HomeMy WebLinkAbout10730-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N,Y.
Certificate Of Occupancy
No..Zllg.l. 1 ......... Date .......... Jul.y..27 ............... 19 83.
THIS CERTIFIES that the building ..; screen, p. orch..addi.tion ....................
Location of Property ..... 6670 ........ Skur~k. Lang .............. C~tcho~ue .........
House No. Street Ham/et
County Tax Map No. 1000 Section ... &.04 ..... Block . .. 5 ........... Lot ....7 .............
Subdiviszon .............. × ................ Filed Map No .... ~...Lot No .... x .........
conforms substantially to the Apphcation for Building Permit heretofore filed in this office dated
June 9 1980. pursuant to which Building Permit No. 3.0730 Z
dated .... June- -13 ................ 1980 ·, was issued, and conforms to all of the requirements
of the applicable provis~ons of the law. The occupancy for which this certificate is issued is .........
..... scr.een, porch..addi.L, ion..L.o · eKi. stin9 .clwe&.tinq... .......................
The certificate ~s issued to FRANCIS & CATHERINE GALLAGHER
(owner, te~oa-or-t~m~
of the aforesaid building.
Suffolk County Department of Health Approval ............... .N/.R. ........................
UNDERWRITERS CERTIFICATE NO ..... NS? 2203
Building Inspector
Rev. 1/81
TOWN OF $OUTHOLD
BUILDING DEFARTMENT
TOWN CLERK'S OFFICE
SOUTH'OLD, N. Y.
BU~L.DJNG PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
~0730 Z Date ~ /
Permission is hereby granted to:__
..~.~....../~ ......... ~..~.....~. ........
.. ~,y~,~.~... ~.~?.. ...............
t~ ~'~~.~l~ ..... ~'~~ ........ ~~ ....... ~.// ........
,. ~ t~/~.....u~/~... ~.... 7~... ~, ~ ~ ~ ~... ~/~ ~....?. ..............
~ ~,,~ ,~,~ ~, .~ ....... ~~...~~.....~~~.~-~.
Building Inspector.
FORM NO. 6
TOWN OF SOUTHOLD
Building Department.
Town Hail
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. Th~s application must be filled in typewriter OR ink, and subr~itted 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 topographm 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. Commerclal buildings, Industrial buildings, Multiple Residences and similar buildings and installa-
tions, a cerUfmate of Code compliance from the Architect or Engineer responsible for the bufldin9.
5. Submit PIanning Board approval of completed site plan requirements where applicable.
B. For existing buildings (prior to Apr)l 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
topograph ic 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. ;
Co
Fees:
1. Certificate of occupancy $5.00
2, Certificate of occupancy on pre-ex/sting dwelling or
3. Copy of certificate of occupancy $1.00
land use
$5.00
New Buddm9 ............. Old or Pre-existing Building(2~) . _.~',. --= /Vacant Land ............
Location oS roper v .... ....... ....
Street H~m/et
County Tax Map No. 1000 Section ,,/C].~ ....... Block % Lot..~ ....
Subd~wsion "0¢ ' · .......... Filed M~p No. .Lot No.
Health Dept. Approval Labor Dept Approval
Unde~zHters Approval ......... Planning Board Approval ................ ~ , .~
~equest for Tem0or~rg Cerdf~cate .Final Certificate .~ -
Fee Submitted $. ~'
Construction on above described building
Applicant
Rev. 1D-10-78
ng THE NEW YORK BOARD OF FiPJE UNDERWRITERS
BUREAU OF ELECTRICITY
~,[L~'~; ~ 1~2 85 JOHN STREET, NEW YORK, NEW ~ORK 10038
1~573 - 82
.~,~ ~p,,,~.,.. ~o. ~.~,,~ N 572203
THIS CERTIFIES THAT
only the eleetr~l equ~nme~ ~ ~eseribed be~d~trodu~d by t~e~na~n t~ above applieatlon number ~n the pr~mlses of
was examined on fi~ Os' ~ ~ and found to be tn compliance with the kequirements of thts Board.
FIXTURE FIXTURES RANGES C(~OKINGDECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS
SYSTEMS
NO OF FEET
OTHER APPARATUS.
