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HomeMy WebLinkAbout12580-zFORM NO. 4 TOWN OF 5OUTHOLD BUILDING DEPARTMENT Office of the Building InspeCtor Town Hall Southold, N.Y. Certificate Of OccuPancy No..Z.l. 2. gJ.7 .......... Date 9c.t, g~ 198.4. THIS CERTIFIES that the building Addition-renovatio,n. Location of Property ~.0.0. ~9.u.n.d.B..ep. qh Drive Mattituck House No. ' ...................................... Street Hamlet County Tax Map No. 1000 Section . .0..9.9 ....... Block 01 .Lot 009 Subdivision Capt. Kidd Estates .Filed Map No. 1672 69 ...................................... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... A.u. g :..3. 0. ..........19.8. 3. pursuant to which Building Permit No.. ~ a 5.8. Q $ ............. dated ..... S. ~ p .~.... ~ ............... 19.8.3., 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-renovation The certificate is issued to .... .J.o.h¢..&. Florence Johnnidis ......... ..................... of the aforesaid building. Suffolk County Department of Health Approval N/A. UNDERWRITERS CERTIFICATE NO · ~N624649· Building Inspector Rev. 1/81 l~O~ 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) NO 12580 z Permission is hereby granted to: ~.~..~...~ ........... ..~.~..,..~.~ ....... ,o ......... ~ / .~.~....~.~..~~..,...~.....~~....~ ........ ;. ............... at premises located at ..~'.~.~.~.....~.~..~ - (~ !~...'..~.~....i...~~ County ~a)x Map No. 10~ Section ...... ...(~....~...~. ..... Block ..... ..~..J. ......... Lot No......~..o~ pursuant to application dated .~J.~.~.~......~ .............. . 19.~.w,~, and approved by the Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall ,%uthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in typewriter OR ink, and submitte~p?.cctc 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 e~ectrical 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. 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 lines, streets, buildings and unusual natural or topographic featu res. 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 landuse L-rre-~;×±st±ng C.0. $15.00 3. Copy of certificate of occupancy $1.00 Vacanf, land C.O. $ 5.00 New Building ............. Old or Pre-existing Building .......... ;. Vacant Land ............. Location of Property., ~..© ...... ,~zo..~..~...~. ¢.~¥~-.. ~;.~'.~: .......... .~ ............ House No. Street Ham/et O~ner or O~ners of Property .. ~ .~.o. ...... ~.. t~J.~ ...................... County Tax Map No. 1000 Section . ..~. ?. ~ ....... Block ....(~. I ........ Lot... £,O.O..~ ....... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. I.'~,,~..~,O. :~. Date of Permit .5.~{.~,~..Applicant ?.. Health Dept. Approval ........................ Labor Dept. Approval Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ... ~ ~,~.... Fee Submitted $ .... ,~.,.q .o ................... Construction on above descr bed bud ng and peri, it me, ets all,~pliCable codes and re/3¥1ations. Applicant..~._~~:~-'/.~/...~. '~ .~.~.,~'.z:;~ ............. FIELD INSPECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY C DE FINAL ADDITIONAL COMMENTs: / / 'D AS HOTED I~oTIFY B~ ~ n NG DEPARTMENT AT 7~5-1802 ~ A~ TO 4 PM FOR THE FOLLOWIbm H dSPECTIONS: I. FOUN~-~'N ' TWO REQUIRED FOR P~"~'~ CONCRETE 2. ROUG'~' -"AMING & pLUMBING 3. Ih]qLH ' 4. FINAl ~, r' ~] "?r~Ur'TI~N MUST ALL CC~ ........... ', ~ SF-[ALL MEET THE REc "'J ...... S nF T~ N.Y. ~TAI'E ( .... ~mjrT~ON g ENERG'~ CODES. ~ · RFqP~NS~BLE FOR DESIGN O~' ~ ?qSTRUCTION ERRORS. _q FLO0~ Co~3~ [oooo6 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRIC(TY ' Nove~' 30, ~,9~3 85 JOHN STREET, NEW YORK, NEw YpRK 10038 THIS CERTIFIES THAT Flor~ce Jo~nic~s, 49 ~md ~ch ~., ~tti~, N.Y. in the followln~ location; [] Basement ~ 1st FI. was ~a.*i~ed on k'Cmyeaiber 17, 1983 FIXTURE FIXTURES OUTLETS SWITCHES INCANDESCENT FLUORESCENT [] 2nd FI. Section Block Lot and found to be in compllan~e with the requ rements of th s Board. RANGES ·OVENS DISH WASHERS EXHAUST FANS 12 8 7 12 DRYERS MOTORS FUTURE APPLIANCE FEEDERS TI~E CLOCKS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPARATUS= GUS~aV Bartra 227 E. Breakwater Rd. Ymc~ituck, N.Y., 11952 This certificate m?st not be altered in any mannqr; return to the offic s E NO Oi~ECRC~COND. NO OF HI-LEG OF HI-LEG NO, OF NEUTRALS OF NEUTRAL LIC:. #~529 of the Board ~f may be their credentials. