HomeMy WebLinkAbout10135-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
No...g.~ .5.6.6. ......... Date .. fl..~l~x.~..25,..1.9.79 .............
THIS CERTIFIES that the building ................................................
Location of Property ~/~1~oI ....... Mg~th.f.ield- .Ho~d~t:~i Souehol d ..............
County Tax Map No. 1000 Section . 71 ......... Block ...... 1 ........ Lot ... 24 ............
Subdivision ..... XXX ...................... Filed Map No.. XXX. · · .Lot No .... XX]~. ......
conforms substantially to the Application for Building Permit heretofore f'ded in this office dated
· . ~.r..c.h..~.9. t ........, 19.7. ~pursuant to which Building Permit No... 1Q135Z ............
dated ............ l~larah. 20., ...... 197.9., 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 .........
.................. .P.R.I.V.A.T~..O~F~. F.A/~IILX .D~qELLING. .............................
The certificate is issued to .... ~,I.I.C.I~,9,~JL .MORRIS ......................................
(owner, lessee or tenant]
of the aforesaid building·
Suffolk County Department of Health Approval .... 9..-~.O.-:9 .S .... .6./.3..4./.7 ~ ..................
UNDERWRITERS CERTIFICATE NO ..... Ix/43 B.420 .....................................
Rev 4/79
Building Inspector
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE P~REMISES UNTIL FULL
cOMPLETION OF THE WORK AUTHORIZED)
N? 10135 Z Date .........................................................
Permission is nereoy grant d to: , ,
...... ~.....,..,,z ~
...... ~~~.:z~.: ....... ~.~ ..
to
pursuant to application dated .......... ~:.:.~ ............................. , 1~.~., and approved by the
Building In,pector.
THE NEW YORK BOARD OF FIRE UNDERWRITERS
p~l BUREAU OF ELECTRICITY ,
r~ 85 JOHN STREET, NEW YORK, NEW-YORK 10038
J.ne i9, zg? .,,,,,,,c.,io.N,,.o./,,. 0188z5 N 438429
THIB CERTIFIES THAT
only the electrlcal eq_ ul o~ent e~ descHbed be ~. int appl' na o the ' a ' nu be 'n ghe premises of
in the following location; [] Basement [] 1st Fl.
~ase~.mi.do. June l~R 1979
[] 2nd FI. Section Block
and found to be in compliance with the requirements of this Board.
SERVICE ni~C~NECT .o. O~
1 200 ob
METER.
1-S~ke Detector
JRYERS FURNACE MOTORS FUTURE AF~U~NCE FEEDERS
· K.W. OIL4~ H.P~ GAS H.P, AMT. NO. A.W.G.
RANGES
ll.~
;FEClAL REC'PT
R
NO, OF CC. CO~D,
PER ff
JCOOKING DECKS J OVENS I DISH WASHERS
2/o ' ',
EXHAUST FANS
MULTI-OUTLET DIMMERS
SYSTEMS
I
Laurel, N.Y. 119~18 Llco2l#8 E ~
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their c~dentials
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. --
FOR, M[ NO. 6
TOWN OF SOUTHOLD
Building Delm~tment
Town Clerks Office
Southold, N. Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building
Inspector 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 electrica~ instaUation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and
installations, 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 o~ property 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 in-
formation required to prepare a certificate.
C. 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 June 20~ 1979
New Building ....~.~?...o~. ....... Old or Pre-existing Building ............................ Vacant Land ............................
Location Of Property ~/~f~e~d~S~¢ ...........................................................
Owner Or Owners Of Property ......~.?;.o..~.~..e.?;....i¥..o..~.?..~?. .................................................................................
Subdivision ................................................................ Lot No ............. Block No ............. House No .............
Permit No. 10135Z Date Of Permit ..3.../.?...O../...7.?....Applicant Inland Homes~
Health Dept. Approval ...?..-...S..O..T..O..5........6../...~.~./...7.?....Labor Dept. Approval .....N.../.~ .....................................
Underwriters Approval .....~.....~..~...~...~....~...?......u.!.~.?.;!Planning Board Approval ...... X..e..s. ...........................
Request For Temporary Certificate ........ ,y...e.~ ......................... Final Certificate ........ ~..e..~ ...........................
Fee Submitted $ 5. O0
Construction on above described building a~cLperrnit meets all applicable c~ and regulations.
Applicant ...~~.~~ .....................
Inland Homes, Inc. ~obertql. Hiltz
Sworn to before me this
20 June ..7...9.
................ day of ........................................
Notary Public .....~u..~..~..?..]:.~.. .............. County
(stamp or seal)
AifD ID i T'~ c-~ r,.J f-\ L
FORUM ~qO.
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. I'.
Examined
..... ............... , ......
~isopprovod a/c ...................................................................... ....~.
...............
App,,cat on Na. .........
APPLICATION FOR BUILDING PERMIT
Date ..... ~J~. X...c~,.. ~.9. ........................ 19...~.g. .....
INSTRUCTIONS
a. This application must be completely filled in by typewriter or' in ink and submitted in triplicate to the Building
Inspector, with 3 sere 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 giving a detailed description of layout of property 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 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 epplicant 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.
INLAND HO~4ES, INC.
(Signature of applicant, or name, if a corporation)
Box 117, Mattituck, N.Y. 11952 (Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
General Contractor
Name of owner of premises Michael Morris
If applicant is a corporate, signature of duly authorized officer.
Robert E. Hiltz - Pres.
(Nome and title of eorpor0te officer)
Builder's License No ............... 'i .....................................
Plumber's License No ..... .5..1...7..~..~. ................................
Electrician's License No. .2...1.~..8..~.~.. .............................
