HomeMy WebLinkAbout12136-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N,Y.
Certificate Of Occupancy
No..g.~.q .~.8~. ......... Date ..... .A.U..G.U~.~..89 ................. 19.8.3
THIS CERTIFIES that the building . .N.e.w...I~.e.~.~g ................................
Location of Property . .q .~¢.0..I~..a.u.r.e.l.¥9.o.d[ . .D~.5,¥9. ~q~Tfi~- ........
House No. ' ' Street .............. l~l'e~
County Tax Map No. 1000 Section .... 'l. ~?. .... Block .... ~, .......... Lot ...~, ........
Subdivision..~.a.u..rp.l. wo. 9~..E.s. ~;~.1;.~.~ ........ Filed Map No.. ~5.~9~..Lot No .... .'1~. .......
conforms substantially to the Application for Building Permit heretofore Fried in this office dated
·.. ~J.a.n.u~ .a.ry..q~ ......,19.83. pursuant to which Building Permit No...~[~q. 3.6.Z ............
dated .... .l~.e.b.~7 .u~;r~. ~ ............ 19 ~3~., was i~sued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ~or a one £amily dwelling
The certificate is issued to I)p~ald. ~. I)or.~hea. ~Kau££man .............................
(owner, le~ee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval ~12-so-~7
N609226
UNDERWRITERS CERTIFICATE NO ..................................................
Building Inspector
Rev. 1/81
BUiLI~iI~
(THIS PERMIT /~USt'B~ KE~]' ~)Ni
cOMPLETION OF THE
Pi~rmissloY is hereby granted'
to, "i
at p~mises located at.
C0uoty T~x Map No. 1000
~.o.~ io op.,~o.o. ~o~"~: ...................... , .....
Re~.~ 6/30Z80 ; 5 ~
Not- ........ ; ...............
and approved by the
TOWN OF SOUTHOLD
, Building Depaffment
Town Clerks Office
Southold, N. Y. 11971
APPLIGATION FOR GERTiFiCATE oF OCCUPANC:Y
instructions
A. This application must be filled in typewriter OR ink., and submitted in DUPLICATE to the Building
Inspector 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 Underwrters
4. Commercial buildings, Industrial buildings, Multiple ~esider~ces and similar buildings and
installations, 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 c~pplicable.
B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey, of property 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 condltion of buildings.
3. Date of any housing code or safety inspection of buildings or premises, or other pertinent in-
formation 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 $1.00
¥
New Building ................ Addition ................ Old or Pre-existing Building ............... ¥o¢~t Lond...?.. ........
£/
Location Of Property .,.,., ....................................... : .............. ~ ............. ,~....,~.. .....................
Owner Or Owners Of Property ......~....O....~...~/./...C~.......J.~.....~...0....~..~...~..1..~.,.~. ......... ~/OL~...; .~...~..T~.....~....~. ................
Subdivision ........ No.../.'.[.... ..... Hous
Permit No. Z'..~.../..~....~. ..... Date Of Permit ...¢~../.~..L~.Applicant f~:~T' ~hl'/./ .~'.(2. x)$'Z-
Health Dept. Approval ............................................ Labor Dept. Approval ................................................
Underwriters Approval .............................................. Planning BOard Approval ........................................
Request For Temporary Certificate ........................................ FtnaJ Certificate ..........................................
Fee Sub. n~itted $ ....................................
Construc~fon on above described budding an~perm~t meets ~1 ;pplicable codes and regulations.
Sworn to before me this ~ ~ . ~'
C o, :: 11
Notary Public ................ ..~.~.~ ~ ~ounty
looo2s8 THE NEW YORK BOARD OF F{RE ~
UNDERWRITERS
['~ BUREAU OF ELECTR, I~IT~
~- s~ .~oH. STREET, N~W ','O.~ .~ ~O.~ ~OO~
THIS CERTIFIES THAT ' '
only the elec trlcal equipment as ~scribed below a~ int~duced by the applicant ~a~ed on the able application number tn the premises of
irt the following location; ~ Basenteztt ~ I st FI.
was examl.ed on July 6, 1983
FIXTURE FIXTURES
21 25
[] 2nd FI. ; Section Block
and found to be n com~lia~tce tv th the requirements of this Board.
RANGES OVENS
Lot
DRYERS
OTHER APPARATUS:
1 -Smoke Detector
1
NO, OF HI-LEg A W G NO OF NEUTRALS A, W, G
OF HI-LEG OF NEUTRAL
4', 1 4
Elect. 'Ventures
P, O. ~ox 151
C~ter h~)riches, N,Y., 11934 LIC.~847
This certificate ~ust not.be altered in any manoer, return ,o the office of the Board~inc~rrec,. 'nspect~r, may be identifiec credentials.
COPY FO~ ~U LO NG DEPARTMENT THIS~COPy OF
[ ] FRAMING
REMARKS:
7GS
BUll. DING DEI~.
INSPEcT'
FOUNDATION XST [ ] RouGHI ~LBG.
