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HomeMy WebLinkAbout10309-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No. Z965q Date Au~lst 2l~ .7.9. ................................. 19 THIS CERTIFIES that the building ................................................ 92;~5 Mstn Road East M~rlon Location of Property h~ Wo~ ....................... ~t' ....................... ~/~ County Tax Map No. 1000 Section 03'1 . .Block 03 .. .Lot. ~ .0.'19 . . Subdivision ............................... Filed Map No ......... LOt No .............. conforms substantially to the Application for Building Permit heretofore ~ed in this office dated .... .J.u.l.y...9 ........... 19.7.9. pursuant to which Building Permit No ...... q..0.~.0..9 .......... dated .... .O'.u.~.. 'l..2 ................ 197..9., was issued, and confonns to all of the requirements of the applicable provisions of the hw. The occupancy for which fids certificate is issued is ......... One Storm addition to East Marion Fire D.ep..artment House East Marion Fl.r.e .Dip..t?$.c~ The certificate is ~sued to .................................................... of the aforesaid building. Suffolk County Depa~hiient of Health Approval .. ' ........ UNDERWRITERS CERTIFICATE NO .................. Pencil. rig ................................ Building Inspector R~ FOE~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTM~:NT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PT~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 10309 Z Permission is hereby granted to_~.~ ....... ,~.~e®-..Z...k/. ~ ~. ~....~... ............. ,o .~6~.~ ~. ~...~ z...~/z~.....~zz~ ~.~ ~ ~...~.... ~~ ........ - ...... ~. ................................ .; .............. : ......... . ......... ~ .................. z. ......................... ~. ............ at premises located at ~.~....~....~/~.~..~...Z~.~/~.-~.~ Buildingglnspect°r'~'~O ' ~.~. Fee ,.~.~....~... ~ . 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 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 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: 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 /.'~2;.'~j~'.=,,,,. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ... House No, Street Hamlet Owner or Owners of Property ../.~.'../J ;/,,~;~.~ ¢,. .... fl,./,:(.,.. F, 5. l ........................... County Tax Map No. 1000 Section .../~.~'~'...-: .~.:?/Block?.~ ..... ?./. ?... Lot ................ Subdivision ................................. Map No ............... Lot No ............... ? . Permit No./.~'. ~.r~. ~2. ?. Date of Permit ..j~.,/?~, .~/...Applicant . ./~,.~:~.j~,,../..,~.... ~ ~.',,)~, ,, ,. ~ ,~. ~-/ ...... Health Dept. Approval . .~.. .................... Labor Dept. Approval ~ ...................... Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate .~. .................... Fee Submitted $.. , _~.~..~.c~ ................... able codes end regulations. Construction on above described Duilding and perfi~i eets all ep~/~c Applicant.. /%~, ~... .,,,.,:,_..~.~, ...................... Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRIOiTY,i . ~.~ 85 JOHN STREET NEW yORK, NEW Y~RK 10038 r,a~;;'.~Y .~, ~.~ ~,,~.,,.,,,~o.~,,~,,~ ~41~ N644703 THIS CE~IFIE5 THAT only the electrical equipment as described below and introduced ~y the ~p~licant ~m~d on the above application number in the premises of in tae fotlowbtg location; ~ ..~.m.~t ~ ~t ri. ~ 2.d Ft. Outside Sectlo. Btoc~ Lot ~as examined on ~Y ~ ~ ~'~ and fouled to be in eomp~ian~e wlth the re~ulrements of this Board. FIXTURES OVENS EXHAUST FANS FIXTURE SWITCHES OUTLETS ~LUORESCENT VAPOR DRYERS FURNACE MOTORS FEEDERS LJNIT HEATERS MULTI-OUTLET; SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT ffHER APPARATUS: S E R 'V I C E A,W, G [NO OF NEUTRALS A,W. G OF HI-LEGI OF NEUTRAL NO. OF CC. COND [ 1 Pa. Ul this certificate mFst not be altered in any ~ return fo the be their credentials. MANNER. ~)OD c~ FI FP~AI~/~F--- FOBM NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT 'TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Ex ,nod ?? .. ............. ,~proved .....