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HomeMy WebLinkAbout12296-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Zflf1872 Date August 25 19 ~5 THIS CERTIFIES that tile building .... .'Q~i~..QQiTI..o.n., 5.e.c.q~..d..~.l. gg.r ............... Location of Property .... 2.q D.5 ................ ~ill..I~Q8 cl ........... .~.a.~.~ .i.t.u. qk. ..... House No. Street Hamlet County Tax Map No. 1000 Section ..... ~ 0.0....Block ..... 3 ......... Lot ..... Subdivision ............ ~z .................. Filed Map No....~ .... Lot No ....... x. ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... Al~ri,1 .~. 2 ..... , 19 8.5 pursuant to wh/ch Building Permit No ...... .q.~29~. ........ dated ..... .~.a.y....~ ................. 198.~., 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 ......... Bathroom addition to second £1oor o£ existing dwelling. The certificate is issued to MICHAEL & FiARY GA~DOSIK (owner, ~2 of the aforesaid building. Suffolk County Department of Health Approval lxl/R UNDERWRITERS CERTIFICATE NO. NGf13230 Building Inspector Rev. 1/81 N? ~2296 TOWN O~ Sou~6~D BUILDING DEPARTMI~N'~ TOWN HALL SOUTHOLD, N. Y.: BUILDING ~HI5 PEru T MUST BE KEPT ON THE PRESIS~S UNTIL ~ULL C~PL~ION OF THE WORK AuTHORIzED) Z Dale ~ permission is hereby granted to: · ......... ~.~.~..~../.. .... .~.;...~/. ....... ...~~,/~,...~.~.~...../.~.~ ,o...~:~ ~~....~,~.~.....~...~ff~ ........... ,~.-.,....~,.-. .~.~>~ ...... ~,~/~ ................. ,, ............. ....., .............................. , ......... ~ ............... ....... ......... .................................................. Cou~ Tax Map No. ]000 Section ..... ~.~ ...... Bilk .~..~ ......... ~t No. ,..~.,..~ ......... pu~aont fo opp icetion dot~ ,.. ~ .... ~;.~.,.....~;...~;,., 19 end ~pprov~ by the Building Inspector. Fee $ Rev. ~6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, 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 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 peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 2.Sworn statement of owner or previous owner as to use, occupancy and c'~)ndition 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 p~x-istiffg dwelling c~r land use ~P (b-'~ $5.00 3. Copy of certificate of occupancy $1.00 ............... New Building ............. Old or Pre-existing Building ,. ~ ....... Vacant Land ........... Location of Property kl~[.~).O~. ~. House No. Street Hamlet Owner or Owners of Property .~..t.~,h~.E~..~. .~',~.. y~..~..~.~ ..................................... County Tax Map No. 1000 Section ............... Block ............... Lo~t ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. ! .~-..~.~...~-.. Date of Permit S/~//~3..Applicant .~D j .c~ .~.E,. !..(~..~.,t j~..o~j .~. .......... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate J~. ..................... Fee Submitted $ ............................. Construction on above described building and permit meets a. II apl~lical~le codes and regulations. Applicant..~.~. f~, .~,. ¢ .~,~,~ ~,,,. ........................... iooo ? THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY THIS CERTIFIES THAT only the el~t~ca~ equipment ~ ~scrlbed be]~ and ~nt~duced by t~ applicant named on the able application ~umber i~ the premises of Block was exarnlned on ~ --~ and fou~rd to be in compliance with the requirements of this Board. FIXTURE OUTLETS EW~TCHR$ 5 9 6 FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS INCANDESCENT FLUORESC~N? DRYERS FURNACE MOTORS APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT OTHER APPARATUS: EiecCric roan heaters; I-G.F.I., 1-.~loke D~-ctor. S E R V I C i~ RCC~, A W, G. NO. OF HI4~G A, W ° NO OF NEUT~ALSJ A' w G' NO O E COND. OF CC COND. OF HI-LEG OF NEUTRAL ~ain Road Orient, N.Y. 11~67 This certificate must not be altered in any manner; return to the office of the Board if ,!ncoffect. InspectoFs may be identified by their credentials. .-~> 3 DEI~ARTN!E~T, THIS COP~ OF{ A~¥ MANNER. FIEED i~SPECTION COMMENTS FOUNDATION (lst) F. OUNDATION 2. (2nd) ~OUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY FINAL ADDITIONAL COMMENTS FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved. . . -V.. ..... Permit No. