HomeMy WebLinkAbout10178-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
THIB CERTIFIES that the building ................................................
Location of Property ~ ~.o[~20. filen. Road ........ ~i ........ .Sg~.t~l~,. ~,~, ....
H~mlet
County Tax Map No. 1000 Section ...075 ..... Block .... 02 ......... Lot ....... .0.1~.q. ......
Subdivision...'de~l.~ .Cl'e~ .,T,~.q~e8 ....... Filed Map No ......... Lot No .... ~...; .....
conforms substantially to the Application for Building Permit heretofore fded in this office dated
.... Apx':kl..'17 ....... , 19.7.9 pursuant to which Building Permit No ....... '~0']715~ ........
dated .... ~pg't.~...'18 .............. 19 7Q, 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 .........
................... Prt,~tage..0~e. F.a~ly..I~,IBg ............................
The certificate is issued to~'. ........ l~].iL~l~l~e.'~ .l~elll~. ................................
of the aforesaid building.
Suffglk County Department of Health Approval .... /).-~.O-. 'J ./4~.... ]~0.v.q~.e.~.. 'J. ~,. ?.~7~. ....
UN~, ERWRITERS CERTIFICATE NO ............ ~l..~~~.~../ ........ i ......
Building Inspector
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N,Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
instructions
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 buddings (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,
Fees:
I. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or land use
3. Copy of certificate of occupancy $1.00
$5.00
Date....~h .~. ~. · ............
New Building ............. Old or Pre-existing Building ............ Vacant Land .............
Location of Propertv ........................ ' ........... ~ ................
Ham/et
House No. Street
Owner or Owners of Property,...~. t.~ .'~ ~,~. ~., ~. ~.~-~ .... .~..P~-~'.~. · .~.~..~/'/~'~'.~ ''~
County Tax ~ap No, 1000 Section ............... B~ock ............... kot ................
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No.~.~./.?..~..~: Date of Permit..~///../.~'/>.~pplicant..~../~..~.~..~¢,.~/'~ ~;)~ ..... ~. ~'.~.f..~ .~.~ .... ,
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $ .............................
on re~on,s.
Construction above described building and per~all~v~cab~d
Applicant ...... .~.. ~,.~.. .~____~:.~. ~
Rev. 10-10-78 ~ ' ~.~
THE NEW YORK BOARD OF FIRE UNDERWRITERS
glR BUREAU OF ELECTRICITY
r~ 85 JOHN STREET, NEW, YORK, NEW YORK 10038
,.re Deeembez. 3. 1979 035~61
THIS CE~IFIES THAT
in the following location; ~ Bazer,~t ~ lzt FI. [] 2nd Fl. ~tion Bl~k
1~79
w~ exam~a on ' and found to be in compliance ~ith the requirements of this B~rd.
FIXTURE LEC~TA,-LE.I = ' I FIXTURES RANGES COO~ING DECKS
DRYERS I FURNACE MOTORS I FUTURE AFPUANCE FEEDERS PEaAL REC PT TIME CLOCKS I BELL UNIT HEATERS
3 ~r 1 30 t !
/
SERVIC~ DI$CONN~C? l NO. O~ S E R V I C
~ ,M'. --A,~p. ~(PE ~pR. I ~ 2w ] ,~ 3w 3 ~' 3w 3 ~* 4W ~0. C~C~.¢OND. OF *~CW~jO NO. OF HI-LEO
50 C~ x 1 1/~ '
OVENS ImSH WASHERS
OT~r~. 1-Fr' hp
!-Smoke De~;eo~or
MULTI-OUTleT
SYSTEMS
NO. 05 FEET
Lot
EXHAUST FANS
DIM/ViERS
Goodale E]eetmtoal Contr., Ina.
