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Home My WebLink About12146-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z,~ ~,c),~,9 ......... Date ....... .O. qt 9'.b.e.~...6 ............... THIS CERTIFIES that the building . .~T~..~)~lP~ ................................ Location of Property .... q265..t~r~....l~ql o..'~.~. [~r~. ~I~, ) ..... ~p.~.I¢9.1~. House No. Street ..... County Tax Map No. 1000 Section . ...0.50 ..... Block .... .O.q ........ Lot .... .QQ~ ..... -... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... J~rzt~a:ry'~ .~.z~ ...... 198~. pursuant to which Building Permit No. ~ ~/l.z~. ' dated .. ~..ob~ttarcy. $ .............. 198}., 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 ......... O~e ~amily I~elli~g The certificate is issued to .KO~.~ · ,T~OI-I~ ~ · .BU~C~ ............................ fowner, lc*gee or tenant] ......... of the aforesaid building. Suffolk County Department of Health Approval ~1 UNDERWRITERS CERTIFICATE NO. · .N6q:~'~ q ~ ............... . ............... ' Rev. 1/81 Building Inspector 12146 Z: Petrnissio~n is hereby granted ~qnty Tbx Map Ne. 1000 pQ~uant ito application da~ B~ijdl~g ~nspector. ~ j TO ?~EMOVE EXC~:SS FILL ~FROM A~OVE PREMtSES~BY D~I~'~WAY CONSTRUCTION .?,..,,..~.i~t NO. ......................... .."~., 19,,.~;.,, and approved by the 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 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 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 ~5.0~.0 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date .O.Q~. ~.'...~. ) . I .Cl. ~ ~. ....... New Building ..... ~ ..... Old or Pre-existing Building Vacant Land ............. Location of Property ...//~-~z~.~..--. ........ x~..~. ~../~' ..... ~)~',~.~, ~z~..~... House No. Strbet Hamlet Owner or Owners of Property ...----/~.~, ~/. ~[(~../. ~..¢-¢,~'~¢~., ......................... County Tax Map No. 1000 Section ..... ~.,¢~--.f__,J .... Block ..... (¢~.~. ..... Lot ...... ~.¢~.,~ .... Subdivision ................................. Filed Map NO ........... Lot No .............. Permit No./.~7...//~,. :Z~. Date of Permit . .~-~'~.~.*/~,¢l~lcant... ~'"~/~..~¢-¢¢2'/~¢/,-~z'.. Health Dept, Approval ~/~i?/t/~. ~..../.~.-.5.~!'?.~.Labor Dept. Approval .... x4./,4 ............... Underwriters Approval~ .................... ~o//~ )/,z~ Planning Board Approval ...................... /,J Request for Temporarv Certificate ..................... Final Certificate ....................... Fee Submitted $..~..~,~ ..................... *~ 0t~¢-~b¥' O Construction on above described building and permit meets all applicable codes and regulations. Applicant..~-¢~....~'.' ~ .... ~¢~,,¢~,. ......... Rev, 10-10-78 lOOlCrn THE NEW YORK BOARD OF FlEE UNDERWRITERS :~$ BUREAU OF ELECTrICiTY ~- 85 JOHN STREET, NEW YORK; NE~ YORK 10038 THIS C~I~I~S THAT only the electrical eq~ipme.t ~ described below a~ introduced by the applicant gem6d o. the ?b~e applicetio, number it* the premises of was examined on ~g~ 1~ ~ ~ and found to be in cotnpliance with the requiremonts of thls Board, FIXTURE FIXTURES RANGES ! OVENS DISH WASHERS EXHAUST FANS 22 33 2~ 2:2 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS UNIT HEATERS MUtTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPARATUS: Uotors:l-l~ 1-G. FaC, I. S E NO, OF CC. COND A, W, glO 1-4.5 K.W. C G ~ $ Elect. P, O. Box 215 Southolcl, N.Y., 11971 This certificate must not be altered in any manner; return to the sq~mNG DEPARTME of the incorrect. may be identified ANY MANNER. 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUG#I ~ LBG.' ~ ' FOUNDATION 2ND [~uLATION FRAMING [~ FINAL REMARKS: DATE COMMENTS ~ ~ FIELD ~ "~ IN,oPEC~ ION 1. FOUNDATION (]st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY G,ODE FINAL ADDI. T?N~n COMMEN?~: FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL File No ................................ PLEASE TAKE NOTICE that your application dated ...~...4~ ........... 19 ~. County Tax Map No. 1000 Section ....~.~ .... Block ...~ f. ....... ~t . ~. ~ ..... Subdivision..~,~ ....... Filed Map No .... :..,' ......... Lot No ...... ,:-. .......... is returned herewith and disapproved on the following grounds. ~ ~ ~/~ ~.. ~ff~<.. BuildMg Inspector RV i/8o F,ORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ~.~.....~ ..... , 19 .~. ·~ Approved ................ , 19... Permit No.. tr?./. ....... .... / APPLICATION FOR BUILDING PERMIT Date,. ~t4 .... .~ .'~*. ..... Application No../..~/./..~..~. ........ INSTRUCTIONS a. Tkis 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 must 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 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 appt!,cant, or name, if a corporation) · lgol .o ..... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ·' Name of owner of premises .. ~.O~'~'.! .~.O.~[t'~..~.~..'~'~'~'~'~'~'~'~'~. ........................................ (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 .......................... Plumber's License No..,~..~..~.~.1~.. .............. Electrician's License No.~...~AI~.. ¢llr~l~ ........ Other Trade's License No...~./~ .............. Location of land on which,proposed work will be done...,g~.~.e~. ~...~.I~.1~... ,~.,~,t.,~[..~t~lO..dti. O~,o... fi '¢~q'~r'~7 .... '~' '~' '~' '~' f'Sir'e~'-~'~' . .~c.~.~.... .... ,~Ha~.m.l~./..~. ................... County Tax Map No. 1000 Section ...... ..~..O. ........ Block .. ~. .............. Lot.. ~. ~.t[..--J~...~.. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construcfion: a. Existing use and occupancy .... /~/~.~.~.. ............... ; .................................... b. Intended use and occupancy ...~;>~t'~'...¢~'. ~ii~1~. t.~,. ~. t,~ ~.~t~. 3. Nature of work (check which applicable): New Building ...,-~.... Repair .............. RemoTai .............. Demolition 4. Estimated Cost . .~.O/. ~ ......................... Fee Addition .......... Alteration .......... ............ Other Work ............... ~.~.~ (Description) ......................... (to be paid on filing this application) 5. If dwelling, number of dwelling finits ............... Number of dwelling units on each floor ................ If garage, number of cars ..... ! ................................................................... 6. If business, commerciai or mixe4 occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structure~ if any: Front ............... Rear .............. Depth ............... Height . .............. Number of Stones ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... !.. Height ............ ~, ........ Number of Stories ...................... · 8. Dimensions of entire ne~}v construction: Front .... ,.,~7.O. ...... Rear .... .~.~.." ...... Depth . .~..~.~.~.... Height ....~[...~. ~.... NuN!bet of Stories.. ~ ....................... .~ ........ ~ ........ 9. Size of lot: Front .... /.O.~,/.~. ........ Rear ....... ~..~,.~..~,, ...... Depth ~'.~.~. ..... ~.~,~. ...... 10. Date of Purchase ........... i .................. Name of Former Owner ............................. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed constrtiction violhte any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ........ ~.~ .... Will excess fill be removed from premises: Yes ~ No Name of Architect .:,~. ...... !. ~ .............. Address ...... ?.~.:~Phone No. PLOT DIAGRAM Locate clearly and distinctly alll buildings, whether existing or proposed, and, indicate ail set-back dimensions from prope~y lines. Give street and block humber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK,..,.~ S.S COUNTY OF .... ~,~'~d'~.'..~.~.i: ........ ~ ~.~.. ~ ¢..~..~.~[ ............ being duly sworn, deposes and says that he is the applicant (Name of individual sig~ing contract) above named. He is the .... ~..~.~. ~.~...~. ..... ~. ~:1;.~.~. ................................................ I (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 cont3ined 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 filed therewith. Sworn to before me this ........................ day or ........ ,~;~t~../.~., 19~.:~ Notary Public,. ....... ~ ..... ~' ~' '~' '~'~' '~'5' County ~ ~..~<~. HO, 52,~]25850, ~uffolk Cou_Enty, ?~,,r~ t.~ir,s March 30. SUFFOLK CO. HEALTH DEPT. APPROV^L SUFFOLK COUNTY DEPT. OF HEALTH ~FOLK Co. TAX MAP SUFFOLK CO. HEALTH DEPT. APPROVAL If copper tubing is used for water distributing system; piping shall be of types K or L only DESIGN OR CONSTRUCTION ERP. ORS. code compIiance slabs SLAB INSULATION Degree Days Min. By Zone R Value 5000 5.5 6000 5.5'/ 7000 5.5 8000 5.5 9000 5.5 The insulation must extend at least 24" under the slab or at least 24" below grade down the foundation wall, FOUIIDATI ON NALL The insulation is installed on the inside face of the foundation wall and provides a ~hermal break between slab and foundation, ~-alternate location OUTSIDE F0UNDATION WALL The insulation is installed on the outside face of the foundation wall and provides a continuous thermal barrier at the slab edge and foundation wall, All exposed exterior insulation above grade should be covered with a protective material. )rotec~ive 9 over insulation .] 32