HomeMy WebLinkAbout10911-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
Z10622
Date ........... ~..ug.u.n.t.. 7 ............. 198~.
THIS CERTIFIES that the building ................................................
Location of Property ...1.2.5,0...M.g.: . .B.e.u.l.a..k. A~.?.n.u?.~. Str~ Bouthold, New York Ham/et
HouseNo. 051 Pt. 002
County Tax Map No. 1000 Section ............ Block ............... Lot .................
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
October 2 19 8..0pursuaut to which Building Permit No. 1091 I g
dated ..... ~.u. $.u.~.~.. 7 .............. 19..8. ! was issued, and conforms to all of the requirements
of the apphcable provmions of the law. The occupancy for which this certihcate is issued is .........
Private One-Family Dwelling
Barbara Koch
The certificate is issued to ..................... [o~n'o'r,'l~'~J~'~}(~ ...................
of the aforesaid building.
Suffolk County Department of tlealth Approval 10-S0-70, 7/23/81 R.A.Vtlla, P.E,
VNDE~WI~ITE~S C~aTIFIC^T~ NO...~.S. 2. ?.~ .3.~. .......................................
Building Inspector
Rev. 1/81
N°. 10911 :7
Permission is hereby grar~ted to:
FO~ ~0. ~
TOWN ~F ~lJT~¢~
TOWN HALL
BUILDING P:E~!Y~
~TH S .~,~ MUST .~ K~PT 0~ ~.,~ P~,s!s UN~,~ ~u~
COMP,~TIO~ O~ TH~ WOrK ^U~H0mZm~
Date 7.i .............. , 19...
at prem,ses located at ...~-~..~..~-~.~-.~-~ ........................
................ : .......... ~. ............... ~ ................ ,~,~..~.Z~./.c~.....~O/ ,
~. t ~ .... c. ........................................
Count, ~ox ~,~ ~o. ~000 Soct~o, ..... ~. : ...... 8~o,k, .~,.~. ......... ~kot ~o ............
pursuant 'o application dated .... C~ZO.~... ........ .f...~[ 19,~, and approved by the
Building Inspector. ~ /'
Fee $..L.~.~ ..........
Rg¥. 6/30/80
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 m 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.
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-
t~on required to prepare a certificate,
Fees:
1. Certificate of occupancy $§.00
2. Certificate of occupancy on pre-exist~ng dwelling or land use
3. Copy of certificate of occupancy $1.00
$5.00
Date (-..~.~"~y'. ....
New Building ............. Old or Pre-ex~stihg Building ............ Vacant Land .............
Location of Property ,, .~'.?~.~'~:~..~./~-.~..,~'.~,'~..~-~::,/~.:,~.-f~."., -",~-¢~'¢'~.-.. House No.
- ............................
Owner or Owners of Property , . .~.-,~.~.'-:-. ..... .~..;. · . - '?"
County Tax Map No. 1000 Section ... ~. ~,~.~. ..... Block .... .~;,~ ....... Lot.. :~.-~.'.
Subdivision ................................. Filed Map No ........... Lot No ..............
Health Dept, Approval ~. ~:¥~,~./:.~. 7n~f.~.~.//~ .:.,/./~55~:ept. Approval ...............
Underwriters Approval...~:~¢. ~.~'~'. ...... Planning Board Approval ........
Request for Temporary Certificate ..................... Final Certificate . .~;%: ......
Foe Submitted $ .............................
Construction on above described building a~::~s a~ ap~codes and regulations.
Applicant · :. % .-'..~?.; .~¢..,~.~ .'~. ..................................
Rev. 10-10-78
~(~0037~,~, THE NEW YORK BOARD OF FI~RE UNDERWRITERS
BUREAU OF ELECTI~ O TY
3ulry 27, 19~ JOHN ST~, ~EW VO~K, N~w ~ORK ~OO~8
THIS CERTIFIES THAT .....
only the electrical equipment as described below and introduced by the applicant ~med on ~he above aoDlication number in the ram's
in taefotlowinglocatlon;. .~ Basem.%~ ~'~ 1st FI ~ 2nd a. PO~ ~2
d~.Ly ~ l~c.,. ' Section Block Lot
OUTLETSFIXTURE SWITCHES FIXTURES RANGES OVENS EXHAUST
NCANDESCENT FLUORESCENT VApOR
DRYERS
FUTURE APPLIANCE FEEDER~
TIME CLOCKS [,INIT HEATER MULTI-OUTLET DIMMERS
SYSTEMS
NO OF FEET
SERVICE DISCONNECT
OTHER APPARATUS:
S E
NO O FpE.~C.~CON D
R *V I C E
AWG
L~.: 657-E
This
ot be in any manner, return to the ofhce of th Board if
~ING Tills ~
Inspecto[s may be
IN ANY
Fi~L~,~NSPECTiON COMMENTS
FOUNDATION (~si)
FOUNDATION (2nd)
2.
