Loading...
HomeMy WebLinkAbout10247-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building ................................................ House No. Street Ham/et County Tax Map No. 1000 Section ...1.3.7. ...... Block ....0.k[ ......... Lot ..... 0.0..~ ......... Subdivision ................... ..... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... .d...ur3. 9..[k. ........ ,19.7.9. pursuant to which Building Permit No..~.O.2.~J.Z .............. dated ........ ~.u.r)9..[[ ............. 19.7.c). , 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 ......... ~4atilda Buz'~,ow s The certificate is issued to ..................... [o~n'~'r, ~~ ...................... of the aforesaid building. Suffolk County Department of Health Approval ........... iq./.~ ............................ UNDERWRITERS CERTIFICATE NO .......... 1~ ./t-9~.~iO~ .............................. Rev 4/79 Building Inspector FORM NO, 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHO~.D, hi,. Y. BUJLDIHG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10247 Z Permission is hereby granted to: // ~ ", ,',/ ,,,, /l -- /"~ . .: ::.~/ ~ ,~,,~'~,~. . /. :/.~ / ~.~.' ,.~ . . . . ~,~. ',u ~ . . . ~. ~,~ t~ . ~...~6~-.~.~.....~-~..,~.'.~:. ........... to, .~.~.~:',t'~,..~ ...... ~>,,~.~.,/~.~/,~ ......... ~/.~.x~ . .?....~...~,/.~ ................ ....... e~ ~¢~,~. --. . .~. .,~ .~:. ...... ~ ~'~.e..,~.~. ............................ ~ ................................................................ ot pr,re,scs ,o,oted ot.:~.',.~:.,.~X~-~:~.~...~,:~.~~..~-.:. ......................... .......................... ~....~..xd:...~.Z..:~~...~..~ .................................................. ...................................................................................................... .~.2.~.~,¢~..~..¢ ...... pursuant to opplic~tion d~tod .......... ~2.~ ...... .~ .................... , lg~.g., ond opprovod by the Building Inspector. Fee S./Z~.T..'~ ....... FORM NO. 6 TOWN OF $OUTHOLD Building Departmant Town Hell 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 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 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 $5.00 2, Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date ......................... New Building ~.O..[~).[ .~. t.? ?.. Old or Pre-existing Building ............ Vacant Land ............. Location of Property :'~.'/.~.'-~.-~ . ..~.'.~.t.L.~..~ House No, Street Hamlet Owner or Owners of Property ,..~,~. ,, ,-i~ ,t,~,, .C~,~©.~, ¥~, , .................................. County Tax Map No. 1000 Section ......................... Lot ................ Subdivision ................................~ ~ Filed Map No ........... Lot No ..... ~, ....... Permit No. i(~-~-'~.'?~. Date of Permit ~./.~,/~...Applicant..~JL~c'~,~,~ IJ..LIJ:P~. · · ~.Qt~L[;..~.P~. ·t~, Health Dept, Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ...... .~.~..~.0.~. ......... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $...~?),0., .~. ....... .~,.~-~,....1~ . .~.71 7 Construction on above described building and ~ a~a~~s and regulations. Applicant.. .. .... .,.. ANDREW MULLER CONTRACTING CORP. ROUTE 25A · MILLER PLACE, LI., NEW YORK 11764 e PHONE 5!6-744-2177 p~t~ Memorandum from.... BUILDING INSPECTOR'S OFFICE TOWN OP SOUTHOLD TOWN H^LL, SOU?HOLY, N. Y. 11971 765-1802 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN HALL SOUTHOLD, N. Y. 11971 TEL. 765-1802 August 7, 1980 Andrew Muller Cont. CoFp. Route 25A Miller Place, New York Dear Sir: : This is to advise you that the job under Building Permit No. I0247Z issued to M. Burrow~ on June 4. 1979 for addition appears to be completed as of our last inspection. Be£ore you can legally use or occupy this structure a Certi£icate o£ Occupancy must be issued. Please 2ill out the enclosed £orm and return same to the above o££ice. There is a fee o£ $5.00 £or a Certi£icate o£ Occupancy ~' Thank you £or your prompt attention. Very truly yours, GEORGE H. FISHER Sr. Building Inspector enol. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITy ~ -85 JOHN STREET, NEW YORK, NE~/Y'0RK 10038 T.,s CE.T,..ES T.AT ~10~7z N 4 9 3 3 0 3 only the electrical equipment as described below attd introduced by the applican~ t~arned on the abo~e application ttutnber in tko premises of 1~J.11i~,~ B~ows,15 Stlll~a~er Ave. ,CuCchogue,N.Y. in tke followlng location; [] Basement [~. 1st FI. w.sex.,~i~edo. ~ptemt~r 11, 1980 FIXTURE FIXTURES OUTLETS SWITCHES FLUO~ESCEN¥ o 7 [] 2nd FI. Section Block Lot and found to be in cotnpliance with the requiretnents of this Board. RANGES DISH WASHERS EXHAUST FAN! DRYERS OTHER APPARATUS: E R V I C E OF CC COND A. W G, NO OF NEUTRALS A W.O. NO. OF HI-LEG OF HI-LEO OF NEUTRAL Per__ may be identified b credentials. ANY MANNER. ANDREW MULLER CONTRA~TING CORP. ROUTE 2SA·MILLER PLACE, LI. NEW YORK 11764®PHONE §16-744.2177 TO t! August 7, 1980 Andrew Muller Cont. Co~0. R~Uto~PSA : . _ Miller Place, New York Dear 8ir: : This is to advise you that the ~ob Under Building Permit No. 10247Z issued to M. BurrowSi on __d~4- lqTq ' for addition ~. ~: ~ppears to be complete~ as of Our last inspection. 'Before you can legally use or occupy this structure a Certificate of 06cupancy must be issued. Please fill'out the enclosed form and return ssme to the above office. There is a fee of $5.00 for a Certificate of Occupancy Thank you for your prompt attention~ Very truly yours, GEORGE ~. FISHER St, Building InSpector encl. FOI~M NO. 1 TOWN OF SOUTHOLD BUILD!NG DEPARTMENt' TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ........ (J~'uil~ing Inspector) Application No..~.(~.~....~.....~... ......... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and s, ubmitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Pict 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 diagram which is part of this application. 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 code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) .... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................... . Name of owner of premises ..... .~,,?,.~...,~.../.,,/~,,~,../~,. ...... ,,~.,.~,,.~,.,.~,,~,,,~,.o~,,.,._~.. ..................................................... i ................. If applicant ia a corporate~ signature of duly authorized officer. Name and title of corporate officer) ~'~::'(-~ Builder's License No.....~.~,.~.(c.-_________/~......~..'.~...~......~...~........"~. /~'~/.~' i~.~'~('. Plumber's License No ..................... .~....~...,¢~..,¢~... .................. / Electrician's License No ........... ~T....A-....~_ ~ ............. Other Trade's License No....~ ............ ;.=_.......,~. .................... 1. Locat on of and on wh ch prgposed work w be done MaD No ~ Iht Nn Streetand Number ~1~: (~..~..~..~. /~.~ ~..~.. ~.~....~'..//'/'~/¢~:~ ~JT.~-'-- C~ ..~E.~/~ ' ~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........ .J.....~../~t.~..i,..~./.......~..l..~z;;g~..C...~;,..'~.....~. ..................................~ -.-----'/' ................. b. intended use and occupancy ......J[.....~--~...¢~....)...L ..~._......i~.....~...~.,L.~.~..~.t.~,.~...~...~..,z~....~.~,~ 3. Nature of'work (check which applicable): New Building ....................... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) t t t ..~.....~ ,. E simaedCos ....... .................... .......... : (to be paid on filing this application) 5, If dwelling, number of dwelling units ...... /. ........ Number of dwelling units on each floor ......................................... If garage, number of cars /'~ ~ ~ 6. If business, commercial or mixed occuDancv, specify nature and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front ........ ..~....(~. ...... Rear .......... ?....~.. ......... Depth ......~...~w..;..~ ............ Height ............... .~.~.. ..................................... Number of Stories ...... ~......./.....~../..'.~.~...~..~._.,~ ~ ....................................... [)imensions of same structure with alterations or additions: Front ......... ~.'...~.....~... Rear .......... .~......-~...:..[. ................. · ..!~epth ~..~...;..~.. ............................ Height ........ .~...~... .................... ..... Number of Stories ...~..~;~....~...~... .......... '1~.'"'~ "Di'~hensions of entire new construction: Front ......................... Rear ............................ Depth ................................. Height .................................................. Number of Stories ! 9. Size of lot: Front ...................................... Rear .......................................... Depth .................................................. 10, Date of Purchase ..................................... Name of Former Owner ............................................................................ 11, Zone or use district in which premises are situated ............. -----.(,..~J.,~"/ .................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................................................ 13. Will lot be regraded ..... ~..~ ................... Will excess fill be removed from premises: [ ] Yes 14. Name of Owner of premises ....................................................................................................................................... (Address) (Phone No.) Name of Arch tect .. . (Address) (Phone No.) Name of Contractor ................................................................................................................................................... (Address) (Phone No.} PLOT DIAGRAM Locate clearlv 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 wheth- er interior or corner lot. STATE OF NEW YORK, COUNTY OF ....~..~.~.~w,../l~ ................. .............................. z-l,.~...'..."~..~.,.'r.~'~t.-l.~.,~r,..~..'...~..~ ................ being duly sworn, deposes and says that he is the applicant above named. (Name of indivi~al signing bdntract) ' He is the .................................... ~. ,..~....~~ ........................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all o-. -~l..s"t~a+t~e~m~*e~nts containein the a.~o'd~i~Hca thiStionu~"a'pplicati°n~'~the~w,th, ttrue to the best of his knowledge and beliefl and that the work will be performed in the manner ............ ..... ............................. No. fi2-7597250; Suffolk County (Signature of applicant) A APPROVED A,S~N OT ED ------.--~TIF¥ BUILDING DEPARTmeNT AT 765-2660 9AM to 4PM FOR REQUIR. ED INSPECTIONS: I, BEFORE BACKFILLING FOUNDA- TION OR START FRAMING 2. FRAMING INSPECTION 3, BEFORE4COVERING PIPZS OF ANY KINr 4, FINAL ~,W~EN JOil COMPLETBD NOT R~ONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS '~L~ck 5. ~IL CONSTRUCTION MUST MEET v~4oaw I~CIUIRBMENT$ OF N.Y. STATE CODE AND TOWN HOUSING CODE & ZONING E¥ f J ; FOUHbATIOH iI -- [