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HomeMy WebLinkAbout10770-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building ................................................ Location of Property 980 OaR D~lve ~ou~hold, NoY. h3~s'~ ~io: ....................... 's't/e;i ....................... h~l'oi ........... 0'I 006 County Tax Map No. 1000 Sectiou 077 .Block .............. Lot ................. .............................. or 297 & Subdivision (icc se Bay Es$~.te S .Filed Map No ......... Lot No?~. '.~6{;' '3'{J0 ' ' ' conforms substantially to the Apphcatlon for Building Permit heretofore filed in this office dated ....... .~..l~.J:.~..~. ...... , 19~.0.. pursuant to which Building Permit No....~.°.T?9.z. ........... dated .... ~.?..1~/..~. ................. 19~.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 ......... One Family Dwelling with addition and alteration Cha~le s T~ownsell The certificate is issued to .................... [ohin'o'r/~ ..................... of the aforesaid building. Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO .............. P.~.~.~ ............................ Building Inspector Rev 4/79 FORH NO. 2 TOWN O~ $O~THOLD BUILDING D~:PARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10770 Z Permission is hereby granted to: , ·d.~':~.~...~.~z~...b-.~.-~...,..../~ .... ~.......6~ .......... ~ ....... .... .C.~...~z~.~.~..~..~.....~ .... ,o ....~.....:.:~.....~....~.~....~x~2.z.e.~...a:....~.c~ .... .... ~....~.~z~g....~z....~=.~...~ffz~ ................................ .t pr~m~e~ ~o~t~d ot ......... ~E ........ ~4.~...../(~..- ............. ~~.~...~..~ ...... ................................. ~.~ ...... ~.,~.,.., ....... ~ ...................................................................... ~,~ ....... Z,.~, ............................................................................ ~ ..................................... ~ .... ~,~ ~o ~,,~,on ~ed ......... ~Z~....Z ................. , ,~.~.., ~ ~rov~d ~ ~h~ Building Inspector· Bui~ing 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: I. 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. 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 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. 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 . ~JMq. y. ~-.cx~ ~.. ~ 9~-IQ ......... New Building ............. Old or Pre-existing Building ...¥~... Vacant Land ............. Location of Property .................... 0~}¢. ,~_~:'[ Ye .................. ~[c~ Lt J;~Lo.J. r~ ......... House No, Street Hamlet Owner or Owners of Property . .~ [.q.{l.y~ ~..'~[?{.)%~1.~ ~._. ..................................... County Tax Map No. 1000 Section ...©77 ......... Block ... F).~ .......... Lot.. ,0.0.(~ .......... Subdivision...(~(.}9~,q. U.~.h .-.~-? .%-,.".,~,., .......... Filed Map No ........... Lot No. ~':..¢?-!-..2.~.. ~!~,,..~.o% ~00 Permit No..'ID.'~.70.... Date of Permit ·, ./.~/..)w..Applicant. ,,L~.e,Q.. ,.~.e..,,]~.:L~.,~. ~,g,,~(t ~,r~.~. .'-n'[ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate .. ¼t~[NXX][)~, ............ Fee Submitted $ ............................. Construction on above described building and permit meets all applicable codes and regulations. THE NEW YORK BOARD OF FIRE UNDERWRITERS T,r%R~ BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK NEW YORK 10038 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the .appli~anJ tian~fl ~1~ the above application number in the t~remises o ~:ow~ell, Oa~ Dr~ At end of ~, ~)~l~[1Old~ [~.Y. - '~ in the following location; [] Basement ~ I st FI. DRYERS [] 2nd FI. Section Block and found to be in compliance with the requirements of this Board. RANGES OVENS SYSTEMS E Lot EXHAUST FANe, OTHER APPARATUS S E AWG OF CC COND I C NO OF Hi-LEG A W G NO OF NEUTRALS/ A W O OF HI LEG I OF NEUTRAL 1680 %~ash~n~m'~ Z'ohc~J~a, N.Y. 11716 Th,s certificate must not be aJtered In any manner; return to th COPY FOR BUILDING kLe. 627 E office of the Board f COPY OF GENERAL MANAGEI~ Inspector may be ~denhfied by their IN ANY MANNER, FIELD ~NSPE~TION COMMENTS FOUNDATION FOUNDATION 2. ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY COpE FINAL ADDITIONAL COMME_NT_ S~__ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 . .:. .... , _, ....... ^pprowd '&:7"__ _: .... ,19 ee it (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .d'ulF..