~attituok, N.Y. 119~7 Lte.?83E ~N.~
p,, v
TMs ced~fic~e mu~ flo~ ~ ol~ere~ in ony monner~ m~orfl ~o ~e o~ce o} ~e ~o~8 iF incorrect Insp~o~s moy ~e ~enfifie~ ~Oh~ls, ~1
~vr~ rv~ uv,~v.~ u~r~K/~lo I~ ~UPT ~F CBKTIFI~TK MUST NOT M ALTKRID IN A~ ~NK~
"~OL.~ ~ H FP~AI¥~-
.5
"7
AD DlTIc.~k.//-\b O
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
TOWN HALL
SOUTHOLD, N. Y. 11971
TEL. 765-1802
November 13, 1979
First American Title Insurance
Company of New York
210 Court Street
Riverhead, New York 11901
Att: MaryE. Miles Re:
Building Permit #10178Z
320 Glen Road
Southold~ N.~.
Miss Miles:
Upon completion of construction and compliance to the
Southold Town Building Code, a Certificate of Occupancy
will be issued for the above premises.
At such time, we stall forward
request. /
Very t~uly yourS,
EDWARD F. HINDERMANN
Building & Housing Inspector
same to you as per your
enol.
EFH/mw
Fi~ s t Amerwan Title Insu~ ance Co mpany
of New
£ 3 0 Court Street, R~ver]l ead, New ~Z ork 11901
November 5,1979
Town of Southold Building Department
Main Road
Southold, N.Y. 11971
RE: Title No. 101-S-8401
PREMISES: 320 Glen Road
Southold
OWNERS: Winds Way Building
Corp.
TAX MAP# 01000-78-2-21
GENTLEMEN:
Please furnish us with a copy of the Certificate of
Occupancy covering the above premises.
Enclosed please find our check in the amount of $ 1.00,
a copy of the survey and a self-addressed stamped envelope
for your convenience.
Very truly yours,
FIRST AMERICAN TITLE
COMPANY OF NEW YORK
INSURANCE~
ENCLS:
Survey Department
Member of New York Board of T~Be Underwriters-New York State Land Title Association
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1802
Examined...~..~..(.e...., 197.~5~
Approved...~...'T...( .~.. .... 19 .~... Permit No..~. ~.
Disapproved a/c ......................
APPLICATION FOR BUILDING PERMIT
Date ......... ¢/,/. ~..
INSTRUCTIONS
a. This appliqation 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 lot and of buildings on premises, relationship to adjoining premises or pubhc 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 apphcat~on 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 ~n 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 Bmlding 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 buildings for necessary inspections.
.... ............
(Signature o~ applicant, or flame, if a corporation)
(Mailing address of applicant)
State whether applicant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, ptmnber or builder.
Name of owner of premises .... 'i ~ ~ .~. ~. ........ ~ ..................................................
(gs on the tax roll or latest deed)
If applicajl~s a corporation~ si~)aturfi(of duly authojie~fficer.
(Name and title of corporate officer)
Builder's License No ..........................
Plumber's License No..~...~..~.~.q. '~'0' ~ '~
Electrician's License No. ~/.~7~Jri~.~. ~ .4~...~-~...~..
Other Trade s L~cense No. ~ .~-~:~W... .............. ~x
1. Location~oposed work will be done.~.~/-~'. ~./~.~r.../~...... ?..~. ~.../..~?.( ..~...~ .~ .)~.~'~ .......
............. *' · ........................
~Numb0te Street
County Tax Map No. t000 Section .. ?. 7..ff. .......... Block .. ,O..~. .......... Lot.. ~.~./.~2~ .........
. ..........
SubdivisionZ~j~/~ .............. .3.fi'..~fi.~..... 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 ....... ~..~C~t~../.~.. :4.G. ~ .........................................
b. Intended use and occupancy . . . .~..~.~..-...~.~.. ~.~... · .~...~f-4..~.~- ?. ('./.4~...~ ..............................
