HomeMy WebLinkAbout12090-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. Zl1815 Date July 28 .,1983
THIS CERTIFIES that the building ...°. n..e .-f.a.m..~ ?..y.. cl..~.e.1. ~. x.' .n.g .......................
Location of Property 1505 Custer Avenue Southold
House No. Street Hamlet
County Tax Map No. 1000 Section ....7.0 ....... Block ....... 9. ....... Lot 1 6
Subdivision ........... .x ................... Filed Map No. x .Lot No. x
conforms substantially to the Application for Building Permit heretofore filed in this office dated
Dec embev 17 19¢.2 . pursuant to which Building Permit No. 12090 g
dated ...... ~..~ .n.uti. r..y..3 ............ 19 2~2, 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 .........
....... oa.o~ f am.J, ly. &we l Li.ng ..................................................
The certificate isissued to Marino& Albba Succich
(owner,
of the aforesaid building.
Suffolk County Department of Health Approval 12 - £ 0- 153 7 / 28 / 83
UNDERWRITERS CERTIFICATE NO .... iq 60979
Building Inspector
Rev. 1/81
TOWN OF $OUTHOI~D
BUILDING D:PaRTM~N~
TOWN'HALL ~'
SOUTHOLD: N. Y. ~*
BUILDINGi
(THIS PERMIT MUST BE KEPT ON THE PRE~ S~ uNTIL i JLL
COMPI..~rlON OF THE WORK AuTHORiZED)
Permission is hereby granted tg~
· ..;.;-:;;.....~'-...~r.:~.?..~,.~.-.:.,i~z~-~,~ /
' .......
~7..~7 ~r ~~ ~/~d~ ...........
t~ ............................. ~ ............. .~ ........................... .~? ............. ~...~-.~ ............. ..~ ......................
...... ~ ......... ~ ................................................
at p.mlse:s ,~ated at .~.~ ......
. , · , ................. ~ .................................... .*, ...... ~?..~f ................ ~..~ .......... ~ ..........................
~ ,~ ~ ~o. ~ooo ~,~,,o, .~Z~....:.... ~,~ .~;...¢.Z ........ ~o, ~o. :..~.~. ........
pu¢~o~f to opplic~f~on d~$~ ................................... ....... :"V'" y'"" ~...;.~.., o ~ pp~ bF She
BUilding IdSpector. .
F~ l ........ ~ ...............
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 buiMings, 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 Tines, 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 or land use $5.00
3. Copy of certificate of occupancy $1.00
New Building ............. Old or Pre-existing Building(Z} .. ......... =/Vacant Land -i ...........
Location of Property . ..~. =~.~.~. ..... ~J~ .~.,~'~' .~....~...~¢~.. ;.....~..~..i~?.~.~.~..~..... ........
House No. Street Hamlet
Owner or Owners of Property ...~1~. ~ .~..~.
County Tax Map No. 1000 Section ..... ~.~ ....... Block ..... ~. ........ Lot....~'. ~ .~. ........
Subdivision ................................. Filed Map No...; ....... Lot No ..............
Permit No.~.~.Z. Date of Permit .Applicant . ~.~4~4..".~.~..~¢....~2....~11~...'~.~. ......
Health Dept. Approval . ./~..-. ~ .~. ~ ~. ~.. .... Labor Dept. Approval ...................... ,..
Underwriters Approval ........................ Planning Board Approval ..................
Request for Temporary Certificate ..................... Finat Certificat~ .... . .e~..- .........
Fee Submitted $ '' .~...-~.
Construction on above described building and permit'meets all apP~cable~codes and regulations.
Applicant ....... ¢ ..... ,.~ .~..~, .~ ,~1~, ,~¢1~
:[oooo~o THE NEW YORK BOARD OF FIRE UNDERWRITERS
nS BUREAU OF ELECTRICITY
~- 85 JOHN STREET, NEW YORK, HEW YORK 10038
Oate a'.~y ~, ~..'-~'~3 App,catio,,No.o,,~"e ~0.~769~83 N 609727
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant nan*ed on the above application nu tuber in the premises of
~k~u-~rk Cont.~ N/8 C~er Ave, E/O Bennett~ Southold,
in the foliowlng location; [] Basement [] 1st FI. [] 2nd Fl. Section Block Lot
was examined on ~ .~, ,~ ~ ~¢J~ and found to be in corrtpi~n~e with the requirements of this Board.
RX;Oa[ EIXTURE$ RANGES =OOK;NGOECK$ OVENS DISH WASHERS EXHAUST FAN~
2~ 37 34 28 3
3 F
'1. i00 CB x 1 4 1 4
Motor~ ~I-F.
l~Smoke Detect~~
This certificate must not be altered in any manner; return to the office of the 8oard if incqrrect. Inspectors may be identifie their cre.dentials.
