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HomeMy WebLinkAbout12607-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. UPDATED Certificate Of Occupancy No .... .g .~ 3.5. 0. 5 ....... Date ....... .J.u.n..e..1.3. ................. 19 .8.6. THIS CERTIFIES that the building ....... n.c..w..d.E e..1.1.J..n.g' ?.i.~ h...d.e.q ~.: .............. Location of Property .. 5.~5. North Bayview Road Southold Hou~ No. ' ..................... '~'tle~i .......................hlt3ie~ County Tax Map No. 1000 Section ...7.9. ....... Block ........ .3 ......Lot ....4.3. ........... Subdivision .13~y.v. 5,~. ~.qg.d.~..g.s..~.~.ke. s. ..... Filed Map No....~.5.2..0 .Lot No ...... .2.3. ..... conforms substantially to the Application for Building Permit heretofore Filed in this office dated ·..4u~.. l 7 .......... ,19. ~3.3pursuant to which Building Permit No ..... ! .2.6.0.7. g. .......... dated ....... ~.e. g ~: .e ~b. e. ~'..1.5. ...... 19~. .3., was issued, and conforms to aU of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Private one-family dwelling with deck. ANNE L. LaMORTE & RITA LaMORTE HAGER The certificate is issued to ..................... ioW,~,:,~,~3~ ..................... of the aforesaid building. Suffolk County Department of Health Approval ................. 1. 3. r.S.O.': 8. ~ ................ UNDERWRITERS CERTIFICATE NO ......................... ~ 6 .4.6.4.~ ] ................. Building Inspector Rev. 1/81 FORM NO. 2 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) 12607 Z Permission is hereby granted tg;.__ ...... ~..~.,~.~....~..,. .......... ............... ........ ~..o7~./~,~,,~.=.~. .............. ~. ,o .... ................ · at premises I=ated at .~.~ ............ ~ZZ..../~X~~...~/ ............ ...... ~.~.~.~z.~....~.~.~....~ z ............... :,.....~. ..................... ~....~ co~,~ ~ M~ ~o. ~0oo s~,~o, ...~.Z.~ ...... ~ ...~.~t ........ ~o, ~o..~....~d pursuant to application dated ....... ~/ ...................... , 19 and approv~ by the Building Inspector. Fee $.,/.. ,~... ~,., ~?c...,, Building Inspector Rev. 6/30/80 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificnte Of Occupnncy No. Z12526 Date June 8 ]9 84 THIS CERTIFIES that the building. D.e.w.. ql w.e.1.1. .i %q g. ................................ Location of Property . .5..8.4.5 ..............N..o.r.t.h., .~.ay.v./. ?.w..R.9 .a.d ..... i... S. 9.u3.h.? House No. Street Ham/et County Tax Map No. 1000 Section ...079 ...... Block ...Q$ .......... LOt.. ,0..4.3 ........... Subdivision...B.a.y.v.~e.w., .W.o.q~.s..E,s.~....'.s. .... Filed Map No...5.5..2.0..Lot No. 23 conforms substantially to the Application for Building Permit heretofore fried in this office dated .... J. qn..e..~.7. ......... 19..8.:~ursuant to which Building Permit No .... 12.607. v. ......... dated ........ $ .ep.'q.e..mb..e.~...1.5 ...... 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 ......... ....... ~. p.~iv~.t~, o v.e.': ~ ~n.i.l.M..d.w.e..1.1.i.n.g .. ..................................... The certificate is issued to .... JOAN. 13~Y~T .A]NZ .B..U.I.L.D.E..R,..I.N..C.. ........................ (owner, lezsee of the aforesaid building. Suffolk County Department of Health Approval . .13v$.O.'~,..4/..2.3./.8.4. ,..R. qb..L:..A.:..V.i.]:]: .~., UNDERWRITERS CERTIFICATE NO ......... sN. 6.4.4.4 O ~- ............................... Building Inspector Rev. 1/81 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 · 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANC~ Instructions A. This application must be filled in typewriter OR ink, and submitted I ~ 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 featu res. 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 sYrnilar 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 pm3perty 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: I. