Loading...
HomeMy WebLinkAbout10945-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No .... g.l.0.h 9 ] ....... Date ....... ~y..13 ................... 19 8.1. THIS CERTIFIES that the building ......... ~ ...................................... Location of Property/:/&~s~ ~o1. ~' Xlt d. S.al t. R.oad ~ .... ~/e~i~a ~.~i tuck ~. ~.w.. ~Ork ~/~ County Tax Map No. 1000 Section .. J b.4. ...... Block . .. 05. ......... Lot ... 9~.Q .......... Subdivision..Sal.~ .Lak.e .Vil&ago ......... Filed Map No... ~3A0.Lot No. B ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated October..~,3 ................ 19 .S0pursuant to w~ch B~lding Pe~it No ..... 1096.5. Z ......... dated ..... 0¢ ~be~. 2.~ ........... 19.. S0was issued, and conforms to all of the requirements of the appUcable provisions of the law. The occupancy for w~ch this certificate is issued is ......... .......... ~ ~lon~..a~..al ~¢.na~lo~. ~o..~c~yA~. 9~.~. ~.~.~. P.~9 ~ ~.q¢ .... The certificate is issued to ...... Ea~a.md · a~6 · ~a;~her ~e. Bu~klgg .................... t o wne~ :e~e~ ~e~a~L . . of the aforesaid bui]d~g. Suffolk County Department of Hea]t~ Approval ...... ~ ~ ~ ................................. UNDERWRITERS CERTIFICATE NO ..... ~./.R ......................................... Rev. 1/81 Building Inspector (THIS PERMIT MUST BE KEPT ON THE PP.E/~IS~S UNTIL ~ULL cOMPLETION OF THE WORK AUTHOR ZED) · ,,.$E.~.,;; · .............. ~. ~ iOg~ Z D~te' .. .~. ...... ~ Permissio~ is hereby granted to: ~ . ~ ............ ?,-'~t'"~ ......... ~ ...... Y .................................................. , ........ , ....... ~-'"~' ....... ....-..... .............. .... ~ ..... ,...~ ...... ~.......................~ Co~ ,~ ~op ~o ~00o s,~t o~ ...?.~.~ ...... ;. ~,~,.~ ........ :~ot ~o.~.:~d~ ......... p~r~nt io application d~t~d .~...~.., 19 .., ~nd ~opprovod by tho Bu~l~ing Inspector. . , : ; , Rev. 6/30~80 · : ~ ~: ~: 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 featu res. 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 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 buildin.gs 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 dwe{ling or ~and use 3. Copy of certificate of occupancy $1.00 $5.00 Date ...1~. ( . ../ .......... New Building ............. Old or Pre-existing Buildingw .......... Vacant Land ............. . Location of Property...~.'.~..~.....:~.-.~'z~; .~. ............... .o.<~ .... House No. Street Hamlet Owner or Owners o f property ._~_,~,~__Z. ~4:2/~..,~:..(. Z.,~('.,~..~-.~'~ / ,_.. .......... County Tax Map No. 1000 Section .... .~..~.. ...... Block .. ~. ~ ......... Lot../..~?.Z:.~. ....... Subdivision ................................. Filed Map No ........... Lot No. ~ ......... Permit No../~].~.¢7Z~.' . .~-Dat, of Permit/.~) .Applicant...~/../: ././/~..~.~.-..~.~.~. .......... -. ~ Health Dept. Approval ................. Labor Dept. Approval .. / ............. Underwriters Approval ........................ Planning Board Approval . . .~./~ .......... Request for Temporary Certificate ..................... Final Certificate .................... it' · ~ e m~tted- '~' re Sub ' Construction on above described building and perrpit~n)eets all applic~)le codes and regulations,, t~ I~ ,~. N. ~0'55 '~4, - ~09.0 ' THE ~ate l'l~y THIS CERTIFIES THAT NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW yORK 10038 ~pp,cation No. o./ile l~7~i N 5 1 ~ ~ ? 0 only the electrical eqttipfnent as described below and introduced by the applicant harned on the above application number in the pre,nises of Mr. Buckle. y, Salt Lake. Drive, off Bay ~%~enue, F~ttituck, N. Y. in the foBowing location; [] Basement ~ 1st FI. [] 2nd FI. Section Block Lot was examined on ~L'~I 30,1981 and found to be in compliance with the requirements of this Board. 1 1 1 1 DRYERS FURNACE MOTORS FUTURE APPLIANCE EEEDERS TIME CLOCKS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPARATUS: S R NO %ERCC,~CO~V R V I C OF CC. COND NO. OF Hi-LEG A.W.G. NO, OFNEUTRAL OF HILEG A. WG OF NEUTRAL Walter Finger 405 Birch Aver~ae Cu~chog~m, N. Y. L~c~ #1845 This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be COPY BUILDING THIS COPY OF MANNER. FIELD. INSPECTION FOUNDATION (~s2) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING COMMENTS INSULATION PER N.Y. STATE ENERGY COpE FINAL ADDITIONAL COMMENTS: 765-1802 9 AM TO ,~ PM FOR FOLLowING th',ee~ ' THE ' I. FOR pOUR,~_TWo REQU RED 2. ~...u ~ONCR~TE ' 3. ROUGH:_ FRAMING & PLUMBING INSUL~7'iON 4, FINAL . CONs%qUCT!ON MUST BE COMPLETE FOR C, O. ALL CONSTRUCTION Sh~LL MEET STATE CONSTRUCTio · CODEs. k~O~ ~_.. N & ENERGY ~' ~* ~UCTION ERROR& i! T FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL,: 765-180:~ Examine ~...