HomeMy WebLinkAbout12784-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z18842
Date FEB. 23, 1990
THIS CERTIFIES that the building
Location of PropertM
House No.
County Tax Map No. 1000 Section
Subdivision
ADDITION
EAST END AVE.
FISHERS ISLAND
Street Hamlet
005 Block 001 Lot ~01
Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOV. 4, 1983 pursuant to which
Building Permit No. 12784Z dated DEC. 6, 1983
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 ADDITION TO EXISTING DWELLING.
The certificate is issued to MARK ANDREWS
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N640476 4/13/84 ....... N090554 9/6/89
PLUMBERS CERTIFICATION DATED N/A
Rev. 1/81
' Buildin~ inspect0~ ~
FOB3g NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OE THE WORK AUTHORIZED)
N~ 12~$~ z
Permission is hereby granted to:
.~...~...~.....~¥..~~..
.......... ~....~,...~..~~, ~ .
Qt prem ses iocQtea ot .................................................... , ...............................................................
County Tax Map No. 1000 Section J Block / Lot No. /
Building Inspector.
Fee $... ,~......~.. ..........
Rev. 6/30/80
TO~N OF SOUTROLD
BUILDING DEPAKTMENT
TOWN HALL
SOUTHOLD, NEW YORK
765 ]802
APPLICATION FOR
CERTIFICATE OF OCCUPANCY
NEW CONSTRUCTION ...~....OLD OR PRE-EXISTING BUILDING ...... VACANT LAND ........
Location of Property ..................
NOUSE NO. STREET HAMLET
Owner or Owners of Property...,
County Tax Map No. 1000 Section ...... Block . / Lot
Subdivision ....................... Filed Map ........ Lot ..........
'He lth pC Appr 1 U d ri
a De . ova .................. n erw ters Approval ..............
Planoing Board Approval ................
Request for Temporary Certificate ....... Final Certificate .... f. ..........
Pee Submitted: ~.~.~'.~ .............
C o z/£f~)-,
Fi~LD INSPECTION
FOUNDATION (1st)
FOUNDATION ( 2nd )
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
q~DE
o
FINAL
COMMENTS
ADDITIONAL COMMENTS
THE NEW YORK BOARD OF FIRE UNDERWRITERS
fl BUREAU OF ELECTRICITY
~)~,~. )~ ~ e~ JOHN STREET, NEW YORK, NEW YORK 100~8
~.~ ~..,,~..~.,~....z.~ ~o/s~ N 640476
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicator homed on the able ¢ppBcation nu tuber in t~ pretnises of
~k ~vs~ ~iva~e ~l, Fl~ers ~sl~d, N.Y.
~n the following location; ~ Base,tent ~ 1st ~7. ~ 2nd FI. S~t~tt Block Lot
and found to be in compliance with the yequirements of this Board.
FIXTURE'S RANGES OVENS EXHAUST FANS
DRYERS FURNACE MOTORS FESDERS TIMECLOCKS MULTI-OUTLET
SYSTEMS
DIMMERS
SERVICE DISCONNE(~T
OTHER APPARATUS:
Dr a~er B
Fishers Isl~ud~ N~Y.
06390 Lic#29~
This certificate must not be altered in any manner; return to the o~fice of the Board if incorrect.
GENERAL MANAGER
may be identified by their
?NG DEPARTMENT: TH S COPY OF .CEI~ ~
THE NEW YORK BOARD OF FIRE UNDERWRITERS ~:"~: ~
Ji-')'~%0%~ BUREAU OF ELECTRICITY
~- 85 JOHN STREET. NEW YORK, NEW YORK 10038
THI~ CERTI~IE~ THAT
only the oiec trlcal equipment ~ ~scribed below a~ interlaced by t~ appllca~t ~m~ on the a~e application number in the premises of
in the following lacutlon; ~ B~sement ~ Ist FL ~ 2nd ~. Ot~T Section Bl~k Lot
FIXTURE
OUTLETS
DRYERS
SWITCHES
FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS
FURNACE MOTORS
TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS
SYSTEMS
SERVICE DISCONNECT S E R V I C E
OTHER APPARATUS:
NO, OF CC COND A.W O
PER ~J OF CC. COND
NO OF HI-lEG
OF HI-LEG OF NEUTRAL
06390
This certificatq must not be altered in any manner; return to the office of the Board if
COPY FOR BUILDING DEPARTMENT. THIS COPY
:t,
OJ~Np~t Mf. AaER
Per ~' ] ' ~'' ~
may ~ identified by their credentials.