FOUNDATION ZND [~.~/INSULATK)N
[ ] FINAL
DATE
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION ~ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING
REMARKS:
/~FINAL
COMMENTS
FIELD I~S ? EC~T ION
1.
FOUNDATifON (1st)
FOUNDATION ( 2nd )
o
ROUGH FRAME &
FLNMBING
TNSULITION PER N.
STATE ENERGY
q,ODE
FINAL
ADDITIONAL COMIV~T~:
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N,Y. 11971
TEL.: 765-180;3
E×amined.~.~-.....~ ..... ,19.~.?
Approved ...... 19( , Permit No.. ?
Application No../..cTY./..~.-~( ........
Disapproved a/c ................. ~ ........ /~. ........
............... ~77...77..7 ........ ~~'..~....~~ ,
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date . ./././.~ ............ 19 .~'.g
INSTRUCTIONS
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 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 gi'qing a detailed description of layout of property must be diawn 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 regulations, and to
admit authorized inspectors on premises and in building for necessary inspections.
(Signature of applicant, or name, if a corporation)
. ~ ~.~. (, . ~ U~ ?. t t .~. , . .I.~. e~ Cz,. ~ c/~ ,. ~/.. ~Y., . I. l T ~. '~.
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises .~...~.c~.....~.~ .... I...~. ~.
(as on the tax roll or latest deed)
If appli~ant~) is,a corporation, signature of duly authorized officer.
....
(Name and title of corporate officer)
Builder's License No ..... ~..0..o.~..--. (-}. ~ .........
Plumber's License No .... ~.t~.? .h ..~. ...........
Electrician's License No.. ~.~'7..7 ~ ............
Other Trade's License No ...................... ,'~
1. Location of land on which proposed work will be done.
....c.¢..~..:.~..z' % q~. ~...~¢..
House Number Street ' Hamlet
County TaxM~No. 1000 Section ...~.g. 7. ......... Block ....~J ............ Lot...~ ..............
~o ~ ' 7 ........
Subdivision ~7.. ~..~ ....... 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 ...... ~~ ....................................................
3, Nature of work (check which a~plicable): New Building ........ Addition .......... Alteration ..........
Repair .............. Remqval .............. Demolition .............. Other Work ...............
; Z~.~.' (Description)
4. Lstnnated Cost ............................. Fee ..........................
i (to be paid on filing this application)
5. If dwelling, number of dwelling ~Units ..... ] .......... Number of dwelling units on each floor .... J ............
If garage, number of cars ..... I ) ..................................................................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .....................
7. Dimensions of existing structures, if any: Front .............. ,. Rear .............. Depth ...............
Height ............... Number of Stories ........................................................
Dimensions of same structure with alterations or additions: Front Rear
Depth ...................... Height ...................... Number of Stories ..............
8. [hmenslons of eptire new construction: Front .. 3.' ........... Rear . .~'.~ .......... Depth .~.6.~6.. ~ .~...
Height .... /.~. ......... Number of Stories .... ! ............................................. .o .....
9. Size eliot: Front .../..~.O.' .... ~'. ......... Rear../.~'. ............... Depth .a2.i:.D.~ ............... ,.
10. Date of Purchase i ............ Name of Fo mer Owner
11. Zone or use district in which pr~mises are situated .....................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: ...............................
13. Will lot be regraded ......... ; ................... Will excess fill be removed from premises. Yes. No
14. Name of Owner of premises .O .~,~..~.~..'.¢~..,~. Address .
Name of Architect ~4q~ g~?-~...'....'T~., ddress . ~ .g~-~ .~. J~hone $~i- ~ ....
Name of Contractor ,~. ~...~,? ........ Address . .~,
PLOT DIAGRAM
Locate clearly and distinctly alll buildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and block inumber or description according to deed, and show street names and indicate whether
interior or corner lot. ~ ~:~2,.,~o~ ~
STATE OF NEW'K, ~_ ? ~
COUNTY OF~... i~'~ ,,~
........-" ~)~'~'i'' ~'' being duly sworn, deposes and says that he is the applicant
(Name of individual sign}ny contract)
above named.
He is the ............. ~~¢~. ~ ~ ...................................................
of said owner or owners, and is dul~ anth~form or have performed the said work and to make and file this
application;that all statements contained in this application are true to the best of his knowledge and belief; and that the
work will be performed in the manne~ set forth in the application filed therewith.
Sworn to before me this
.............. day o .
Notary Public, .................
~~./.. County
...........
, (Si~'nature of applicant)
EUZAI]ETH ANi~ EVILLI~
'~OThRY PUBLIC, Stale of New Yofl~
No. 52,81258501 Sulfolk Col~t¥.
r*'rm £×mres M~trch 30,
[4AUFt h/JAN
t
i
DATE' ~B.P.
FEE.'_~BY:
765-]802 9 AM TO 4 PM FOR THE
FOLLOWIh[G IN$?ECTION5:
1, FOUNF)ATION - TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMIHG & PLUMBING
DESIGN OR CONSTRUCTION ERRORS
II iJ
4
ffcopper tubing is used
[or water distributing
sys~en~; p/ping sha~l be
of types K or L only
/' /4-'-0'.'.
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