S E R V I C
NO OFEC¢CONDpR~' A W O
OF CC COND
NO OF HI-LE?,
AWG
OF HI LEG
NO OF NEUTRALS
AWO
OF NEUTRAL
Francis X. C~llagher
6670 Wm~k La.~ P.O. Box 3~
Gklt~ N.Y. Llg35
)rrect
IN ANY MANNER.
FOUNDATION
FOUNDATION (2nd)
2.
ROUGH FRAME&
PLUMBING
INSULATION PIR N.Y.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS:
FORM NO. 1
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1802
Examined q~2~/g~-.~., t/..~:..., 19 Application No./~.' .......
ApprovedJ~/d~-'~..../~ .... ,1 c~.~. Permit No./~. 7~.~. '
Disapproved a/c .... : .~7. '77 ......... : .............. ././ /
(Buildiffg Inspector)
APPLICATION FOR BUILDING PERMIT ¥
Date .~.~".d/. 57..df.'../.~.. 5.~)' 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 Bmlding 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 re/gulations, and to
admit authorized ~nspectors on premises and m buildings for necessary inspections. ,? (.~
.-?2. s b..
(Mailing addres~ of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.............................................................................
Name of owner of premises . ./~.~..~. ~..~../. ~... ~..~. (~...~L//..~..~././.~ ~/~2.~...g2~..-(.?..t~. 5 ./?. 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....~..~ ......... ~ ~r~
Plumber's License No ................. ~ ...
Electrician s License No.../(J~...~. ~.~.~'.. ,~..~ .~,~
Other Trade's License No .....................
Loc ion~folandonwhichproposedworkwillbedone..5~..~.~/~/../Q"(..d~,./~..,~/.~:.~ ( ~ 6 ~6.2 ) .....
}~;u~e.Z~i~.m~g~r.. .~¢~.... d]]d~...///./~., y..//~./S~r.¢~jb~.' .~: ~. D~..~.....~..'.~...~t~m/..,~). }~.~. '~.'~.-'' i i i~.-.', l: ....
County Tax Map No.1000 Section ...... ./? ./~. ...... Block ......... ~ ...... Lot... 7 ..............
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 . .5~.~. ........ .~..~.~-~.~' .... ~.~./~.~ ~. ..................................
b. Intended use and occupancy ........ .~."'~. '.~./~.~... ~..~....~. ~i'~.~.'.~;~'~2~ ./Y~/~/~J..~z~7~-~J~?~ ......
3. Nature of work (check which applicable): New Building .......... Addition..~. ...... Alteration ..........
Repair .............. Remoyal .............. Demolition .............. Other Work ...............
[ y (Description)
4. Estimated Cost . o?..~...~..d..: i .~..~9 ..................... Fee ......................................
I (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 mixedloccupancy, specify nature and extent of each ~type of use ............. .~ .......
7. Dimensions of existi[tg structure~, if any: Front.. 7~.~.~./. ...... Rear . J~.'~:J'f. ....... Depth . ,~.D..c).. ~. .......
Height . ./ ............ Numl?er 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 .. ?.6 / Depth ].~..
Height ............... Number of Stories ........................................................
9. Size of lot: Front .../F9 · ~..; .......... Rear .... /..~. ~ ............. Depth ./.~T.Q../ ..............
~. Date of Purchase . ./.~/.~ ..................... Name of Former Owner .'.~?.'7 .......................
~1. 1. Zone or use district in which premises are situated .....................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: ................................
13. Will lot be regraded ..... .Z(/..c). i .................. ~g.~ll excess fill be removed from premises: ~ No
14. Name bf Owner of premises . ff..~'~./~.~/..~.g~./2.//~)~/J~ess . ~ .~ .-x/..~..~?..~..~. Phone No.°?//~ :~'.~.-.~.~.c.-?.~
Name of Architect ........................... Address ................... Phone No ................
Name of Contractor ......... ................. Address ................... Phone No ................
PLOT DIAGRAM
Locate C/early and distinctly all Jbuildings, 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,
COUNTY OF ..................
................................................. being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is the ...................... ~ ...................................................................
: (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 of ..................... , 19...
Notary Public, . ................
I nO 5Z'~5~Z'' "' ' (Signature ompplic~t)
Oual~hed m Suffolk Coun~