BE:ALtERED IN ANY MANNER.
AHDI~W~
.. l~aS~D OH 5UF~VEY
~IOp. w IC H, COHH.
I~.~V. APR.
SHANI~ L.i~P,, PAL/A~I~ ~ ~IN~
/
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL,: 765-1803
.......... ..........
oC~ (Buliding Inspector)
APPLICATION FOR BUILDING PERMIT
Date ................... 19...
INSTRUCTIONS
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 throu~out 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 rl~g~tions, and to
admit authorized inspectors on premises and in building for necessa~ in~ctionficl ~ . /' J
.~(~. (Signature of app~_~ant, or name, if a corporation)
· ,.
(Mailing address of applicant)
State(~ther applican~wner, lessee, agent, architect, enCneer, general contractor, electrician, plumber or builder.
.... ..............................................................
Name of owner of premises . .~..~t~...A.M.~.~.t~.~ .... ..~...~.~?.^...c~..~..~..~..~......,~.~...~.. ~:a~,.~ d~-q
· ' (as on the tax roll or latest deed) ...... ~
If applicant is a corporation, signature of duly authorized officer.
.....
(Name and title o~ corporate officer)
Builder's License No... <~.. ]... H~ ..........
Plumber's License No....~.~. ~..~.. ~ ..........
Electricians License No...~. ~!..~...~. ..........
Location of land on which proposed work will be done· .~2~ ~T... :.~A.(~.~. ~ ~ ..........
House Number Street Hamlet
Subdivision ..................................... Filed Map No ............... Lot ...... . .........
(Name)
2. State existing use and occupancy of pre~, i, ses and intended use and occupancy of proposed construction:
a. Existing use and occupancy .... . .~..~./.~.,~. ~..~:.../.~.O./~. ~. ............................................
b. Intended use and occupancy....c~...~.T./:./.~, q .r~ ..... / .~.~.;./~x.f. ..................................
3. Nature of work (check which applicable): New Building .......... Addition ~ Alteration
Repair .............. Removal .......... Demolition Other Work...
4. Estimated Cost...t~. i,~.~.. ...................... Fee... ~..~... ~ ......... !.D~7~n.'~t.i~)...
(to be paid on fling this application)
5. If dwelling, number of dwelling iunits ............... Number of dwelling units on each floor ................
If garage, number of cars .... , ...................................................................
6. If business, commercial or mixed occupancy, specify noture 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 wlth alterations or additions: Front ................. Rear ..................
Depth ................... ~.. Height ...................... Number of Stories ......................
8. Dimensions of en~tire new construction: Front .... {.Z./... '/ ....Rear .... t'.Z.~. .......Depth . ./..~. .........
Height .... [.O. '. .......Number of Stories ............................................... i ........
9. Size of lot: Front Rear ...................... Depth ......................
10. Date of Purchase ........... . .................. Name of Former Owner .............................
I 1. Zone or use district in which premises are situated .....................................................
12; Does proposed construction/v}o!ate any zoning law, ordinance or regulation: ....... /~O ......................
13. Will lot be regraded ~(..o. ................ Will exceas fill be removed from premises' Yes No
14. Name of Owner of premises/q(/~-. ~.. g.n.3.~..w.~ ..... Address . .~.~.~.~..-.~./4 ,,rca . Phone No'¢d~ 7.~.
Name of Architect . .~,1~...*~6..~f.~ q--, ......... Address ...... ti'i i i i.. i ii i i. Phone Nol .~.' .~ .~7.~.'~.'~_ __....~.'
Name
of Contractor
...... Address ...... ........... Phone ' '
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 degd, and show street names and indicate whether
interinr or corner lot. : ]
STATE OF NEWc,YORK ....
COUNTY OF..~,'~F~'[ .~ ~' ~
trt~ ''lt.' ~.~' ~'~s~..-[--~ ~:' ~'
.... *-~f9.~[~ ~.. x~Bg.U~j~ .................... being duly sworn, deposes and says tha~he is the applicant
(Same of ~nd~wdual s~ n contract
.... g )
above named.
(Contractor, agent, corporate officer, etc.)
of s~d owner or owners, ~d is duly author~ed to perfom or have perfo~ed the said work ~d to m~e and file this
application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the
work will be perfomed in the manner set for~ in the application filed therewith.
Sworn to before me this
....... ~ ...... ayof~ ~qOv~¢~ 19~
n~n~ Pu~u~, s ' (Signature of applicant)
,:~MM~SStON EXPIR[S ~ARCH ~. 1~ !