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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~ !