~..~....~...¢......./...~.~.. ......... 19..~.. Permit No.....~.~...~.~.~...i,~....~...... Disapproved a/c ...................... ................. ........ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter o~. tn ink and subm.{ted 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 o~ areas, and g!yJng a detailed description of layout ofproperty must be drawn on the 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 applicdtion, 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 Deportment for the ~ssuance ora Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New Yo~'k, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demo t on, as here n descr bed. The applicant agrees to comply with all appli.cable laws, ordinances, buildipg'3Jode, housing code, and regulations, and to o dm it authorized inspectors on pram is es and ,n bdildings for nec ess~ ~/~~~~ '(Sil~nature of applyont, or nome, if a corporation) ..... ...... ~ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, gener~i contractor, electrician, plumber or builder. ............................... ............................ ........ ......... : .............................................................. Nome of owner of prom sas .~/~.t.~..~. E /..~. ....... , ......................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ............~..~....~ ............................ Plumber's License No ............ /~/~.!~.~, ........................ Other Trode's License No ............................................... ]. Location of land on which proposed work will be~done. J~ap No.: ................................. ...~.. Lot No ......................... Street and Number ..~...~....~.~.~.....?.......~./...~......~.~..~. ............ : ....................... ;.~-:..~.~..~.~.~...~.v;;~...~}M nic~ lity?' . Slate existing uso and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .......... ..F./.'..~..~....~..~...~..~...~. ............ ~....~ ....................................................................... b. Intended use and occupancy ....... ..~...~../~........~...~. ...... ..~'.../.'.~....~....'.~.,~.~.$[,.~.. ............................................... 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work .................................................... (Description) 4. Est,mated Cost .......... ........................ Fee .................................................................. (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 occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front .......&~...,~...?... Rear .........~....~.......i ......... Depth ...~...~... ........ Height ...... ~.~. ........... Number of Stories ....... ,~'.. ...................................................................................................... Dimensions of same structure with alterations or additions: Front ...... ~...-~... ...................... Rear ..t~...~ ................... Depth ......... ~....~.. ................ Height ....... Z.~.. ............... Number of Stories ...~. .......................... 8. Dimensions of entire new construction: Front .......... /...~...',..~. ............ Rear ........ /..~..'..~.. ....... Depth ..~....~..,'. .......... Height .....~.,~..~. ....... Number of Stories ..... /. .............................................................................................................. 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purch~ ............................................ Name of Former Owner ~ ............................................ 11. Zone or use district in which premises are situated ....1~..~..$.~.~.£E ............................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded . ......,J~G. ............... Will excess fill be removed from premises: (~'J~Yes ( ) No 14. Name of Owner of premises ..