ROUGH FRAME &
PLUMBING
INSULATION PER N.Y.
STATE ENERGY
CO E
FINAL
AD]
I
~OOT~
, ~'~, ~..'- F-",.~ ;~ ,: ,-,,t,-,-,.,.~,
· · , 1,1~ / .... -: ' , " I
-' , . lin
91 I~',:
c ~ N~. 8008- 012~S
~.~'~'~"~-~o.~ ;',.' ~%~' .. -,. ,.
-
. ~ ~ ~ ~ ~ ,, ~",'. ~OD~I~ VA~ ~UYL, ~ ~; - ' '- .,.,
,' /' ~ ',:-- ' ~ .I/~" "'~ ~ ", . ' '-'
,. , ~ ' .'
,~.~ .......
FORM NO. 1
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 76~1803
.....
...................... .......
APPLICATION FOR BUILDING PERMIT
Application No..t/.(?7(*./'. .........
Date ................. 19
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 promises 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. 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)
.... ....
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Nameofownerofpremises ~q~5(44~ K c.~-i ......
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer,
(Name and title of corporate officer)
Builder's License No.. (._2~. ~ .~'.~.!-:.. .............
Plumber's License No .... 2..Q ~s..I :....~. :.l .~.~.~' ~
Electrician's License No. ~) ~'~ ~ t
Other Trade's License No ......................
.... .... , ..... ................................ - .............
House Number Street Hamlet
County Tax Map No. 1000 Section ....~.~]~ ........... Block .... % ............ Lot.. ?.0 .g.T'...~..qw. ....
Subdivision ..................................... Filed Map No ............... Lot ............... (Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .... .~.O~.'. ?.~. T I,-o~'
b. Intended use and occupancy ... ~.~. ~?...~..~ .~.q.c.c~....~.~.O.'.~.~.. ?..~..%c.,%,.~.~.$ ............................
3. Nature of work (check which applicable): New Building . ~ ..... Addition .......... Alteration ..........
Repair .............. Removal .............. Demolition _'2f; .......... Other Work ........... .....
~'-_~2:>, agS~f__) ~ (Description)
4. Estimated Cost .../..O.°. t .o. ?.o... ................... '..... Fee . ./..~.~... ~.q, ..........................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ..... I ......... 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 structure~, if any: Front ..... '.-w. ........Rear ..... .-- ........ Depth.. :7 ...........
Height Number of Stories ~
Dimensions of same structure with alterations or additionsi Front ................. Rear ..................
Depth ...................... Hei ht ............ . ......... Number of Stories ......................
8. Dimensions of entire new construction: Front .... ~.... ~ ..... Rear ...~ ........... Depth ...~...to ..........
Height ... ~,.¢. ~.~: ..... Number of Stories ...... ~'.. i ............................. ; ................
9. Sizeoflot: Fro~lt ...g./a.G...~..~.: ......... Rear . ~.~.6.,.~?. ............ Depth . .Z. 1~....~. .............
10. Date of Purchase ./~?.Y..~.:. [~ .~.O.~ ............ .Nalue of Former Owner . C.'.c:.~.~'.B.??T.~..; ..&..e.q: .tq. pc.~.q...
11. Zone or use district in which premises are situated.. .~.o~a. ~.~.?.~T~..~? .....................................
12. Does proposed bonstrucfio, n violate any zoning law, ordindnce or regulation: .. [QP. ..........................
13. Will lSt be regraded ... b/.q... ................... Will excess fill be removed from premises: Yes (~
14. Name of Owner of premises .~..~.K~..a.~.~. ~.o.c..~ ..... Address . .~.°.qV.~.°.?....~.' .?:.. Phone No. ~.I,.~. :. ~.~.~..~...
Name of Architect .¢ ..~.~/¢ .¢..q....D.e.a?... ~ ?.,.... Address .. ~.~c~ .o .~. ~.c...~3).°,.... Phone No.. 7.3.¢.: .5..~. ¥ .31..
Name of Contractor . .Cv.~.o, IgG:e. ~.o.c..~ ......... Address ...~....°2¢~.. ?.~ fl. ....... Phone No. 2.S..~: .~. ¥.&.¢. ....
PLOT DIADRAM
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 NEE
COUNTY~ OF..~.~. 2'. 2Y)./..~ .......
..... .~g,~ff,~-,d2....~.O(d~. .... . .................. I' being duly sworn, deposes and says that he is the applicant
(Name of individual sigr~ing contract)
above named.
He is the .......................................... i ...............................................
(Contractor, agen:t, corporate officer, etc.)
of said owner or owners, and is duiy authorized to perform :or have performed the' said work and to make and file this
application; that all statements contained in this application ~re 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
(Signature iof applicant)'