Other Trade's License No ...............................................
Location of land on which proposed work will be done. Map hJA 100--071--1--24
..~ ......................... ~ ................ Lot No .........................
Street and Number ~/.~. ~.o..~..1;.~..~..~..~..~.~.. ~9. i~.~..~...S.p.g,.l;~Q,],.q~.~,..~...~...~,.[~.7.~.' ....................................
Municipality
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Exisiting use and occupancy Vacant
b. Intended use and occupancy 1 - Family
3. Nature of work (check which applicable): New Building...X...X.~ ....... Addition .................. Alteration ................
Repair .................. Removal .................. Demolitior ..................... Other Work ....................................................
· ~ ~_~._~-- (Description)
4. Estimated Cost$~5~QOD.,O~ ..................................... Fee .....~...~.. ...............................................................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units~. ........................... Number of dwelling units on each floor ............................
If garage, number of cars .............................................................................................................................................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................
7. Dimensions of existing structures, Jf any: Front ............................ Rear ................................ Depth ....................
Height ........................ Number of Stories .................................................................................................................
Dimensions of same structure with alterations or additions: Front ....................................Rear ............................
Depth ................................ Height ............................ Number of Stories ................................
61;8 ~ ~1,8 Depth ..~....: .............
8. Dimensions of entire new construction: Front .................................... i~eor .............. - ..............
Height..........1St ........ ,. Number of Stories .....................................................................................................................
9. Size of lot: Front ....... .Z..$..5. .......................................... Rear ........... .1..~...1. ........................ Depth ....Z..5.~ ......................
10. Date of Purchase ........................................................ Name of Former Owner ........................................................
11. Zone or use district in which premises are situated .....................................................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: p...o. ...................................................
13. Will lot be regraded ....~...e..s. ................. Will excess fill be removed from premises: ( ) Yes (×) No
14. Name of Owner of premises ...[4..i..°.h.~.e...z...~.°..~.,i..s. ................ Address ................................ Phone No .......................
Name of Architect .............................................................. Address ~I~"'I'IT ..............Phone No .......................
Nome of Contractor ..z..~..z..~.~..d....~..°..?..e..s...~..z...~..?.t ................... Address Ma.t,~'i t:J,ck. ......... Phone No.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock 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 ~Ol~lf:, ..I I¢S
COUNTY OF .... .~.'~..z..z..'.o..z...~. .......... ~.
..................... ~.1~,..]~...~,~.],.1;~,.,j~ ....................................... being duly sworn, deposes and says that he is the ~pplicanl
(Name] of individual signing ~ntracf)
~bove named. I '
Con tractor
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 statements contained in this application are true to the'best of his knowledge and belief; and
tha~ the work will be performed in the manner set fo~h in the application filed therewith.
Sworn to before me this
........................
....... ............................. .............................. ........ ~Nota~ Public, . ~.~...~...$ Coun~ ;;.
~ .... ~ ' Robert E~i~i~ ot appl1~
NOTARY PUBLIC, SJ~fe of N~
SUFFOLK CO. HEALTH DEPT. APPROVAL~,:-
H.S. NO ....
STATEMENT OF INTENT
THE WATER SUPPLY AND SEWAGE DISPOSAL
SYSTEMS FOR THIS RESIDENCE WILL
CONFORM TO THE STANDARDS OF THE
SUFFOLKeJ~_.D. EPT'/.~OE_ HEAI~E.H. SERVICES
SUFFOL~K COUNTY DEPT, OF HEALTH
SERVICES -- FoR APPROVAL OF:
CONSTRUCTION ONLY
DATE: ~
H. ~. REF.~NO.: ' ~ ~ ~.,~
AP.ROVED:
~AL
GREENmRT NEW yORK
SUFFOLK CO. HEALTH DEPT. APPROVAL
H.S. NO.
q~,,, '79 JUN Iq ~ I1: ,,
: THE WATER SUPPLY AND SEWAGE DIS~AL
SY~EMS FOR THIS RESIDENCE WILL
'~'~ F~CL~ CONFORM TO THE STANDARDS OF THE
~ ~ SUFFOLK CO. DEPT. OF HEALTH SERVICES.
~ ¢ (s).
~ -' ~ ~: r A~L~ANT
· ' ~ ~ ,~' SUFFOLK COUNTY DEPT, OF HEALTH
¢ J ¢' i. ' ' : SERVICES FOR APPROVAL OF
J e4 - _~p~'~c ~ '' CONSTRUCTION ONLY
~ -~ ¢: .......... ,- 5[ ~ ' H.S. REF. NO.:
' A~ROVED:
-- -r-~l ~ i ~;S ...... SUFFOLK CO. TAX MAP DESIGNATION:
~- DIST. SECT. BLOCK - ~L.
~ ~ w~Lc · t~.q OWNERS ADDR~:
;45,0 /~ ' ~ ~ ::-
DEED: L.
TEST HOLE ~P
MAp · -
.oo~5 v.. ~L, "5' '
.1
LI~N~D LAND SU~YOES
GREEN~RT NEW Y~K
14
APPROVED AS NOTED ,
DA,E, .~/Z~ 17 ~'
NOTIFY BUILDING DEPARTMENT AT
765-2660 9AM to 4PM FOR REQUIR-
ED INSPECTIONS:
TION CE STAP. T FRAMING
3. EEFORE COVERING PIP.~S OF ANY KIND
4. FINAL WliEN JO~3 COMPLETED
NOT RESPONSI3LE FOR DESIGN
OR CONSTRUCTION ERRORS
S, ALL CONSTRUCTION MUST MEET
REQUIREMENTS OF N.Y. STATE CODE
AtO TOWN HOUSING CODE & ZONING
?