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HomeMy WebLinkAbout10428-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy Z10052 Date ..... ffl,O_~' 29 1980 THIS CERTIFIES that the building ............................................... 580 Island View Lane Ox, eenpo~,t, N.Y. Location of Property hJ[,s'o ~io: ...................... 'x~ebi ....... ~ ............... h3~/'el 57 2 County Tax Map No. 1000 Section ........... Block ............... Lot ................. Subdivision Peoonio Bay Estates 1 12J~A . _ 639 .............................. Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated 0ctobex' ~1- 197...9. pursuant to which Building Permit No. 10l~20g dated Ootobel' ~ 1979 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate ~s issued is ......... Addition to existing One Pamily Dwelling Edith Ooelz The certificate is issued to .................... ~d~'r[e'r,~ ..................... of the aforesaid building. Suffolk County Department of Health Approval .......................................... 1t 11.8o611.9 UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev 4/79 TOWN OF SOUTHOLD BUILDING DEPARTk~E~qT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 10428 Z Date Permission is hereby granted to: ...~...,..~...~.~.?z.Z~.~ ...... ..~~~/~ ~,. ~ - ~o ....~~....~~~....~~....~.~~ ...... ~~.:~~ ~ ~...~~ ................................ ~ ........ ~ ................... ~. .......... :....~. ~...~..~.r~....~..~.~.~.~.:. .................. ,~....r~.~ ............. pursuant to application dated ..~ ........... ~. ............................ , 19.L~., and pproved y t e Building Inspector. FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall $outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions Bo 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 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 Aprd 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusum 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 requ ired to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 New Budding ............. Old or Pre-existing Building Location of Property ..~ House No. Street Hamlet Owner or Owners of Property .~ ./~r.C.-/~,.. ~.: .~. ~./~ .~ .... ~. ~.~.~.~". ................. County Tax Map No. 1000 Section .~.~. .. Block .,~., Lot ~ Subdivision ~c:(n.~'(~;. ~.. ~'~ .F.led Map No. [.~ ~_~ .~. ~ot No...~. ~.~ .... Permit No./~ ~/~.~.~. Date of Permit~;].~;/.¥.~Applicant . .~..~ ~ ~. ~/.~. · · Health Dept. Approval ........................ Labor Dept. Approval ........................ Unde~riters Approval..Y.~ ~. ~.~ ~ ........ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ..... ~ ............. Fee Submitted $.. ~' ...................... Construction on above described building and permit meets all applicable codes and regulations. Applicant . . "~. ~ ' ~- . ................ THE NEW YORK BOARD OF FIRE UNDERWRITERS ~)' BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 only theelectr~caleqalpme~asdescribedbelo~a~di~t~d~cedby tl~appllcat~t~dontheab~eaD~llcatio~n~mberi~the re in the followlng location; [] Basement [~ lst FI. wosexa.,in~do, t:4ay gg, ],980 FIXTURE OUTLETS 2 RECEPTACLE~ 2 ~ ~.d ri. Se¢~io~057 Bio& 2 and found to be in complla~ce with the r~quirements of this Board. Lot '2 SWITCHES FIXTURES RANGES EXHAUST FANS FLUORESCENT DRYERS FURNACE MULTI-OUTLET SYSTEMS NO OF FEET OTHER APPARATUS EI~c. R~om E R NO OF CC COND PER ,~ AWG OF CC COND ~ t c HI4EG NO OF NEUTRALS AWG OF NEUTRAL Gree~kuorg, N.Y. 11944 Th~s certificate must not be altered in manner, return to the office COPY THIS OF Board ,f~ ANY MANNER. , Al) D ITIo~JA L l · :NOTIFY B U t L[:)-i-NG ,765-]802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: ]. FOUNDATION _ TWO REQUIRED FOR POURED CONCRETE '2. ROUGH'- FRAMING & PLUMBING 8. INSULA,Z/ON '~, FINAL ; CONSTRucTION MUST 13E COMPLETE FOR C O, ~LL CONSTRUCTION SHALL MEET HE , REqu~,u:~,~TS OF THE N. STATE CO~S'mUCT~ON CODES. NOT R~SPONS~,L~ ~S~GN O~ ~ONS-mUCT~oN E~r~O,S. 71 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 ..... , ....... Z APPLICATION FOR BUILDING PERMIT ...... INSTRUCTIONS a. This application must be completely filled in 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 tot and of buildings on premises, relationship to adjoining premises or public streets or areas, and gtving 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 apphcation, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for mspection 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 Builfl~ng 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 regulatmns, and to admit authorized inspectors on premises and in buildings for necessary inspections. .. .c~. ........... ;..,;;.; ...... (Signature of applicant, ~r.