HomeMy WebLinkAbout10708-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No..~ 1..0.8.7.6. ......... Date ........ Ee.~ r.ug.~.7..8 .............. 19 .g.2.
THIS CERTIFIES that the/o~lxti~gm.. 17.o.o.~. ........................................
Location of Property .).0.20 Private Road I;3 (Manog .H, ill. L,a, ne)..C..utch, gg.up
House ~id ....................... 's'de3i ............... Hamlet
County Tax Map No. 1000 Section 108 .Block 03 .Lot 013,008
ivD. n or
Subdivision,. [:l.e?,n, ffF..A.d.e. ~. ............... Filed Map No ......... Lot No...~ ..........
conforms substantially to the Application for Building Permit heretofore filed in this office dated
June 2 ~'.0 ~0705:4
...................... 19.9 pursuant to which Building Permit No ......................
dated ..... ~1 .u¢.e..4. ................ 19.8...0, 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 .........
an lnground swimming pool.
The certificate is issued to ..... tl.o.b. ?.r.~..g. :..~...Pg.t.r.i.c..i.a..h. :..S.qh. ¥.a?.~ .................
(owner, ~e~e"orr'te~m't)
of the aforesaid building.
Suffolk County Department of Health Approval ...... lq./$ .................................
UNDERWRITERS CERTIFICATE NO ..... ~:!~5.4. 9. ~[ .4.8 .....................................
Building Inspector
Rew 1/81 '~
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 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.
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:
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.O0
New Building ............. Old or Pre-existing Building ............ Vacant Land .............
!.o. ........ Lo.,)...
Location
of
Property
House No. Street
H4mlet
COUnty Tax Map No, 1000 Section .... ~.~ ....... Block ... ~ ~ ....... Lot..~. [ ~.'. ~ .....
Subdivision ~.;~.'~.~9C~ .~ ~.~ ........... Fded Map No ........... Lot No ..............
Permit No.~ ~.~ ~ ~.~.. Date of Permit ~. [ ~J ~,..Applicant. ~T .... ~,. ,~.~
~ Labor Dept Approval
Health Dept. Approval .................................................
Unde~riters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .... ~ ................
Fee Submitted $.. ~. ~. ¢... Z ...............
Applicant...L.~. ~.~ ~/.[~~~ ~ ./.. ~..': .... ~ .~ ........
Rev. 10-10-78
THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRIC3TY
85 JOHN STREET, NEW YORK NEW ~ORK '10038
aate February 1, 1982
.~.p,,c.t,o.,No.o,,.fi,e 080225/80 N 549748
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant r~am~d on the above application nutnber in the pretnlses of
Robert Schwsxz, E/S Manor Hill La., N/O Main l~ad, Oatchogue, N.Y.
in the followlng location; [~ Basement [] 1st FI
was examined on .]'tlIILl~l~ 28, 1982
FIXTURE
OUTLETS
DRYERS
IECEPTACLES SWITCHES
1 1
FIXTURES
NCAND~SCE NT FLUORESCENT
[~ 2nd FI. O~side Section Block
and found to be in compliance witk the requirements of this Board.
RANGES OVENS
Lot
EXHAUST PANS
OTHER APPARATUS:
?az~_l.~a~ds: l~Scir. ,12~amps.
1-G.F.I.
SYSTEMS
NO. OF FEET
S E R V I C E
I~ ~C~ A W O NO OF HI LEG A W O NO OF NEUTRALS
NO O E COND OF CC COND OF HI LEG
AWG
OF NEUTRAL
(Swimming Pool) This cer~ifi~m~e covers compliance at ~he date of inspection, oz~y. Because
of unusual environments it is advisable to have frequent test and/or repairs made by
a qualified person.
Manor Hill Lane, P.O. Box 627 Gm- ~ '
, , ~RAL ~MANAG?R
Cutchogue, N~Y~ 11935
e Per_
turn to the office of the Board f 0co~reqt. Inspector~ may be idenhfied by the~ credenhals.
FIELD INSPECTION [DATE COMMENTS
FOU~ATIO~ (~ s ~)
FO~ATION (2nd)
ROUGH F~ME &
PLYING
INS~ATION P~ N.Y.
STATE EN~GY
CO~E
FINAL
~DITIONAL CO~ENTS:
-~ 7 /jAH.'~ LAN£.
