HomeMy WebLinkAbout10706-zFORM NO. 4
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
' ~ Southold, N.Y.
Certificate Of Occupancy
:No... Z.1.0292 ........ Date . ...D.e.o.e.m..b.eF.. 1. .0 ............... ,19..8.0
THIS CERTIFIES that the building .............................................
Location of Property . ./4-.~.0...M.:l..~.]: .8~..~..P. ~.~..k~.a.~ .......... .89.u.~.hg.l.d' ..................
House No. Street Ham/et
County Tax Map No. 1000 Section . . .~.8. ....... Block ....... .2 ....... Lot .... 1.2. ...........
Subdivision ............................... Filed Map [No ......... Lot :No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
...M..8.y..50. ........... , 19..8.0pursuant to which Building Permit No .... 1070.6. Z ..........
dated ...ff..1~..e..6. .................. 19...~,0was issued, and conforms to all of the requirements
of the apphcable provisions of the law. The occupancy for which this certificate is issued is .........
One Family Dwelling
The certificate is issued to ....G. 1..Or.~.8...0:..fi..~..O.n/p~jnk),./.~__ ............ . ~ ......
of the aforesaid building.
Suffolk County Department of Health Approval ....~./.R. ...................................
UNDERWRITERS CERTIFICATE NO ..................................................
Building Inspector
Rev 4/79
~OK~ NO. 2
TOWN OF $OUTHOLD
BUILDING DEPARTMElqT
TOWN CLERK'S OFFICE
SOUTHOLD, lq. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 10706 Z
Permission is hereby granted to:
pursuont to opplic~tion doted ......................................... , 19~, ond opproved by ~he
Building inspector.
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 featu res.
2. Final approval of Health Dept. of water supply and sewerage disposai-(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 alt 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 buildings or premises, or other pertinent informa-
tion required to prepare a certificate.
C. Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or land use $5.00
3. Copy of certificate of occupancy $1.00
Date ...................
New Building Old or Pre-existing Building ~ Vacant Land
Location of pr2~2;t~'.i i i i .~.'~..~. .... ~../.~' .~0~.'I i ~ .~ .~ .~. ~d~.~.
House mo. ~7 Street / Hamlet
Owner or Owners of Property ... ~ ~ ~. ~ .'~.z-~0 ~----v/ / .
County Tax Map No. 1000 Section ........ ~...~.... Block ...... ~ ...... Lot ...... /...~---------------~,. .....
Subdivision ................................ Filed Map No ........... Lot No ..............
Permit No./.~.~.~.'~.. Date of Permit .~¢.%'~.~..~..Applicant ......... '~. f~.~f~.~ ¢~ ~/. ...........
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $..~.'..~-~ ....................
Construction on above described building and permi~t/~l/ee/~ all al)~licable cod,ejs and regulations.
Applicant..~ ..................
FIELD 3NSPECTION uoivnvl~Nm,~ ___~_~
F01~TDATION (ls2)
F0tmmAT~0N (and)
2.
ROUGH FRAME &
PLUMBING
INSULATION PER N~Y.
STATE ENERGY
cope
4.
FINAL
ADDITIONAL COMMENT~S,:
THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
[~F~[~L 85 JOHN STREET, NEW YORK, NEW ~ORK 10038
..re Nov~[~r 19, 19d0 ~p~U~at~o,,~a.o./il~ 099405 ~ ~
only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of
G. O. Azmmd, PL~dL~d P~rkw%,, gotv~old, N.Y.
in the/allowing location; [] Basement []' 1st FI.
,~a~xa,.,i.odon t~o¥~r~r 17E 1980
FIXTURE
OUTLETS
g0
FIXTURES
FLUORESCENT
~ 2nd Fl. Section Block
and found to be in compliance with the requtrements of this Board.
RANGES OVENS DISH WASHERS
DRYERS
°t"~F~[%~rd/~, 1-5 cir. ; L~an~
t GF£ Recep~;le
i ~D'~ De~ctor
t-4.b~
OF HILEG
'ikack lighting:24'-0" tract% 4 lights
*gi~c Roan timters;2-4.0, 2-L5, 1-1.0,
AWG
Town tiarbor Lmm
~outhold, N. Y. 11971
GENERAL MANAGER
Th,s cerh~ by t~heir credentiaJs
COPY FOR BUILDING DEPAR , NY MANNER.
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
..... No../.0.7.0..4. .......
