HomeMy WebLinkAbout10766-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N,Y.
Certificate Of Occupancy
No. Z10419 Date ..... l',,a r ~,a, 3,~... 19.83
THIS CERTIFIES that the building ................................................
Location of Property . 2570 Kin~. Street Oriont~ N.Y.
ho~s'o hid ..................... 's'tie~i ......................
County Tax Map No. 1000 Section ...... 0.~t0...Block ........ Q~ ..... Lot .... p.Q6. .........
Subdivision .............................. Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
· ,J.t~.ly..7. 19 ~,O an 10766 Z
............ , . '.. pursu t to which Building Permit No ......................
dated . . . .J.u.l..%..~., ................. 19..9. 0, was issued, and conforms to all of tile requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is .........
..... Addition..at ta.c. hlng..exis.t, to~. ~ ~,'.~,., .~ .to. ,n,.;~e.1 .l..t.~2 g ....................
The certificate is issued to~ ichard ?assanao t
..................... ?o¥.'e;', '/g&'di L '-' .................
of the aforesaid building.
Suffolk County Department of Health Approval ....N/9~ ....................................
UNDERWRITERS CERTIFICATE NO ....... N.4 9 7 7.,,A ..................................
Rev. 1/81
........... · '-.'- .... ,~. . t . ~ ......
Building Inspector
TOWN OF SOUTHOLD
BUILDING DEPART/v~ENT
TOWN CLERIC'S O):FICE
SOUTH'OLD, N. Y,
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON TIlE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 10766 Z
Permission is hereby granted to:
pursuant to application doted ....... .~..~.'~%..../. ................... , 19~.(~., ond opproved by
the
Building Inspector.
Building Inspector
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 w~th 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 Aprd 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 featu res.
2. Sworn statement of owner or previous owner as to us~, 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 or land use
3. Copy of certificate of occupancy $1.00
$5.00
Date ...~ .......................
New Budding ............. Old or Pre-existing Building ~ Vacant Land
.... ......... ..............................................
Location of Property ~ 7 /¥'/~ '~ 4/' '
House No, Street Hamlet
Owner or Owners of Property ............................................................
County Tax Map No, 1000 Section . . . .g". z, (~ Block .O ,~ Lot.
Subdiwsion ................................ Filed Map No ........... Lot No ..............
Permit No /~2~'~ 'Z~- Date of Permit ~./.~/..~..°,Applicant "~)¢//"~'~ ."'/¢'~'~'~
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 permit meets all applicable codes and regulations.
Rev 10-10-78
THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
VC[L. 85 JOHN STREET, NEW YORK, NEW Y~ORK 10038
Date ~ ~,
THIS CERTIFIES THAT
only the electrical equipment ~ described below and introduced by the applicant named on the able application number in the premises of
location;
~J Basement ~ 1st FI
,~,,,*ox.,nin~do., October 20~ 1980
FIXTURE FIXTURES
DRYERS
[~ 2nd FI. Section Block
and found to be in comphance with the requirements of this Board.
RANGES
Lot
OTHER APPARATUS
S E R V I C
I
AWG
OF NEUTRAL
Sal Prato
Gr.~m~ko~ ~N~Y. 11944
TNs cerhficate~ must not be altered in any ~anner; return to the office
FOR BUILI~
Board if (
GENERAl. MANAGER '
Per 1.]. "
FIELD IN~PECTION
1.
FOUNDATION
C0M~I.ENTS __ __
FOUNDATION
2.
ROUGH FRAME &
PLUMBING
INSULATION PER N.Y.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS:
FORM NO. 1
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
No.
Examined ~.~ t~, 19~..(~ Application /~.~t~. I.- ........
Disapproved a/c ....... '~ ...........................
APPLICATION FOR BUILDING PERMIT
Date ~ .~. c.<) .~.'. ..... , 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 Ordmance 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 auth°rized inspect°rs °n premises and in buildings f°r necessa~iiffli~ffii~li~can~, or name, if a '0 p' "~' Q~' · · · ' 77 '' ~' 'rv~' '~'c'~o~' ~ at'on)'i ......
.. ..... ..................
(Mailing address of applicant)
State whether applicant ~s owner, lessee, agent, architect, enginee al contr_.~_~/ lectrician, plumber or
builder.
(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 .... ~. g~.¥.c.' / ..............
Plumber's License No ........................
Electrician's License No ......................
Other Trade's License No .......
1. Locationofland on which proposed work will be done ....... ~.[..&4.J ...... ~.¢/...~..ff.(.~4 .~.....
House Number Street Hamlet
County Tax Map No. 1000 Section .... ?..~..4 ........ Block
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
¥/
b. Intended use and occupancy ....... ~.'~. ~..~..~J°~.... c~-~ .... ~.' .~.' ~t.O. ?..~.~/ .....................
3. Nature of work (check which a~plicable): N~w Building .......... Addition .......... Alteration ..........
Repair .............. Removal ...... ....~ ..... Demolition .............. Other Work ...............
: (Description)
4. LsUmated Cost ........ q< .~...'f'~. .......... Fee .........................
I (to be paid on ~ing this application)
w~ ng, numbe~ of d~llin nits ............... Number of d~eIling units on each ~oor
If garage, number of ~ars ..... ~
6. If business, ~ommercial or mixe~ occupancy, spe~y nature and ~xtent of each {yp~ of us~
7. D~ensions of~xisting sI~tur~s, ifany: Front ............... Rear .............. D~pth
H~ight ............... Number of Stories
' .'. .................. · ."...: ...... ............. .'
9. S~ze of lot. Front .......... q ........... Rear ...................... Depth ......................
10. ~)ate of Purchase ........ ~&~.mo.~ ............. NameofFomerOwmer ..~m~m.q,~ ................
11. Zone or use district in which premises are situated ........ ~2t~o.~ / ..............................
12. Does proposed construction vie ate any zoning law, ordinance or re~lation: ..... ~ .......................
13. Will lot be regraded ..... ~ .., ................... Will excess fill be removed from premises: Yes
14. Nme of Owner of premises .. ~ Cc ~..ff~?~dd~ess ...¢~(~¢.~ ....... Phone No.~&~ ~Z~...
Nme of Architect ...... ~P ¢.~. Address ................... Phone No ................
Nme .of Contractor ...... ~ ~*~. ~ [~fi2 ~ ~ ~dd~ ................... eho~
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from
and blockinumber or description according to deed, and show street names and indicate whether
property lines. Give street I
interior or corner lot.
STATE OF NEW~fORK, . , z.
COUNTY OF .~.A.. ,' S.S
...... q~. ~. ~....,~.0 (-t' ./'~.. ,~./~.~..~. ............... beil
(Name of individual sig~ing contract)
,, duly sworn, deposes and says that he the applicant
above named, i
' C., ./..
He is the ..................... I ............. ~ '~'' ' '~' '~'' ~' ~ ..........................
(Contra~r, agent, corporate officer, etc.)
of said owner or owners, ~d is dqly author~ed to perform or have perfomed the said work and to m~e ~d file ~is
application; that ~1 statements contained h this application are true to the best of his knowledge and belief; and that the
work will be perfomed in the m~ner set forth ~ the application filed therewith.
Sworn to before me this ~
............ .~..~ .... day ~f...~ .......... ,19~ .