M IN
HOLE
top so,/
loam §roy
~and
~IMEN T
ONS ARE SHOWN THUS ~ o
r WATER ~4AIN .I NILES-+
~ER VICE =PRIVATE WELLS
REVISIONS
dULY I,I, 19~'7
MA Y 4, 1978
YOUNG & YOUNG
400 OSTRANDER AVENUE, RIVERHEAD,
ALDEN W. YOUNG
SURVEY for:
RO/TERT d. SCHWARZ ~ P/3T/?/Cl/~ /l
LOT L~ "M/NOR SUL~DIVISION OF WERN~
' ~ CUTCHOGUE ~O~H~oNL~E~
TOWN OF SOUTHOLD ' J THE TITLE
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-180:3
----- :
Disapproved
a/c
.............. .~-- .-~,.-~.. .............. // ...... ./.../;
(B6i~ing Inspector)
APPLICATION FOR BUILDING PERMIT
Application No, /'~ 7f~2 ~.. .......
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 atterations,.m'-t6Y'~r~q~tJ opt.~em~litio~s herein described.
The applicant agrees to comply with all applicable laws, ordinances~~t',.,h~llg 4de/r~nflfl/regulations, and to
admit authorized inspectors on premises and in buildings for necessary insp~fijl~.~
(Signature)ffa~plicant, , if a corporate)
", ~ (Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises . . .~....~... ~" . .~.~..Z.~.~.e'~'~ ~' ~'~"C'~'t~t"°"'q
(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 L~cense No.. ?...~..'.t~..fl: ..............
Plumber's License 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 Sect[on .... ./.g~... ....... Block .... ~ ........... Lot.
/.~.
Subdivision ./r~.-.~.~., .'/'~a~ ? ................. Filed Ma o ............... Lot ...............
(Name)
2. State existing use and ~ccupan~~ ~f premises and intended use and ~ccupancy ~f pr~p~sed c~nstructi~n:
b Intended use and occupancy ~ q:,~/.~. ~-t'~'~..~. . .,~. ~.~.. . ~
........... . ...................... .~/...F~.~: ...................
3. N~ture 'of work (check which applicable): New Building .......... Addition .......... Alteratio~t~.. .....
Rbpair ...... Remdval ........ ~ ..... Demolition Other Work..e.. 7.2.-77.. .....
i (Description)
4. E~timated 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 .....................
7. Dimensions of 9xisting structure's,, if any: Front ............... Rear .............. Depth ...............
Heightl ............... Nun~ber of Stories ........................................................
Dimensions of same structure with alterations or additions: Front ................. Rear ..................
Depth .................... I.. Height ...................... Number of Stories ......................
8. Dimensions of entire new construction: Front ............... Rear ............... Depth ...............
Height ............ ,,~[ .~r~f Stories ....... ~I~ 7~ '1~' ~ ................... ~ .............
9. Size of lot: Front .... .'ST..?.~.'..". ·- ........Rear ...................... Depth .....................
10. Date of Purchase ............................. Name of Former Owner .............................
.... I , · O ~' ·
1 1. Zone or use district in which pr~mlses are situated ....... /4 ................ ~)g') .....................
12. r)oes proposed construction viol~tie~any zoning law, ordinance or regulation: .....
Will lot be regraded ........ , .......... Will e fi r o
14. N~..~ ~fO ...... f~.r~ml ...... . ................. Address ...............................
~ Name of Architect ........ ,. ~ .......... Address ........ ~tto~.lt,,~. Phone No ................
Name of Contractor .~$ J i~ ~ Address ......
~ )~.t~F'/~k ..................... Phone No ................
PLOT DIAGRAM
Locate clearly and distinctly all. buildings, whether
property lines. Give street and block number or
interior or ~orner lot.
to deed,
and. indicate all set-back dimensions from
show street names and indicate whether
STATE OF NEW,~h~]~,~Zle2 e ~
COUNTY OF ...............
.../.~.~..~,... ~~; ........ being duly sworn, deposes and says that he is the applicant
(Name or, q'ndividual sigging contradOt
above named.
H ith ~ ......... ~ ...............................
(Contractor, agent, corporate officer, etc.)
of said owner ~gr owners, and is duly authorized to perform or have performed the said work and to make and file this
application;that ail 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 6f..
Ng.t,a~ ~Public,....,.~s..,~k ......