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HomeMy WebLinkAbout12794-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hale Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building ..... .8.w.~m.m..i.n.~ ]?eel Location of Property ..... ~.2..~ Center St. Matt±tuck House No. Street Hamlet County Tax Map No. 1000 Section'.....~.2.~. .... Block .... .0,2. ....... .Lot ..... .7. :2. ........ Subdivision ............ .x. ................. Filed Map No. x .Lot No. x conforms substantially to the Application for Building Permit heretofore filed in this office dated ... ~9¥¢~t~7. ~} ..... 19~,5. pursuant to which Building Permit No ....... ~..~7.9.&.g. ........ dated ......... ~.eOeln.b.e.~7.9 ....... 19B.~.., 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 ......... inground swimming pool. HAROLD L. & ADA L. KEYES The certificate is issued to ..................... [o~,n'o;','~ ...................... of the aforesaid building. Suffolk County Department of Health Approval .................. J~/.~ .................... N657517 UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 FOBM NO. ~ TOWN OF SOUTHOLD 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? 12794 Z Permission is hereby granted to: .....~./..~..:...~Z ...... ...... ~ ...... ~._....~.~ ....... ~.=....~..... ...... ~/~~.~......~, ........... ro ....... O~z~. ~.z.....~ ...... ~ ~~.... ~. z~z.~...~.c~ ..... ~.~. ............ ~Z~.~.....~~ .................................................................... at premises I~ated at ....~:~ ........... County Tax Map No. 1000 Section ..... ./.~..5. .....Block ..~..:0,~. ......... Lot No. ~..~.../~..L..~... pursuant to application dated .....~..~-~.... ........&~.. ..................... , 19 .~.~,.., and approved 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- lions, 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-existin~;'T- land uses: 1. Accurate survey of peoperty 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- lion required to prepare a certificate. C,"-Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling/ land use 3. Copy of certificate of occupancy $1.00 --Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Date ........ '1,.~.~..\~. ......... New Building· Old or Pre-existing Building .......,.... Vacant Land Location of ProperW -~.'~. ~. ............ ~.~~:~Z~ Y'~,~ ~ ~ ~ Hou~ No. Stree~ Ham/er Owner or Owners of Prope~ //4~ Z U ~ ~, County Tax Map No. 1000 Section ...../~. .. ..... Block ..~.~. ....... Lot..... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./. ,~.~ ~./~..Z. Date of Permit /?'J~.//.~.~....Applicant .................................. Health Dept. Approva~l ........................ Labor Dept. Approval ........................ Underwriters Approval .J.~...~..~.?. ~.~-/.~. ......... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... em- Fee Submitted $ ............. Construction on above described build ng and permit meets all applicable codes and regulations. Applicant Rev. 10-10-78 1000218 THE NEW YORK BOARD OF FIRE UNDERWRITERS l~t8 BUREAU OF ELECTRICITY ~- 85 JOHN STREET, NEW YORK, NEW YORK THIS CERTIFIES THAT only the electrical equipment as described below and introdaced by the applicant ~amed on the abo~e application n~mber i~ the premises of H. Keyes~ G'enter ~' ' ~ or. off Marratoohee Rd~, Mattituck, in the following location; [] Basement [] 1st Fl. was ex.,niaed on February 16, 1984 FIXTURE OUTLETS ~ECEPTACLES SWITCHES DRYERS [] ~.d FI. Outside Section Block Lot and found to be in compliance with the requirements of this Board. FIXTURES RANGES COOKINGOECKS OVENS DISHWASHERS EXHAUST FANS FLUORESCENT SYSTEMS OTHER APPARATUS: 1-G.F.C.I. OF HI-LEG NO OF NEUTRAtS A. WG OF NEUTRAL (Swimming Pool) This certificate covers compliance at the date of inspection only. ~ecease of unusual environments it is advisable to have frequent test end/or repairs made by a qualified person. [~ certificate must not be altered m any manner, return to the office of the Board if incorrect nsoecto~s ma~e ~-.~ -~-~ ~,~-~ ucr~n.vmm~./~ ~UPY~OF CERTIFICATE MUST NO~BEALTER~D N ANYMANNER FIELD INSPE.,?ION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ~ODE FINAL COMMENTS ADDITIONAL COMMENTS: FORM NO. 1 ,ccf o~ ~'~' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined~... ?..' ..... , 19 ~.~-~ Approved ...... -- ..... , 19~... rermit No ........... Disapproved a/c ....... . ................ ...~...3/... ' .................... i (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tins 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 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 regu~atio?, and to admit authorized inspectors on premises and in building for necessary inspections. ...... ~.,~ :. :5. ~,~.~.~...'.~.,.~, s 0.~..0.o. ~. (Signature of applicant, or name, if a corporation) jr> L (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . .~..~.~[~..~.~.: ....................................................... (as on the tax roll or latest deed) if applicant is a corporation, signature of duly authorized officer. .... ... (Name and tide of corporate officer) Builder's License No ........... Plumber's License No .............. ! .......... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. C ~a-r~ &r. 5.~..: ........................ House Number Street Hamlet County Tax Map No. 1000 Section .... [..~...~ ....... Block ........ .O...~. .... Lot...O..C)..?.~.: .~. ..... Subdivision ...... ~. .............................. Filed Map No .... ~ .......... Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy ........................... 3. Nature of work (check which a~plicable): New Building .......... Addition .......... Alteration ...... ^. R~pair .............. Removal .............. Demolition .............. Other Work..'~. ~.~.. i ~, '5'~-- (Description) 4. Estimated Cost ..... ~.~.QQ.Q..Q.?. ................... Fee ~ (to be paid on filing this application) 5. If dwelling, number of dwellinglunits ............... Number of dwelling units on each floor ................ If garage, number of cars ........................................................................ 6. ]f business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. l)imensions of existing structures, if any: Front ............... Rear .............. Depth ............... Heighi ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front .... ' ....., .. Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 10. Date of Purchase .... ~.~.xJ..\~5,.~. ~ ............ Name of Former Owner ............................. 11. Zone 6r use district in which pr~mises are situated ..................................................... 12. I)oes proposed construction viohte any zoning law, ordinance or regulation: ...~..~. ......................... 13. Will lot be regraded ....... .~a, .~..... t ............ Will exc, ess fill be removed from premises: ~ No Name of Contractor .... ~/'w.~g ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly ali buildings, 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. STATE OF NEW YORK, !S.S COUNTY OF ................. ..... ~...'c~_q~....'~:k: .~'2C~O,~. .... · 4 .................... being duly sworn, deposes and says that he is the applicant (Name of individual rigging contract) above named. He is the ...... .~..CBq..~.~2~..c~.: .c~..; ................................................................... (Contractor, agent, corporate officer, etc.) 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 Notary Public ' County (Signature of applicant)