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HomeMy WebLinkAbout12537-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate O~ Occupancy Ne. Z11819 Date August 1 .................................................. 19.83.. THIS CERTIFIES that the building ~.. 9P.e...f.a.m.~. ]:..7..d.w.? .1.i.~.n.g. ....................... Location of Property . .r(0. ............. .S.e.a.¥gp.d' .D..p.~y.e. ............. .S.o.u.t:.h. 9.1.d' ....... House No. Street Hamlet County Tax Map No. 1000 Section .0.8.8. ........ Block .... 0.2. ......... Lot ...0.0. 9. ........... Subdivision..S.e.a.¥9.°fi...~.c?.e.s. .............. Filed Map No..2.5.7. 5....Lot No.. 4. ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated · .. (.u.I.y...2.9 .......... , 19 .8.3. pursuant to which Building Permit No..1.2.5..3.7..Z. ............ dated ... ~.u.3,7...2.9 ................. 19 .~.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 ......... ...... a.. p?Av..a.~.e..o..n.e.-.~.a..~.~3.y...d?.e.~.~..~.n.g.. ....................................... The certificate is issued to WILLIAM J. & PAMELA HcGONEGAL (owner, levee or-tenant) of the aforesaid building. Suffolk County Department of Health Approval ...n..o ~..~.e..q.u ~.~.e.d. ......................... UNDERWRITER S CERTIFICATE NO. N Z~2L~933 ........ ./..~¢Y~./~../~/../~ ..... ,~Building Inspector Rev. 1/81 TOVv'N OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12537 Z Permission is hereby granted to: ............... ~ ......................................................... ~ ................. '~' ......................... 7 ....... pursuant Buildln~ Inspector. Rev. 6/30/80 'i' ~ FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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-iS-9 form or equal). 3. Approval of e~ectrica~ 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. 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 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 ~ 5"/ 2. Certificate of occupancy on pre-existing dwelling land use ~;/ $5.00 3. Copy of certificate of occupancy $1.00 Date .......................... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property .... ").O ~'~EA ~) 0 0..~ ~T~\v ~- ~_~Hu-r HO House No. Street Ham/et Owner or Owners of Property ...~?.~....',J .... .~....~.~. I.~...~...J~. .......~..~.....~...~..~'~...~./~...~_.. County Tax Map No. 1000 Section ........ ~...~.... Block ............... Lot ............ Subdivision..~. ~ !~.~.0..~. .... . ./~...~.~..~. ...... Filed Map No. ~,5 7~-~' Lot No. Permit No. !.! ...... ate of Permi ..... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval .... t .~. ~ .'~.'. '.'.'%..' ........ Planning Board Approval ..................... Request for Temporary Certifi.~ate ..................... Final Certificate ....................... Fee Submitted $ .......................... Construction on above described building and permit meets all applicable codes and regulations. Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS p fll BURBAU OF ELECTRICITY I-- 85 JOHN ETREET; NEW YORK, NEW YORK 1~038 ,.,-ch 7, THI~ CE;IFIES THAT t~lllla~ HcOonegal, Seaw~d Be. cot. Hldland P~wy., Soufhotd, L.I. in the fol~Jng location; ~ ~ement ~ Ist ~l. ~ 2~ R. ~t~n BI~ ~t ~ exami~on ~ ~Ch ~ ~ ~ ~ 70 and found to be ~n ~mpl~ce with the ~ui~ments of th~ ~. FIXTUR~ OUTUETS DRYERS SWITCHES FIXTURES RANGES OVENS EXHAUST FANS FURNACE MOTORS SERVICE DISCONNECT S E E V I C E OTHER APPARATUS: Paul ~u trns Town of Harbor t/97Lenel 5ou?hol d~ N,Yo Lic.282 This certificate must net be altered in any manner;, return to the office of the Board if incorrect. THIS COPY OF MUST NOT FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 ~ × TEL,: 765-1803 /~ Approved ........... ~9.~Permit No (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No.,. /~>'~ ~'- fi-ff-- INSTRUCTIONS a. Tlfis 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 m,.ust 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 throughont 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, et for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulatio_n!, and to admit authorized inspectors on premises and in building for necessary inspections. · .. .............. · (Signet, lire of applicank/,or~corporation) , .... (Mailing address of applicant) State wheti~er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... ................... i'"i ;;21;i ...................................................................... (as on the tax roll or latest deed) If applicant is a corporation, signature off~uly authorized officer· ...... .... ..... (Name and title of corporale offic'-e'r) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which prop_.q.sed work will be done./~ ...................... ~ -~ ....................... House Number Street Hamlet County Tax Map No. 1000 Section · · .~: · Z.~. ........ Block .... ~.. .... ..... Lot .... Subdivision 9,.~..~.~3~~..~..~.~ Filed Map No. c~.) ~ .~.... 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 applicable): New Building .......... Addition ....~. '. .... Alteration ...P~... 3...  epair .............. RemoVal .............. Demolition ,.; t~/]' ........ Other Work ............... ~7. ~.~.~..~.~. ':~Tt: *'~ t~ (Description) 4. E,~timat.ed Cost (to be paid on filing this application) 5. If dwelling, number of dwelling ~nits ........ ( ...... Number of dwelling units on each floor ..... [. ......... If garage, number of cms ..... ~ .................................................................. 6. If business, commercial or mixeff occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing stmcture~,ifany: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure wi~h alterations or additions: Front ................. Rear .................. Depth .................... [.. HeiSt ...................... Nmnber of Stories ...................... 8. Dimensions of entire new construction: Front .......... .. .... Rear ............... Depth ............... Height ' . .............. Number of Stories ........................ ~ ............................... Size of lot: Front ........... ........... Rear ...................... Depth ...................... Date of Purchase ........... 2 .................. Name of Fomer Owner ............................. Zone or use district in which premises are situated ..................................................... Does proposed construction violate any zoning law, ordinance or regulation: ................................ Will lot be regraded ......... : ................... Will excess fill be removed from premises: Yes No Nme 0f Owner of promises ... ~ ................. Address ................... Phone No ................ Nme of Architect .......... ................. Address ................... Phone No ................ Nme 0f Contractor ......... ~ ................. Address ................... Phone No~ ............... 10. 11. 12. 13. 14. Locate clearly and distinctly alli buildings, propel~y lines. Give street and block interior or corner lot. PLOT DIAGRAM whether existing or proposed, and, indicate all set-back dimensions from mmber or description according to deed, and show street names and indicate whether STATE OF NEW YORI¢,~ , COUNTY OF .... ~ .~.~.o.t-.(~.. ..... .(gq. ! .C. (t. ~ .//J<7..&....~2/-~¢~... ~( ~ .,-f~..(_. ............. being duly sworn, deposes and says that he is the applicant (Name of individual si rang contract) above named. He is the ..................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is du}y 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 flied therewith. Sworn to before me this 19..~ ...... .... day of....7/ ........ tmyPublic, . ..~ ... J~../h ~,.,.,.,,, .~. / ....... County , No c~;4~ewt/fc, F),i, / ~,,~o ~_, ~ /, -- ~. ~v P, .... ~; ~ of I~ow Yt, .~ - F} .......... ~ ..... .~..~ -/..y~fj..:.:..: ............. U~. 4/,;L aS : ,', I(,,- . ~- '~Xr, ~,, ,, ,~tSignature of applic~t) Qualified in Suffolk C~u~ ~*~'~"~ .....