~)name, if a co p at'on) :¢~'~ ~.~..<~. Z3~.~. o.,¥.,>..7.' ~ .~../.,.": ....... (Mai~ling address o~ gpp~icant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............... © m/.v. ,~.~.~ .................................................................. Nme of owner of premises ....................................................................... (as on the tax roll or latest deed) If applicant is a corporation, s~gnature of duly authorized ofhcer. (Name and title of corporate officer) Builder's License No....~../..~.? ............. Plumber's License No ........................ Electrician's License No..~.'.e'r~..OZS. ?..~. ......... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. ~..~...~... ~7~..~/.~¢..'~.~,¢..l:~:~..~. ..... ..~..q~,~.~ ................................. House Number Street Hamlet County Tax Map No. 1000 Secfion~. ..... ~..~... '.. Block .... ~ .......... Lot .... ~ ............ (Name) State existing use and occupancy of premises and intended use and occupancy of propose~construction' a. Existing use and occupancy . .['~l~.O.t. P ~d~ ............. ~...~ ..................... b. Intended use and occupancy ... !~r&~. ~.eae r~(rtm..~ ..... x~ ........ 3. Nature of wok (check whmh applicable): New Buil~ding .......... Addition .... ' ....Alteration .......... Repair " Remoyai , Demolition :. Other Work ........ i (Description) 4 Estimated Cost ~.~.~..~...(~D.: ~ Fee i (to be paid on filing this application) ' ' ni 5. Ii' dwelling, number of dwelling Cnits .............. Number of dwelling u ts on each floor ....... . ......... If garage number of cars 6. It' business, commercial or mixed occupancy, spec/fy nature and extent of each type of use ..................... 7. Dimension~?~f~xisting structures, if any: Front ..... ~'/5 ...... Rear .............. Depth ............... Height *. Number of Stories ................... Dimensions of same structure wffh alterations or additions: Front ................. Rear .................. Depth. ..................... Hmght ...................... Number of Stories ...................... 8. Dimensions of entire new constr~ction: Front ............... Rear ............... Depth ............. Height ............... Number of Stories ........................................................ 9. Size of lot: Front · ?~* ~ .. ~ ~" 10. Date of Purchase .............................. Name of Former Owner ............................. 11. Zone or use ~district in wMch premises are s~tuated....~ .... ~: ............................................ 12. Does proposed construction v~olate any zoning 1./tw, or&nance br regulatton: .. l~,;~ ........................... 13. Will lot be regraded ... j)[o~.,i., kj...~,....' ....... Will ex??ss fiJ~t?~,re~[v,~d, from premises: ~ Yes No Name Contractor~.:J.2~.O. ~ ~.'~.q */¥ ~..~ it.,{.. Addressd~t~/.~{o.~t¢~a?e Phone No. PLOT DIAGRAM Locate clearly and distinctly allI buildings, whether existing or proposed, and, indiCate ail 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~J~R~,~ . m~.aS COUNTY 0 ' · .............. being duly,sworn, deposes and says that he is the applic~t above named. He is thl ............................ /. ...... , ............................... (Contractor, agent, corporate officer, ~tc.) of said owner ot owners, ~d is duly authorized to perform or hgge perfomed the said work and to m~e and file this application; that ail statements contgined ~ this application are true to the best of his knowledge and belief; and that the work will be perfomed in the m~ndr set forth ~ the application filed ~erewith. Sworn to before me this .................. day of.. 19 NotarvPubhc' ................ ~ ._.~ . ~ .--.~ 5~ u?5[~ .. / ' (Si~ture of applicant) NO, 52,8125850, Suffolk C0~