES SWITCHES FIXTURES RANGES DISH WASHERS EXHAUST FANS DRYERS FURNACE MOTORS FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT S E R V I C OTHER APPARATUS: OF CC COND. 3 NO OF HPLEG AW.G, OF HI-LEG AWO. OF NEUTRAL 5 I~c~l P.,Oo l~ox 572, Lau~l, N,Y. 11948 Lic: 200~ This certificate must not be altered in any manner; return to the office of the Board if !nco~rect. Inspectot/s C0.~¥ fO~ B~ILDIN , ANY MANNER. FIELD INSPECTION COMMENTS FOUNDATION 1st) FOUNDATION 2nd ) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY QODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL.: 765-1803 Examined .%~ .7.'~..q..., 19 ~'.3. ApprovedC'4~-~x4-~Xr- ............... c~, 19~..~. Permit No.. ! .~..~..~.0 ~. Disapproved a/c ..................................... Application No../..g~..q..~. ) ...... (Building Inspector) APPLICAI ION FOR BUILDING PERMIT INSTRUCTIONS /'7 r 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 promises, 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 i~pections. ,. , , (Signature of a~)licant, or nam_e, if a corporation)~ State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. ............ .Oa 0 _, ...... .... O.u.).©. ........................................ Name of owner of premises..1 .~3~'~LIB~ ~.~..~.,...~.. ~ ~*l~.. ~,...~C~ ~ ~ ............. (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 .... .O..L~0 .(I .O_ .'..fff'~'. ......... Plumber's License No ......................... Electrician's License No....~...(O.~..~ ........ Other Trade's License No ...................... 1. Location of land on which proposed work will be done ........... House Number Street Hamlet County Tax Map No. 1000 Section } O -7 Block .~.. Lot... ~ .~. Subdivision ................ .-.~a~l~) ................ Filed Map No. ~( ........... Lot. ~.- 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: occupancy .... ~.Q..aC.Q,.~)0,~..C~...'-.~ .3. S.h.~.I.S ......................... a. Existing use and b Intended use and occupancy .~.O.'.~... ~b~. ~ kd ...... h o.o.se .... S. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... . .~ .~( (k~.C~ (Description) 4. Estimated Cost. . q. ~ ~ ................... Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling ~nits ............... Number o f dwelling units on each floor ................ If garage, number of cars ..... i ................................................................... 6. If business, commercial or mixed occupancy, specify n.aturq and extent of each type of use ..................... 7. Dimensions of existing s, tructure~, if any Front :5~':/,t~.] I 0!.. Rear [ . ......... Depth &~[ Height . .'~./..p[.o,~ fo6~.. Number of Stories..]. ....../. .................... ,. Dmaensm?~o~a, tne structure w~th alterations or, L,a~tdmgns: F~ront,~.. ~ ~ ............ Rear ~, .~. .............. Depth..,-3.~. l ............. ... Height .....[. '.. ~.[.0.~./..~..~-..., Number of Stories../ ................... 8. Dimensions of entire new constrUction: Front ............... Rear ............... Depth ............... Height Num~aer of Stories ................................... u ~-~.%~/. ~ ~. 9. Size of lot: ~ront × 1 fie., .q.~] ........... Rear.. 2.q J.,. ~e ~ ........... Depth .~ D~ !.7...]. &re ,~0.,,/]. 10. Date o~Purchase t,~a~.l 9. ~ .il.~.g.~ ............ Name of Former Owner .V~.[.~.i.~, .~. ~e~th ...... 11. Zone or use district in which pr~mises are situated ............................................ 12. Does proposed constructio~ violate any zoning law, ordinance or regulation: .............................. 13. Will lot be regraded ~-O,~.~.~.¢t'~at'~c[.~30.~...Willexcessfillberemovedfrompremises: Yes . 14. Name of Owner of premises . Y'i ................. Address ................... Phone No .............. Name of Architect .......... . ................. Address ................... Phone No ................ Name of Contractor ......... I ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all ibuildings, 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. .S~ATF. OF NE~W~ cou OF..'~'~-7'ff. .... ~.... S.S , ( amc o individual sign above named. .~e is the ...................... :. ~ being duly sworn, deposes and says tha't~6 is the applicant g contract) 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 ; ......... :~3~-of:(....~~//~ ..... ,19..~) Notary~ ..... s .,~, ..... ~ .~ ~/~q. · Co~hnty ............ ~.~t~.~l~-S'& ~ Co~l~ /' (Signature of applicant) , ,:,, , "~-'-~,-c"~ .... ,~ 9 ~ ~" '.......... FOR AI#I~L~OVAL OF C4DN~'I~U~TION ONlY ~/~/~ .... :~ ' J ~ TH~WAT~ SUPPLY AND SEWAGE ~S~S WILL C~M APPROVe: . -, , . : AP~--ICA~ D, facil'it!~ for t~ls loeatio~ ~ave bee~ bY thl~ delft, merit ~ f~d Chief of een~l E~nee~i~ // ', ~ // ~.-~ ~ / / t/ r'": ' ~-~ L~ ~,,~ ." : ~ ....... _[ ~,~P.OV~ ~s ~EE. I,~/,~O BY: NOTIFY BUILDING DEPARTMENT AT 765 1802 9 AM TO 4 PM FOP, THE FOLLOWING INSPECTIONS ] FOUNDATION - TWO REQUiREE~ FOR POURED CONCRETE 2. ROUGH FRAMING & PLUM~IN~ 3 INSULATION 4 FINAL - CONSTRUCT[ON BE COMPL~T~ FOR C O ALL CONSTRUCTION SHALL MEET THE REOUIREMENTS OF T~ N Y STATE CONSTRUCTION & ENERGY CODES. NOT REBPONSIBLE FOR ~[~[~ OR C~NSTRU~T[ON ii