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Home My WebLink About10363-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. ZI5824 Date June 9, 1987 THIS CERTIFIES that the building Addition and Alteration Location of Pr ..... *- 2295 WELLS AVENUE SOUTHOLD House No. Street County Tax Map No. 1000 Section . .7.0 ......... Block .... .4 .......... Lot 2 0 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... 6/2.q / 79 ......... porsuant to which Building Permit No..1.0.3.6. 3. .z .............. dated .8./.2. 0../7.9 ..................... 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 ......... Construct deck addition & complete basement of existing dwelling. The certificate is issued to RICHARD NASS ..................... id. do;, ...................... of the aforesaid building. Suffolk County Department of Health Approval ......... N./.A. ............................. UNDERWRITERS CERTIFICATE NO. N 5 1 6 3 8 7 PLUMBERS CERTIFICATION DATED: N/A Building Inspector Rev. 1/81 FOI~I NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PER/vliT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10363 Z Permission is hereby granted to: ~.~.~.~.....~././.~..~ .................. ..... ~.~.~.~.....~.~ ........................ Building.~ lnspector,~ Fee $..../'....~......~..Z ..... ....... ~.~/..~./...~.: ........... ~.. B'uil~fng Inspector ,! TOWN OF SOUTHOLD Building Department Southold, N.Y. 11971 765 - [802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted -,~ 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 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 p~operty 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 New Dwe~Li[ing $25.00, Accessory ,$10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50,00 3. Copy of certificate of occupancy $ 5.00, ove~ 5 yea~s $]0.00 o.oo 5.U,oc~at. ed C.O. $ 50.00 Date .............. NewCoz~s tz*uc t, ion ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property .... .~..-~;Z~L.~ .(~,.~.~.., ......... .~.(~..(~ .~.~.~. (~..~ ................... House No. Street Ham/et Owner or Owners of Property ...~.~. ~)._t~(~.[~..~....~.(~ ~. .................................. County Tax Map No. 1000 Section ..... .7..~. ..... Block ............... Lot ........... Subdiwsion ................................. Filed Map No ........... Lot No .............. ',~..~..~ Date of Permit Applicant Permit No. 1.0 ............................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Rev. 10-10-78 Construction on above described buildir~and perm, it meets at+applicable codes and regulat OhS Applica . . .--... ...................... THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ BUREAU OF ELECTRIG[T'~ ~' 85 JOHN STREET, NEW YORK, NEW '~ORK 10038 in the followlt~g locatlon; ~ Basement ~ 1st FI ~ 2nd FI. > Sectlott Block Lot was exan~itted on ~)~'~.], ~ ~ ~[9~1 and found to be ~n con*oliahce witk the r~qulret~e.ts of th~s Board. FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS FIXTURE OUTLETS SWITCHES INCANDESCENT FLUORESCENT DRYERS UNIT HEATERS MULTI-OUTLET SYSTEMS NO OF FEET OTHER APPARATUS. S E R 'V I C t AWG AWG NO OF.:EUTRALS OF NEUTRAL · 11 This cert,f[cate must not be altered in any~manner; return to the office o~ ?l~e Board If ince~'recf Inspectors may.be ident,fied by ~1~ BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL TOWN OF $OUTHOLD OF'FlOE: DF BUILDING INSPEOTOR TOWN OLERK'~ OFFIOE BOUTHI3LD, N. Y. 11971 / A~D AS NOTED ~ FE~---',~ ~ BY ~/ ~5-1802 9 AM TO 4 PM EOR THE FOLI~/ING INSP~C'[ iONS' . ]:'FOUNDA:ION - TWO REQUIRED / .FOR i~)u ~L CONCRETE // ~ RoUG-'- FRAMING & pLUMBiNG 4~'FINAL - C~vmuc'~ON MUST ALI CONS~RUCT'bN ~mAN_ ~EE¢ ' ' STA~:E~iE~gT[~UCT~ON & ~ENERGY '"/~ CO~S~'NOT RESPONS~BEE FOR FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 -.., TEL.: 765-1803 Disapproved a/c .... -; ~--:~~ .................. APPLICATION FOR BUILDING PERM IT ~ Date .......... ~./.o~.d_) 19 .~..~ INSTRUCTIONS a. This application must be completely filled ~n by typewriter or in ink and submitted in triplicate 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 issue 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 codg~housing code, and r~gutafions, and to admit authorized inspectors on premises and in buildings for necessary inspe~. ~//~j (~Sig~nature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. · .................................................................................. Name of owner of premises ~ ~' ~'/~ J- ./d.~. ~ ~'~'~ ......................... (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 ........................ ? Electrician's License No. : .................... Other Trade's License No ..................... 1. Location of land on which proposed work will be done ............ , ...................................... · ............. f. ........................ ................... House Number Street Hamlet County Tax Map No. 1000 Section ....... .'.ff~. ...... Block ........ ~.. ....... Lot.....?~-..~. ........... Subdiwsion ...... . ./~..~. · .~C.~..'~. .................... 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 .. ~.~.).~.~.~Y'.~.ag. 4~.~.~r~.~:~..~. .............................................. b. Intended use and occupancy . ~ .~.~'.~../.~/~.... [VT. ,-~.~..~'f'..~.~...~..,~..~C~.....~..~.....~..-~Y~..-~/~Y..~Y. ~.~ ......... 3. Nature of work (check which applicable)~. New Building .......... Addition .~.e.~'~ .~.. Alteration ,g:~,~,~..~',~.q'~ Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) (to be paid on filing this application) 5. If dwelling, number of dwelling ttnits ..... ~ ........ Number of dwelling units on each floor ................ If garage, number of cars ......................... , .............................................. 6. If business, commercial or mixed! occupancy, spec~ffy n~ure and extent of each type of use ...................... 7. Dimensions of existing structures, if any: Front .D: .a'.~ ?.~..,~...<..~.. Rear .............. Depth ............... Height ............... Number of Stories.: ............ ' ............................. 2- ............ Depth .................... ~. Height ...................... Number of Stories ...................... ' ' pth 8. Dimensions of entire new construction: Front ................ Rear ............... De ............... Height ................ Number of Stories .......................................... ~ .............. 11. Zone or use district in which premises are situated..~. ................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: . fid-d/ ............... 13. Will lot be regraded ..... . .J~..~: ................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ....'. ................ Address ................... Phone No ................ Name of Architect .......... ' ................. Address ................... Phone No ................ Name of Contractor ~ Address Phone No PLOT DIAGRAM Locate clearly and distinctly all .buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. : STATE OF NEW YORK, 'S.S COUNTY OF..SlJFgOIiC ........ . LEWIS L. I~DSO~ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. Heis the ......... , .. ~ (Contractor, agent, corporate officer, etc.) of said owner or owne~, and is duly authorized to perform or l~ave 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 J .day o¢.. g.ugust Notary Public, ~~.~£...~.~.~°)~XCoun y ~ _~T__2 ~, I~*~1~, ~a~__ ...-~ (Signature of applicant)