COPY FOR BUILDING DEPARTMENT. THIS COP'~ .TERED N ANY MANNER.
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[]FRAMING ~] FINAL ~'/~-~
76S.t802
BUILDING DEPT.'
INSPECTION ·
FOUNDATION XST [ ~ ROUGH PLBG.
FOUNDATION 2ND [ ] INsuLATION
~X~] FRAMING
REMARKS: ~'~/"
[ ] FiNAL
INSPECTOR (/r~
FIELD ~IN~.~PEC T I ON COMMENTS
FOUNDATION (1st)
FOUNDATION (2nd)
o
ROUGH FRAME &
PI,UMBING
3.
INSULATION PER N,
STATE ENERGY
C,ODE
FINAL
ADDITI(
FOB~ NO. !
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate 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 ar public streets at
areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application.
c. The work covered by this application may not be commenced before issuance Of Building Permit.
d. Upon approval of this appl'ication, the Building Inspector will issue 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 buildings for necessary inspections.
(Signature of applicant, or name, if a corporation)
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.......................... ..............................................................................................................................................
Name of owner of premises ...... ..~...~).~/.../~...Q ...... .~../d,.~l...C4.. ..............................................................................................
If applic_,gnt is a corporate, signature of duly authorized officer.
......
(Name and title of corporate officer)
u,der's ' c nse No ........... /4
Plumber's License No ...... a~../~ ...... i..~.. .....................
Electrician's License No .... .~.~..5'~.~.......~'... ................
Other Trade's License No ...............................................
~. Location of io~d a~ which~opo~d work *il~ b~ done. Map No.'.~.~'~.'Y.....I..~O.~..Z. 92. .O. :. .9. Lot No.~.~L..,...!...?:..
Street and Number ...Z~...o'..,~."~:~-- ............. .~...~z~.~..~,.~ ........ .~.v..~,.iD..~...~¢~ ......................... ~.c~..t,~....~,>.o.(,~ .............
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Exisiting use and occupancy ..................... . .~.../~ ..~.. ~}. Z~...-~.. .......... ..,~..t~..~.. .......................................................
b. Intended use and occupancy .................................... ..b/. ..................................................................
/
3. Nature of work (check whict] applicable): New Building ........... Addition .................. Alteration .................
Repair .................. Removal ................... Demolition .................... Other Work ................................................ . ....
~ 0i 0 ~'~-'0 (Description)
(to be paid on filing this application)
5. If dwelling, number of dwell'lng units ........ ~ ................ Number of dwelling units on each floor ..... ~. ...................
If gorage, number of cars ..........~.~.~.~ .......................................................................................................................
6. If business, commercial or imixed occupancy, specify nQture and extent of each type of use ............................
7. Dimensions of existing structures, if any: Front ............................ Reef ................................ Depth ....................
Hei§ht ........................ 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 ........................
10. Date of Purchase ................ ~ ....................................... Name of Former Owner ....................................................
1 1. Zone or use district Jn which[premises are situated .....................................................................................................
]2. Does proposed construction v.iolate any zoning Iow, ordinance or regulation: ........................................................
13, Wi I,ot be regraded.. ....~..Q .... W excess f be removed from premises: ( ) Yes ( ) No
Nome of Architect ..............~ ................................................ Address ................................ Phone No.~>.~.~ ...............
PLOT DIAGRAM
Locate clearly and distinctly a;ll buildings, whether existing or proposed, and indicate oil set-back dimensions from
property lines. Give street and blbck number or description according to deed, and show street names and indicate
whether interior or corner lot.
STATE OF NE~'~RK, ~.
C OUN~~.[ ;~...~.~. , ,~ ! /r ~..~..
.......... ~.~~..7;.~'y9.:..~~ ....... being duly sworn, deposes and says that he is the applicam
above named.
~e is the ................................ ~..~,~ ...........................................................................................................
[ (~n~act~, agent, corporate officer, etc.)
of said owner or owners, and is d~ly 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
thaz the work will be perf~d in the manner set fo~h in the application filed therewith.
Sworn/~to ~fore me this/'
..... o, ....... ,
I~ copper tubieg is used ,
~or water distributing
system; piping sinai! be
o~ types K or L
AS NOTED
NOTIF'/ BUILDING DEFrAI~TMENT AT
765 1802 9 AM TO 4 PM FOR THE
FOLLOWfNG IN-.cPECT]ONS:
'1. FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH: FRAMING & PLUMBING
4. FINAL - CONSTRUCTION MUST
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE' N,
STATE CONSTRUCTION & ENERGY
CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS.
"it should be noted that s;nce this
prop~rf~ is (oceted in on
area, the possibility exists that
water supply may coel~n tmc~
amounts o~ pesticides and/or
Special aualysis ~j~ reauired
*-