HomeMy WebLinkAbout10784-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No.. Z-16520 Date December 21, 1987
THIS CERTIFIESthat the building Construct Addition to Living Room of existing
· 'o'n'e' 'f'd~fi'y' 'd'¥dfl'i'~g' ...........................
Location of Property 5340 Main Bayview Road Southold, New York
House No. Street Hamlet
County Tax Map No. 1000 Section ....7.8 ....... Block 04 .Lot 34
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
July 10, 1980 10784 Z
..................... pnrsuant to which Building Permit No ......................
dated July 17, 1980 was issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for which this certificate is msued is .........
ADDITION TO LIVING ROOM OF EXISTING ONE FAMILY DWELLING
The certificate isissued to JOSEPH & EVA SAMUOLIS
..................... ....................
of the aforesaid building.
Suffolk County Department of Health Approval ............ .N/.A. ..........................
UNDERWRITERS CERTIFICATE NO ............... N424932
N/A
PLUMBERS CERTIFICATION DATED:
Rev, 1/81
FORM NO. 2
TOWN OF $OUTNOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 10784 Z
Permission is hereby granted to:
.......
.........
..... .................
at pre~i~.~ ~o~t~d ~t ..~.~.~ ......
.....................................................................................................................
pursuant to application dated ...... .~ ...... .................. ,
and
approved
by
the
Building Inspector.
,ee $../.~......% .........
,
B~lding Inspector
[~~PLiCATION FOR CERTIFICATE OF OCCUPANCY
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
,%uthold, N,Y. 11971
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.
4 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.
Fees:
1. Certificate of occupancy $5.00 /
2. Certificate of occupancy on pre-existing dwelling/ land
3. Copy of certificate of occupancy $1.00
Use--?re-Existing C.O. $15.00
Vacant land C.O. $ 5.00
New Building ............. Old or Pre-existing Building ............ Vacant Land .............
Location of Property ............................ : ~ ... , .... ,~L. .......
House IVo. Sfreet Ham/et
Owner or Owners o'f Property ........
County Tax Map No. 1000 Section ............... Block ............... Lot ...............
Subdivision ................................. Filed Map No. ~, ...... .~..Lot No ..............
PermitNo. ,//,,~,7..,~. D~ate of Permit :f,~.(7,~,,,~A~ppiicant ,.~,~,~?'~' ........
Health Dept, Approval ........................ Labor Dept, Approval ........................
Planning Board Approval
Underwriters Approval ...........................................
Request for Temporary Certificate ..................... Final Certificate ....................
Fee Submitted $ .............................
Construction on above described building and pej:.mit meets all al~licab[~ codes and regulations.
Applicant....~...~...~..~..~~ ............
Re~. 10-10-78
THE NEW YORK BOARD OF FIRE UNDERWRITERS
~m
BUREAU OF ELECTRICITY
r-- 85 .JOHN STREET, NEW YORK, NEW YORK 10038
THIS CE~IFIES THAT
Joseph A. 5amuolls, 534n ~ln ~ayvlew Ad., ~oufhOld, L.I.
~ exami~ on ~ O ~C h 5 ~ ~ 9 7 9 ~found to be in ~mpliance ~ith the r~ui~nt~ ofta~ ~d.
HXTURE ~
OUT,ITS TAC~S SWITCHES
~NC*H~S~E~ I~XTU~ES
SERVICE ~,~;~;b~ o. oF S
;FECI&L aK'PT
R
V I C
,A'2W I.~W 3Ar3w 3~4w NO.C~C~COND. ~.W.O. NO. OFHr-L~3
EXHAUST FANS
DIMMERS
E
!
B.J. Elec. Co.
Stlllwater Ave.
C:utcho~ue, N,Y.
11935 Lic.505 I~Na
I!
,------------~'--This certiticate, must not be altered in any m~nner;, return to the office of the Board if incorrect. Inspectors may be identified by their crm~nt~al;;
1' --............................ 1.. ................... ~Jll
76S-X802
BUILDINO DlrPT.
INSPECTION'
[ ] FOUNDATION 1ST [ ] ROUGH PI~BG.
FOUNDATION 2ND ~ ~ I/NSULATiO~
FRAMING ~*'"~ FINAL
FIELD IN5PEC~ION COMMENTS__
FOUNDATION
(Is~)
FOUNDATION
2.
ROUGH FRAME &
PLUMBING
(2nd)
INSULATION PER N.Y.