~ .......... , 19 ,.,0. 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 ~nspection 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) ?~:~ r~ ,~ Imne~..Cul;cho,(~. e. .;',~,.Y... ........... · ,.,O..~ O .... :~ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· ~'~en e~c~a ] C o~,)Z~ o-'cor . ................................. Name of owner of premises . :."r!~,?.~?.s.. T?.o?x~D ~9:1.~ .................................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer· ..... .(~:qOO!';.q . ,).b. L P U S , . ,'?r:? ',.; :i .d.(~ ~ !: ........... (Name and title of corporate officer) Builder's License No. .'fi'l. .................. Pluznber's License No ........................ Electric,an's License No... J ':~2.?..~YJ ............. Other Trade's License No ...................... 1. Location of land on which proposed work wdl be done. :. '[ .):..-'-... ~. :_,.qu..~:~p.~.c!. ........................... .................... 0c, k..l'~] v'o ........................ ,ou ~n~],(L .................... House Number Street Hamlet County Tax Map No 1000 Section ....~.7..7 ......... mook ..... O/ ........... ........... Subdivision .¢i o. 95.q .?~7.: ~ s .Lf~.2.q 5 ............... Filed Map No ............... Lot -~, O.,':. ~.97..4:. '[,o'b (Name) 500 2. State existing use and occupaucy of premises and ~ntended use and occupancy of proposed construction: a. Existing use and occupancy :k: t'ee~ed '~ ' ............. 99:- 9: .................................................. b. Intended use and occupancy .... ,.oe.3.o $ eft..po~-'c.n' ............. . ................................. interior or coxa~?.lgL.~ 3. Nature of work (check which applicable): New Building .......... Addition . ,X~(.gX~'.. Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 99 4. Estimated Cost ....... : ........................ Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelhng umts ............... Number of dwelling units on each floor ................ If garage number of cars 6. If business, commercial or mixed 9ccupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures,!if any: Front 5.2 ............ Rear .32 ........... Depth . 2.9 ............ Height .1¢.~ ............ Numb6r of Stories ...o. 1¢¢ .................................................. 'Dimensions of same structure with alterations or additions: Front Rear Depth ' Height Number of Stories 8. Dimensions of entire new construqhon: Front...no~e ........ Rear . .'1 ~ ........... Depth .. ~, ........... Height .... ~../4.~ ........Numb6r of Stories .......... 9~.e ........................................... 9. Size of lot: Front ff.~. I Rear ff..~ ..... Depth . .'l~fi.. -I-..o.17..-... 10. Date of Purchase unknown i Name of Former Owner 11. Zone or use district in which pre~r~ises are situated... A ................................................. 12. Does proposed construction viola~e any zoning law, ordinance or regulation: . .r~Q .......................... 13. Will lot be regraded ... B. cl .... , .................. Will excess fill be removed from premises: Yes No 14. Name of Owner of premiseEhar~e s. Tr. ovzasall. Address ~3ak. Df. ire ........ Phone No ................ Name of Architect .. ............. Address ................... Phone No ................ Name of Contractor ~,,t...B, I~lg.,. .............. Address . .~ 0.~. L~r~e ........ Phone No7~./+.-.50 ~'0 ....... PLOT DIAGRAM Locate cl~ariy and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block nflmber or description according to deed, and show street names and indicate whether Sr^T .OF ...... G~orge..Ah~o.r.s .......................... (Name of individual signing contract) above named. being duly sworn, deposes and says ~hat he is the applicant He is the ..... C°n~c~'act°.~ ......... '" ........ ] ' ' (Contractor, agent, corporate office~, etc.) of said owner or owners, and is dulx authorized to perform or have performed the said work and to make and file this application; that all statements conttdned 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 ........... .......... , 19aC~... /~_~/....dayof~' ~ ~ No, 5~'4524771~ ........... ~'. .......................