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved ...........~-~¢.'? ~P .... , 19'~.g.. Permit No. ........... }_X~' Disapproved a/c ..................................... ............................... ..... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received .......... ,19... 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 plma 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. e. 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 regul, atio~t_s., and to admit authorized inspectors on premises and in building for necessary.,.)nsj~ectigfis, a (Signature of applicant, or name, if a corporation) (Mailing address of applicant) // State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... .. . . . ............................................................. Name of owner of premises ..... .'3.~,? ./0'.... (~. .... .'Sd .~./.' . ........................................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ....... ,.~.' '~'f.'..~.= ............ Plumber s License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section ...... .C~. :~.r] ..... Block ....(~.../ ........... Lot...(~. ~-~. ~ ......... (Naine) 2. State existing use and occupancy of premises and intended use and occupancy/of p~oposed construction: b Intended use and occupancy lO. 11. 12. 13. 14. property lines. Give street and block interior or corner lot. Nature of work (check which applicable): New Building .......... Addition ......... J . Alteration .......... Repair .............. Rem?al ...... · .?~..'. · · · Demolition ...... ~. ..... Other Work ............... ~/~ ~ (Description) Estimated Cost ..........~ ¢ ......................... Fee ...................................... i (to be paid on filing this application) If dwelling, number of dwelling!units ........ / ...... Number of dwelling units on each floor ...... /. ......... If garage number of cars If business, commercial or mixed occupancy, specify nature_ and extent of each type of use ..................... Dimensions of existing structures if any: Front ............... Rear .............. Depth ............... tteighf /~ / Number of Stories ¢~,~ ~ Dimensions of same structure vJith alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories ...................... Dimensions of entire new const[uction: Front ~ ~ W' Rear Depth /~/.. r Number of Stories ~ rw (¢ Height .. ~ ............................................................. Size of lot: Front %.- t i Rear r)~' Depth Date of Purchase J f~ g'-/ Name of Former Owner Zone or use district in which pr~mises are situated ................. ~ .................................. Does proposed construction violate any zoning law, ordinance or regulation: .. JO.g, .......................... Will' lot be regraded "~ ..... g~ ~ ~ ................... Will excess fill be removed from premises: Yes ' ' s.~i,~ 67. ~Fot~ ~' Add Phon No Name of Owner of premise · · ~'~ ,.~ .... ress ................... e ................ Name of Architect Address Phone No Name of Contractor ~;.~:£~.,~?~2. i'k'~:e~,~?.. (Jo,7~[, .Cc.. Address glbt, q'. ~I... ~O.~*Jo.*.,r v ~.. Phone No..7~,~. x J&&~'~ .... PLOT DIAGRAM Locate clearly and distinctly al1 buildings, whether existing or proposed, and. indicate all set-back dimensions from number or description according to deed, and show street names and indicate whether STATE OF COUNTY ........ above named. and says that he is the applicant if, k....~__ontractor, age~t, corporate officer, etc.) of said owner or owners, and is duiy~at[thorize~r-f6~m or have performed the said work and to make and file this application; that all statements contalnX~ in this application are true to the best of his knowledge and belief; and that the work will be performed in the manndr setTorth in the application filed therewith. Sworn to before me this ......... ' .~.~ ...... dayoi· s ount; a .......................... tJ i (Signature of applicant)