~ .: ..... ,19~.~. ^pprove :. . ...... , Pe it So:.? Disapproved a/c . :._... i-~f~..~.-i.Z ff.-. ..................... ~;~// ................................. ........_ :' '"'~' ~;;it;;i ........ Application No. /.ch.¢ .~..~-.. i ..... APPLICATION FOR BUILDING PERMIT Date .(.~..: :~.. '.~..'~ ...... ,19 ~Y~: 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 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 the dia~am 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 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 necessaryi4//~:/..~~--inspecti°ns' ~ f~,:~., /: ..... ~ +[.Z, .'. : :, ./¢.....~.'(~.~.,~.~ ............ (Signature of ap l~ant(of~name, if a corporation) ~' (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~:Z '/ Name of owner or premises L ~.).g(/.fi.~:~. ~.. C~:A:~..~('~-... './~..~ .~. ?./.(.L.fv.~.~.~.~. ........................ '.... (as on the tax roll or lat~t deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No....~:.~.. ................. Plumber's License No../.cJ .---~/~;~..~./.~.~Fff~.... Electrician's License No. ~ .... P ........ ~ ........ Other Trade's License No ...................... ~.1_ 1. Location of land on which prppofied work will be done, L ~:..: ........ ' .............. ~ ........ ~.. '. :...'. House Number Street Hamlet co~y ~,~ ~a~ ~o. ~000 S~ction ::7 .......... ~o~k, ? ............... ~ot. &: ............. S,~d~o, .:~Z.&~*. U::&:: ........... ~a ~ ~o. /:/0 ........ ~ot. ~ ........... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy Z (~:/:' :hdc:: ~, ' ....... b. Intended use and occupancy... ~~/~ 3. Nature of work (check which applicable): New Building .......... Addition ...... Alteration Repair .............. Rem6val ....... .. ...... Demolition .............. Other Work ............... 7 d9 0 ~ f[ ~- ' o (Description) 4. t,snmatedl' Cost ............ : ......................... Fee. .............................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number o f 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 pf existing structurds, if any: Front. ~i .......... Rear .. ):'.~ ......... Depth . .~..O. .......... Height ]~. ............ Number of Stories ...... /. ................................ ~ ................ r)imensions of same structure with alterations or additions: Front . ~. ............ Rear, ?~fi..' ............. Depth ....cra .............. .. Height ..... /. ................ 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 Purchase ........... .................. N~me of Former Owner ............................. 11. Zone or use district in which premises are situated ..... Ke~'7~. ~-~.~.77r~'. ~- :..,~,>~ .......................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .. ttg.o. .......................... 13. Will lot be regraded ....... ~.!.:.,~../~..?.] ......... Will excess fill be removed from premises: ~.~ No 14. Name of Owner of premises ~ ?~../.~..q/.c.~./.6.~: .... Address .~-'-~ .J7~../..r~?.K..l~?./... Phone No ................ Name of Architect .......... . ................. Address ................... Phone No ................ Name Of Contractor ~ '.~]: ~).~4~', ............ Address I)?_.~;o.'.~/.4~.~: ....... Phone No. >Z.~.~.'x .JT~>/~.'. PLOT DIAGRAM Locate Clearly and distinctly alli 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 YORK ¢. ...b'~ .z4../(A-~.~...kx,~..~7tNc-d.I/.,>.i .................... being duly sworn, deposes and says that he is the applicant : (San~:;~j~/vidual signing contract) above named. ,. t~ He is the ................... .................................................................. (Contractor, agent, corporate officer, etc.) of ~d owner or owners, ~d is duly authohzed to perform or have perfomed ~e said work and to m~e and file this app~cation; that all statements contgined ~ this application are tree to the best of his ~owledge and belief; and that the work w~l be perfomed in the m~ne'r set forth in the application filed therewith. Sworn to before me this ......... ....... Notaw Public, .........