3. N re of work (check which a plicable): New Building .......... Addition .......... Alteration ..........
Repair .............. Rembvai .............. Demolition., ,~ ........... Other Work ...............
' ~,~ (Description)
4. Estimated Cost ...... ~..O~ .~..~.. :. :~ .................. Fee../.~. ................................
(to be paid on filing this application)
5. If dwelling, number of dwellingi'units...~. ~..Zvr~. ...... Number of dwelling units on each floor ................
If garage, number of cars .... 7 ./~4. ~. ..............................................................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .....................
7. l)~nens~ons of ex~stmg 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. D~menslons of ent,]:e new construction: Front . .7.0 .......... Rear .. ~ O .......... Depth ~. ,,.. ~. ........
Height ..... [~ ....... Nuraber of Stories .... .O./'~./,~T/ .............................. ~ .......~ .........
9. Sizeoflot: Front .... /..P~..('. ........... Rear ..... /..~. r.'.'~..~ ........ Depth ~,.~.../..~.,..~..f~. ..........
10. ])ate 0fPurchase ...~. ~-~. i .................. Name of Former Owner .~..~; ~z~.z~t~.£ ...............
11. Zone or use district in which pr~mises are situated .... /(,/.~ .............................................
12. Does proposed construction violate any zoning law, ordinance or regulation: .............................
' y
13. Will lot be regraded ..... ~i/.~r~ ........ ~ ....... Will excess fi_Il be remove0 from premises: _ , es N~
14. Name of Owner of premises/~]2~,p~. ~.~,,¢,~.~.. Address ~.~14,~.~..~.~ ."?.~.... Phone No.~..ff..-'.ffO'~ .~....
Name of Architect .. t', ..... ' ............... ../... Address ..... . .......... . .... Phone No .... ;~ ..... ~..
Name of Contractor ~./~/~.~ F~ ~ ~.~:)~. ~. Address ./¢. ~,'~,~-w ~-~ ~'~hone $o'.~.~ ~.< .~.~.~,,~ .....
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.Y-ORK _ i,. ,.
COUNTY OF ~. 2[. .... i ' "
......... ~.Z>.,~,~.~. ........ ~ .~..n f. ~././ ........ being duly sworn, deposes and says that he is the applicant
(Name of individual sig~ing contract)
above named.
He is the r.
i (Contractor, agent, corporate officer, etc.)
of said owner or owners, and is dqly authorized to perform 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 manner set forth in the application filed therewith.
Sworn to before me this
"TAR~f/?UBLIO, State of ~[oL~w
Term [xpires March 30, 19~*~
'i
Sviiolk County Department of Health Services
£or Approval of Construction Only
Date: HS Ref. No.
Approved:
l~e ~at~r supply end sewase disposal syst~ns
for this residence ~rlll conform to the stand-
ards of the Suffolk County Dept. of Health
se~lcee.
Applicant:
Hr. Robert W~ndell
Winds Way Building Corp.
Glenn Road
Southold, N.Y. 11971.
,,.~'~
?
Wende 11'
Way Buil~ding Corp.
LOT
.H
.
Ths so,aBe disposal and water, ~up~3,y
facilities for this location h~
inspected ~,hy this d~p~tment and found
Chief of Ceneral ~ngLne~vju~
· FRON
APPROVED AS NOTED
NOTIFY BUILDING DEPARTMENT AT
765-2660 9AM fo 4PM FOR REQUIR.
ED INSPECTIONS:
1, BEFORE EACKFILLING FOUNDA-
TION OR START FR/LMING
2. FRAMING INSPECT/OH
3. BEFORE COVERING P[P;S OF ANY KIND
4. FINAL WHEN JOi~ COMPLETED
NOT RESPONSIDLE FOR DESIGN
OR CONSTRUCTION ERRORS
5. ALL CONSTRUCTION MUST MEET
REQUIREMENTS OF N.Y. 5TATE CODE
AND TOWN HOUSING CODE & ZONING
!'
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