~..~I~1.~.~...17~.~.'~¢-...J~.~.~.~.. ........ Address ................................ Phone No ....................... Name of Architect ..~..¢.¢¢.~....~...~.~.'.~..~..~..¢ ....................... Address .~.~.~..~..~.J~.. ............. .Phone Name of Contractor ...~,~#..~...... ,~.,~.,~.¢..¢.e. .............. Address ~..~¢...~E~..~F./:¢,~Phone No, .~.~5' ....... ~Y(,~., ....... 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. end show street names and indicate whether interior or comerlot. / STATE OF NEW/¥~P,I(/'~-' ~ ........... ~..~.~.~J........~.~.~.~.~ .................................. being duly sworn, deposes and soys that he is the appliconl (Nome of individual signing controcf) above named. (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 fi~e this application; that all statements contained in this application are t~ the best of~his knowledge and belief; and thor the work will be performed in the manner set fo~h in the applicat~ f~d therewith.j Sworn to before me this ~ / / ........ o, ................ ... .... ( ~ ~ (Sig ature of applicant) ~~~ ~at~e of ap~ica, ~TARY ~BLIC, ~ate of New No, 52'~J25850, ~uffoIk .- , //VS'6'/_.,,,47'ZO..N* · ~'z'±. co~',~ -u"P.,e-cz,~/,az::) 'U" Y',~£uZ~ le;'.Lz, hz ,.¥~t ~/' TV/& ' - ~ 'ALBERT A. SACCO ~uo GORDON K. AHLERS ARCHITECTS & ENGINEERS t AILIN'C~ = / 10 ' APPROVED AS NOTED FEE~_~ BY: NOTIFY BUILDING DEPARTMENT ,AT 765-2660 9AM to 4PM FOR REQUIR- ED INSPECTIONS: 1, BEFORE BACKFILUNG FOUNDA, TION OR START FRAMING 2, FRAMING INSPECTION 3, BEFORE COVERING PIP£S OF ANY KIND 4, FINAL WHEN JOB COMPLETED NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS 5. ALL CONSTRUCTION MUST MEET REQUIREMENTS OF N.Y. STATE CODE L AND TOWN HOUSING CODE & ZONING, ALBERT A, SACCO ^~,:~, GOA. DON K. AHLERS ARCHI?EC'r5 & [NGJhI~JR$ 5J4655 MAIN ROAD, SOUTHOLD, N.Y. 119~71 I1' EXI%TINO J2.~O 0 h"q ~ , 4~ u .'_GR-4 Z ~r~llite~t ~nd ~£n~i'~enr's'¢ Seal anti Signature nnl~'ge.gti for imtbl use of drewing. C~a~s, alterations or r~ ~isie~ te er re~se el drawings wit,- out Architect ~r [ngineer's "Alteration el ~,Docupent except by an Architect ~t' Lt~ens~d Profe~ sional Engineer, is illegal", Section 720B, SubdiCsior~ N. Y, State Education La~. ALBERT A. &ACCO ^.. GORDON K. AHLE~$ ARCHITEC'i'S ~ ,.MAIN ROAD, SQU¥i4OLD, N.Y. 11971 i'¸ 4x4 -[ 't c o r /,V Arcili[ect ariel Engineer's Seal Sigr~atu~e, drily good for igltial ~se of visions to or r~*use of dra~ings with- out Architect or Engineer's v6M~ Seal and Signature o~ ~. ALBERT A. SACCO ~u~ GORDON K. AHL~R£ ARCHITECT5 t~ ENG.~N:~5~S 54655 ~Albl ROAD, *'~ ~?' ,.~UTn~LD, N.Y. 11971 ~X i& T' NG Ivl U L'T I - Pd~PO c.E- ~:~oo Pti V,~¢ ~ULE )",4 STING APPAD._ATLI~ P..O o M ...... ~ I I'- O" 48-8 ' 5~t-4 ± 0 % EX I ~"[ f4 ULTI-POP..P 09 E-r E- X I q q' i ?,t G' A P P A t4t A T' ,J S i D O,~" ",~ a 4 ALBERT 54655 MAIN A. SAc..O AND GOi(DOi',I K. AHLEI,TS ARCHITECTS & ENGINEERS ROAD $OUTHOLD, N.Y. 11971 PLA N "Alteration of this Document except by an Architect or' Licensed Profes- sional Engineer, is illegal". Se~;rion 7209, Suhdi¥isi~n N, X~ State Education Law., Architeot and Engineer's Seal end Signatore only goed for mibal use of drawing Changes, attemtians or re. vmiens to cr re-use of drawing& with- oat Ard~]Lct er Eogbeer's Approval voids Seal and Signature oe same. [: A~' T t~'tA P_ i o I',I ~- P P. LOd E.-CT ~ ~10 S CA LFr' i Q E, ©iSTQICT E-X I gTI NG- F P...E. HOUSE DC.A PROM SCALD-; I':=t0'-0" <zc~o Q <[ 0 & 0 Arclfitect and Enl¢~eer's Seal amd Sl~lfla~ure e, ly g~od for initial ~s~ of d(awi~g, Cha~s, 81lemti~n~ or ~. vlsIorm~ to e~, re-U~e ,f drawings with, Architect or En¢'ioer's Approval "Alteration of this Document except by an Architect or Licensed Profel. sJonal Engineer, is Sectiorl 7209, Subdivision N.Y, State Education Law, E-A ~.T ~' IT £, CO N C;T'~ UCT I:C) D.E' ~ I gT D..IC'T N PLAN 'F.~' AS T [~:A {71 0 N, (LJ,y. ALBERT A, :SACCO '~' GORDON K. ARCHITliC'~5 1~ ' 54655 MAIN .ROAD, SOUTHOLD, N. Y, 11971