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No../do~ ~. (: ....... a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, acchmte 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 Occupm~cy 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 ~ode, and regulations, and to admit auth°rized inspect°rs °n premises and in building f°r necessa ,rY~~..t ~ (Mailing address of applicant~, State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................................................... Name of owner of premises fO,c~qt~( ¢ ~ ~ DOSt [(t . .~. ~. ll y ~. ;s /l). D,St /< ~ ~ o5,'0to k / / ..................... (as ;~ ;l~e' ;ax'/o'li ;; ilt;~t' fi;e'~/) ......................... If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ...... ~ ............. Plumber s ~icense No. Electrician s License No...~..~.~.~.; Other Trade's License No ...................... 1. Location of land on which proposed work will be,~,e .................................................. House Numbe~ (~)t'q/Str;;; ............... I~&~n'l;; ...................... foo $ /3 County Tax Map No. 1000 Section ..... '. 7...'~. ....... Block .................. Lot ................... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and ,?ccupancy Of proposed construction: a. Existing use and occupancy...~.,o.~/..~.~.)//.)75.'/./.~....-/:...~.t.~.~,q.q/...~?~.)/[~.~75.(/.~'...(~..t ~.'~.. ............... b. Intended use and occupancy . .~().0.~../.~....tr~7~.~.~.o.o..,rff). ............................................. ' / 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. RemOval .............. Demolition .............. Other Work ............... (D ipti 4. F, stimated Cost ................ Fee .......................... i (to be paid on filing this application) 5. If dwelling, number of dwelling gnits .../. ........... Number of dwelling units on each floor .... ' ............. If garage, number of cars ..... I ................................................................... 6. If business, commerciai or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front...J~': ......... Rear .............. Depth. ~.o~ .~:' ......... Height . 313f.6. ~' ........ Number of Stories ...,¢ .................................................... Dimensions of same structure with alterations or additions: Front . .3.~.'.'..6~m. ~ ...... Rear .................. r)epth ...... ~. ~..m.~. .........i. · Hei~ht .... ~.g.~. F .............. Number of Stories..s?.~..cZ ............... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ................. 2. ..................................... 9, Size of lot: Front ........... i ........... Rear ...................... Depth ...................... 10. DateofPurchase .............................. Name of Fonner Owner ...4qq!~.~. ..................... 1 I. Zone or use district in which premises are situated ..................................................... 1 2. Does proposed construction violate any zoning law, ordinance or regulation: ...... ~..o. ....................... 13. Will lot be regraded .... ,~.0...i ................... Will excess fill be removed from premises: Yes 14. Name of Owner of premises ...: ................. Address ................... Phone No ................ Name of Architect .......... : ................. Address ................... Phone No ................ Name of Contractor ......... i ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly alii 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 N~ORK, ..... ~~,,.i ~ ,., ~~,*c ,~., ~-~ ....... being duly sworn, deposes and says that he is the applicant above named. He is the .................... ~ ................. . ....................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul~, authorized to perform or have perfo~ed the s~d work and to m~e ~d file this application; that ~1 statements contained ~ this application are true to the best of his knowledge and belief; and that the work will be perfomed in the m~ne~ set forth ~ the application filed therewith. Sworn to before me this ................... ,19. ~ (Signature of apphcant) N~RY PUBLIC, State BI New Yo~k No. 5~-8125850, Suffolk Co~z March ? ? !