Examined . ~.~..~. Application
Approved~/4..g~....~.~., .... 197.d. Permit No../..~. ~. 7~..~ ~
Disapproved a/c .... -~ ........... ~ii~i:
(Buildiffg Inspector)
APPLICATION FOR BUILDING PERMIT (~ .-_~~ ~/)
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 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. 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, hou§ing code, and regulations, and to
admit authorized inspectors on premises and in buildings for necessaw~ ~// , j
o: . . ,,. .... .r:.o. : .
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
(as on the tax roll or latest deed)
If apphcant is a corporation, s~gnature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No. ~.'./.f-¢...~...~..
Electrician,s License No 2 ~..~A~....~.~.~...~.
Other Trade's License No ...................... , , //- In on whlc roos work will be done ~x~.,~/{~*~,~,__
.......................................................... , ......
House Number Street Hamlet
County Tax Map No. 1000 Section ........ .~..~. ..... Block ....... ~ ........ Lot... t..~. ............
Subdivision .................................... Filed Map No ............... Lot ...............
(Name)
2. State existing use and occupancy of premises and~intend.ed~us.e and occupancy of proposed construction: /
a. Ex,stin usea doc u
b. Intended use and occupancy o~...} .~.%~.?./:?..~.~.~ .~/Z~/..~./~ .~.~/.~..~.~)/~f~. ~. :~...y~.~.'./....
3. Nature of work (~eck which applicable): New Building .......... Addition .......... Alteration ~
Repair .............. Removai .............. Demolition ...... ...... Other Work ...... ' .........
.~./.~ 2~.,: ~/~(~ (Description)
4. Estimated 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 ... r ................
7. Dnnenaons of existing stmcture~, if any: Front ..... ~..~ ...... Rear ... ~ ......... Depth ....'~..O.~. .....
Height ...... ~2. ~ (... Number of Stories ....... ~...~.'~ .~. .......................................
Dimensions of sam~,stmcture wiih alterations or additions: Front ...... ~ .... Rear .... ~:~-):rqm~... ......
Depth ~. ......... ~ .... ;.. Height ..... .~..'~ .......... Number of Stories ......... ~ ....
8. Dimensions of entire new construction: Front ....... <~hcr,~*-~.. Rear .... ~ .... Depth .... ~ ....
Height ............. Number of Stones ....................................................
9. Size of lot: Front ......... /.4~..~.~:f.~.. Rear ........ ? ............. Depth ~..../_~r~j~n~.. ....
10. Date of Purchase ...... ,/..:~. 7'..~./.'l .~, ?. ......... Name of Former Owner ..../~//. ~ 2(.///..r~. ,~.~ ....
11. Zone or use district in which pr4mises are situated ....................................................
12. Does proposed construction violhte any zoJ~ing law, ordinance or regulation: ...............................
13. Will lot be regraded ....... r~I. . .~...,~,/~. ......... Will excess ~I/be rl~v~(d from premises: Yes I~
14. Name of Owner of premises .~.~.(-~. c .g~.r..~.o.~...O. Address Z~ ~./.Z~,,~..7~..~..~ Phone No. ~.~ ~-71..~..~/.~....
Name of Architect .......... ~ ................. Address ................ .[. Phone No ................
Name of Contractor ......... i ................. Address ................... Phone No ................
Locate clearly and distinctly all,~
property lines. Give street and block
interior or c.orner lot.
PLOT DIAGRAM
bui/dings, whether existing or proposed, and, indicate all set-back dimensions from
tumber or description according to deed, and show street names and indicate whether
STATE OF NEW YORK,
COUNTY OF
..... ~. ,~.~, / t~' .... .t~ff~..0..fl..f.~. ................... being duly sworn, deposes and says that he is the applicant
~ (Name of individual signing contract)
above named.~'
He is the.., .... i ................................................................
I (Contractor, agent, corporate officer, etc.)
of said owfier or owne~, ~d is du~y authored to perfom or have perfomed the said work and to m~e and file ~is
application; that ~1 statements contained ~ this application are true to the best of his ~owledge and belief; and that the
work will be perfomed in the m~ner set forth h the application filed therewith.
Sworn to before me this
:.,..
~0TARY PUSII~, State 0f N~ ~f~ ' ~ ......
~OTi, l~y BUILDING DEPARTMENT Al
:~65-180~ 9 AM TO 4 PM FOR THE
FOLLOWING iFISDECTIOMS:
.1, FOUNDATION - TWO REQUIRED
FOR p~jUR~L CONCRETE
· ~:ODES. NOT RESFONSI~'LE FOR
~, ,~IES~ OR ~;~]N~I~IC~ ERRORS·
LIVIN~ l~oo/',A
-0!
GP~OU~P FLOO,~ ~,,~ H
CE'LLA~
Vv'//VOo~ 'to