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. Updated C.O. $15.00 $15.00 Date .. $¥r~ .:},. ], ~ ............ New Building ............. Old or Pre-existing Building ...x ......... Vacant Land ............. 5845 North Bayview Road Southold Location of Property ................................................................... House No. Street Ham/et Owner or Owners of Property .. A.~.ge...~;..~.~ .Ho..~.t .e. ~..~.d.R.~.t .a . .~ .a .H .o ~. t.e., .Ha. ~e.~. .................... County Tax Map No. 1000 Section .... 9.7.9 ........ Block ..... .0.3 ........ Lot ....... 0,4,.3...'... Subdivision .... .~,ayy. ~e.¥..~99.d,s..~.s.t.a.t.e ......... Filed Map No.. ,5.5.2.0 ..... Lot No .... .2.3 ........ Permit No..]:.2.6.0.7..~.. Date of Permit 6./.3:.7,/,8.3.., .Applicant .... ~o.h.z}..~,e?.t,a,~,~ .~.u.~];.d.e,~.~..[.qe.: .... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate .. ~ Fee Submitted $ . . . .]-.5; .0.0.: . .'~,.. J.~,~./ ........ Construction on above described building and permit meets all applicable codes and regulations. C'C~=/-/~-'~lL/~'(-~..J~~pplicant Michael J. Hall Rev. 10-10-78 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hail ,~)outhold, 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 sin~]lar 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 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 J land use 3. Copy of certificate of occupancy $1.00 --?re-Existing C.O. $15.00 Vacant land C.O. $ 5.00 New Building .... / Old or Pre-existing Building .... Vacant Land ............. Location of Property ....~.~. ~..~.. ....... · .~/. ?..~..~..... '.~-.~..~( Hou~ No. St~t Ham/et Owner or Owners of Prope~ .... ~ P~.. ~.. ~+~+~. · .~ ~ ................ CounW Tax Map No. 1000 Section .. P.Z.~ ....... Block .... ~ .~ ....... Lot ...... ~.~ ~ .... Subdivision ................................. Filed Map No ........... Lot No .............. .. Permit No.l~.~. Date of Permit. ~?~. ~.Applicant Health Dept. Ap proval . ~//~fi/~ ~nde~riters ~pproval. ~ · ~ ..... Plannin~ Board ~prov~l .................... ~ue~t for Tempom~ C~rtificato ..................... Final C~ific~t~ ...... '~ .............. '"-. 8,0 ~ Fee Submitted $... ~ .t ....................... Construction on above described building and per, mit meets all applicable codes and regulations. ~ ~' I~'~ pplicant... IJ,~ ./~.~.CW .... /'.~.~.~... .............. FIELD INSPECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING 3. INSULATION PER N. STATE ENERGY qODE FINAL DATE COMMENTS /h ~ /':,~' ,P ~ -,.~'1/ ,¢. z,!. ~, ? ADDITIONAL COMMENTS: 7iS-~e2 BUILDING DEPT. INSPECTION 1' ] FOUNDATION '~ST [ ] ,ROUGH PI.BG. .. :..j.~.~ [ ] FOUNDATION ZND~] INSULATION /\ [ ] FRAMING [ ]FINAL REMARKS: BUILDIN~ DEPT. INSPECTION [ ] FOUNDATION IST [~ROUGH PLBG. ~ FOUNDATION 2ND [ ] INSULATION [~I~AMING [ ] FINAL [00].07].THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CE~IFIES THAT only the el~tdcal ~uip~nt ~ ~scdb~ ~ and int~uc~ by t~ ~pli~nt ~ on the a~ ~t~ ~um~r in t~ p~m~s of in the foll~ing l~ation; ~ B~ement ~ 1st FL ~ 2nd FI. S~tion Bilk ~t was exami~d on ~ ~0 ~ ~ and found to be in compliance with the requirements of th~ fl~rd. FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT ~1 44 24 21 DRYERS FURNACE MOTORS FUTURE FEEDERS TIME CLOCKS MULTI-OUTLET DIMMERS SYSTSMS NO, OF FEET SERVICE DISCONNECT S E R OTHER APPARATUS: 1-G.F.C.I. 1-Smol~ Detector. Puture Appliance Feeders: NO. OF CC. COND. A.W.G. F~R ~' OF CC. CONO. 1 4 C NO. OF HI-LEG OF HI-LEG OF NEUTRAL 4 Electrical ~15 So~hold, N.Y. llCJ71 578 This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified redentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. F~)RM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 DiSapproved a/c . .~.. ...... LL' 7..' .......... (~./.. · ............................. 'iiii ........ (Btiildiilg Inspector) APPLICATION FOB BUILDING P;RMIT Application No .................. ,Date .~.~.~.~.4 ..... I ."/ .....19~.~ · . ;~ ,: , iNSTRUCTiONtS .... , , This application must be completely fil/ed 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 ispart 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 ptusuant 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 a~rees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (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. ..... a'. ................................................................................ Name of owner of premises . .~'~..~.~...~..~t*,'7~t... ~tZ, O~....~.e,. ................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer· .... x2. ........ (Name and title of corporate officer) Builder's License No... J.~./. .................. Plumber's License No. ~.~..~'~t~(,x ......... Electrician's License No ........... Other Trade's License No .... ~./~. .............. I. Location of land on which proposed work will be done..--'~ .... .~'.~..~.7~., ...... :~,~.~,___~ ;,.i~l.~: ........ i ' ........... /.. House Number Street Hamlet County Tax Map No. 1000 Section ...... I~.'Z.~ ....... Block .... ~. ............ Lot...~/.~ ......... ..~. Subdivision ........ ~.~.YtI~ID... ~0~i>.~...~fl~.. ~.~ Filed Map N,o... ~'-~.. ~__l~lame) ', 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .. ~/'~1 ~-~ ~A 77.. ....................................................... 10. 11. !2. I3. 14. Nature of work (check which applicable): New Building ....~..... Addition .......... Alteration .......... ' Repak .............. Removal .............. Demolition .............. Other Work .......... ~ Estimated C. ost . ~.~0 ...................... . ...... Fee..~.. ~.~.. ....... ~.' ..... (to be paid on .filln~ ~ a~ If dwelling, number of dwelling units Number of dwellir~ 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 ' Deplh Height ............... Number of Stories ........................... .-, ............ Dimensions of same structure with alterations or additions: Fwnt Rear Depth Height Number of Stories Dimensions of entire new construction: Front . .~"~. ;., ...... Rear..a~ ......... Depth i ~,~.. Heilglt .../e.~. ........ l~umber of Stones...d~.~.; ........................ ~ ................... S/ze of lot: Front .. ~.~ ............... Rear .... ~.~. ~...' .......... Depth ../,al'~. .............. Date of Purchase ............................. Name of Former Owner ............................ Zone or use district in which premises are situated ..................................................... Does proposed cons_t!'uotion violite any zoning law, ordinance or regulation: ................................ Will lot Be re/faded ........ /~. ~. ................ Will excess fill be removed from premises: Yes ,~No Name of Owner of premises ~d~. ~t. ~,~. Address . ~,d~/~. ~ ..... Phone No. ~'~'~,~,~3F~'... Name of Architect ........................... Address ...$b t,~ ..... i. Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all building, whether existing or propo~.d,~and, indieate all set-b~ack dilm~/ons from property lines. Give street and blo/~k number or de~/on aCoording to de~d~/u~d.~ow ~et names and indicate whether interior or coroer lot. ~ ~ 0 f'~ ~.~ STATE OF NEW YORK,_ COUNTY s.s ....... ,.~ ~'.. ~...tt,~-.g",ql, n// ........................ berg duly ~om. deposes ~d ~ys that he h ~e appHc~t (N~e ofin~du~ si~g con.ct) '~'r,,, above n~ed. He h the ,..~~ .................................................... , , (Con.actor. a~nt, co~mte officer, etc.) of s~d owner or owne~, ~d ~ d~y au~o~ to peffo~ or ~ve peffo~ed ~ ~d work ~d to m~e ~d ~e ~s app~cafion; ~t ~ s~teman~ con~ed work wffi be peff~d ~ ~e m~ner set fo~ ~e app~a~on ~ed ~t~. Sworn to ~fo~ me th~ ............... /.~ ...... day of ...... m~.~, ~*.:~ ~ ' (S~a~ of appH~t) © To d', ?.