STATE ENERGY
cope
~DITIONAL C0~ENTS:
,/
FORM NO. 1
TOWN OF SOUTHOLD
BUILDtNG DEPARTMENT
TOWN HALL
" SOUTHOLD, N.Y. 11971
TEL,: 765-1802
Approved .... /.7 .... 19 .c~.O. Permit No../.¢ ...... ~
Disapproved a/c ...... ~55~T 7~ ~-'. ...... ~. ..........}~
(Building Inspector)
APPLICATION FOR BUILDING PER~IT
Application No./,~/d~.~,~, ........
INSTRUCTIONS ,
a. Tins 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 diagram which is part of this appli-
cation.
c. Tlxe work covered by this application may not be commenced before issuance of Building Permit.
d. Uponfipproval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit
shall be kep{ on the premises avmlable 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
authorized inspectors on premises and in buildings for necessary inspecti?n,s. , ·
admit ..... //'.'.~.i:~ ([.~:k:~... ~).., .'.¥~. ([.~'~: :~:..~: .......
(Signature of applic,a,~t~or a.~?, if a corporation)
~-
State whether applicant is owner, lessee agent, architect, engineer, general contractor, electrician, plumber or builder.
/ ..).~. 4//~: ~ /X, ................................................
~me of owner of premises ....... 'i: -: .... ,.~ ...... > ........ ~. / ~ ~: ................
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly author]zed officer.
(Name and title of corporate officer)
Builder's License No ...... ' .................
Plumber's License No .........................
Electrician s Lic nse No ......... - ..... - .....
Other Trade's License No ..................... .. ~ /? . /
1. Location of land on which proposed work will be done ................................................
House Number Street Hamlet
County Tax Map No. 1000 Section ... ~ .~ ......... Block .... ~.~. ......... Lot.. ~ ~% ...........
Subdivision ..................................... 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 . .~ / :7.1. · · ~.k";~.;Y.k'.c) ...................... > ...................
and o .pan y .......................... ...................... ........
3. Nature of work (check which applicable): New Building .......... Addition..~. ...... Alteration ..........
Repair .............. Remo,¥al .............. Demolition .............. Other Work .............
. (Description)
4. Estimated Cost ..........................................................
[ (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 ......... .~ ...........
.... . t # ~
7. D~mensxons of ex,stray structures, ff any: Front. l~. ~ ......... Rear ,~...q~. ....... Depth .~.~ ...........
Hexght . ./.~ .......... Number of Stories . J.
Dimensions of same structure with alterations or additions' Front /~ ~ , '- ~O -:~
Depth... ~.-../ .............. ... Height .............. Number of Stories y .....
.... ·
8. Dimensions of entire new construction. Front .... ~. ....... Rear ..........................
Height .../.(a .t ........ Number of Stories ...... ./. ............................ 22 ...............
9. Size of lot: Front ....~.O. ..... : ........... Rear...g.~.~ .......... ii .... Depth '~.~.....~.'ffi~.' ........
lO. Date of Purchase .............................. Name of Former Owne .
11. Zone or use district in which premises are situated (~ ~ t ~. ~
12. Does proposed construction violate any zoning law, ordinance or regulation: ................................
13. Will lot be regraded ..... .t4Xf.~r' ................... Will excess fill be removed frompremises: Yes No
14. Name of Owner of premises . ~!.. ~..'~../~. ~.'P..~(~.~.... Address .~:':~f(O./c/4~.~..Q.~)p'f/.~fione No. ?.4~' 7./.~6~.--..
Narn~e of Architect ...~.~.,?.~/~ ~.tinr." I i.~'_.' ~.. ........ Address .P. .................. :~'~ ir. A r~.2~ Phone No ............... ?.
Name of Contractor ...... o./3..~ .......... Address ~./~? ..... Phone No.
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 YORK, ,~. ;io o
·/'~f. t~/./../.4v~r?:/~,~...%~.~.':. (~"/4,: 7 ................. being duly sworn, deposes and says that he is the applicant
tl~am~f i ~nc~vfdt~al sigrdng contract)
He is the..; ................... r ...................................................... ; ............
, (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 that the
work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
.......... .~.~.....~ .... .; . .day o~'. ~ .... , .......19 .'~,
_, .............
Commis~o~ua'f*~a ~. ~u,o~ ~o~nty ~ , ~ L/ (Signature of a
n /xp~re~l ~larch 30~.