HomeMy WebLinkAbout11360-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMEN!
Office of _the Building Inspector-
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. Zl1539 Date March 9 1983
THIS CERTIFIES that the building . Accessary
Location of Property ....G.O.p...lVJ.~.p. 1. ?.
House No. Street Ham/et
County Tax Map No. 1000 Section 407 .Block 02 .Lot 04/4
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
Sept ember ~ 19 .~.'1. pursuant to which Building Permit No, ~ ~ 360Z
dated ...S.e.p.~..e.m.~.e.~...~ ............. 19 .~.?, 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 .........
....... .a. ??..e.~.r., F.~.r.~..~?..~.$.~ .a..~.~..~.~..~.%.o., .~.~?~ ............................
The certificate is issued to ,..0.o.~.~.)~..~.~.J:n..e..V.I.o..u.~.e.~7 .................................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval .~../..A ......................................
UNDERWRITERS CERTIFICATE NO .......... N 5 c ;', c e
Building Inspector
Rev. 1/81
FORM NO.
TOWN
BUILDIN~
TOWH HALL
SOUTHOLD, N~ Y.
].1360
BUILDING P,ERA4,1T,
(THIS PERMIT MUST BE KEPT ON TH,E PREMISES UNTIL'lULL
COMPLETION OF THE WORK AUTHORIZED) :
Z Date
Permissior is hereby granted to: ~ x.~
purshont {o opplic~tion datod ........ ~.~}..~..,.~.....~ 1¢ 5, OhO Opprov~ by the
B~ildlng Ifispector.
Ac
FORM NO. 6
' TOWN OF SOUTHOLD
Building Depar~men~
Town Hall
SouthoJd, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
This application must be filled in typewriter OR ink, and subr~itted [n duplicate to the Building Inspec-
tor with the foHowin~c; for new bui!din§s or Raw use: '
1. Final su,~/ey of property with accurate location of all buildings, property lines, streets, and unusua,
natural or topographic fe3tures.
2. Final approvaJ of Heaith Dept. Of water suop v and seweraee d soosaf--(S-9 form or equal).
3. App¢oval of electrical instadatJon from Boded'of Fire Unde~rwrJt~rs.
4. Commercial buildin§s, Industrbl buildings, Multiple Residences and similar bufldine~ and installa-
tions, a certificate of Code compliance from the Architect or Engineer responsible for the building.
5. Submi[Fqanning Board approve of completed site plan requlrements where applicable.
For existing buildings (prior to Aprll 1957), Non-conforming uses, or buiidines and "pre-ex/sting"
land uses:
1. Accurate sur~/ey 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. Data of any housing code or safety inspection of buildings or premises, or other pertinent inferred.
tion required to prepare a ce,qifJcate,
Fees:
1. Cerdficate of occupancy S5.00
2. Certificate of occupancy on pre-exlsdng dwed[ng or land use $5.00
3. Copy of certificate of occupancy $1.00
(Cji ~?~ Date.,
New BuRding . Old or Pre-existing Buiidino(Z} ........ ~/Vacant Land
' ..... .......
Location of Property . ~ ~ '
Hou~ No. Seres r Ham/et
Owner or Owners of Property O ......... /~¢~... G~(?.,.
............ . .........
County Tax MapNe 1000Section~ ].~.'2 ~!ock ..~ % .. Lot..
Subdivision ................................
/~ ~60 ~ ~ . .FiledMap'No...: ....... LotNo ..' .......
, -..
H tth D pt App I '
ea e , rove ............. ~ - · L b D App 1
........ a or apt, rove ..................... ..,,.
Undee,vriters Approval .............. '. - · Planning Board Approval ..................
Request for Temporary Cerdj.icate ......... '
, ~ / .......... Final Certificate ........ - .........
Fee Submitted S .... ~ .... ~, ..............
Construction on above ' ' '~'
described building and permit'meets ~11 app~abl~odes and regular o~s
pphcant . ... ', ,.
THE NEW YORK BOARD OF FIRE UNDERWRITERS
~ BUREAU OF ELECTRICITY
~.~'Ch ~ ]~J~ 85 JOHN STREET, NEW YORK,. NEW YORK~)~:~0~/8~,10038
B.te ~,,,,llcatlon ~o. o,~ile ~m:~O N § 9 5 0 g 7
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of
C. G, V~outely, t~5 i~tv Lane (o£f of G~e~d Ave,) M~ttituc~,
in the followlng location; [] Basement [] 1st Fl. [] 2nd FI. Gi~'~ Section Block Lot
F~.~bl~a~ 28~ 19ff~
and found to be itt compliance with the requirements of this Board.
FIXTURE FIXTURES RANGES OVENS EXHAUST FAN
OUTLETS SWITCHES FLUORESCENT
3
DRYERS
SYSTEMS
OTHER APPARATUS:
R V I C
R
OF CC COND.
NO. OF HI4EG
OF HI-LEG
NO OF NEUTRALS
OF NEUTRAL
C. G, Vloutety
~ i~ple
~'~tltuck~ N.Y. 11952 Lic#
11
This certificate must not be altered in any manneo return to the office of the Board if incorrect Inspectors may be identifle~X~by~tfi'eir credentials.
COPY FOR BUILDI , THIS COPY ( ~D !N ANdY MANNER.
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
17 June 1982
TEL. 765-1802
Mr. John K. Bory
94 Greenport Avenue
- Applicant
?bis ia ~o~a~vise you that the job under Bu±ld±ag
Permit No. //~°~ issued tO,Tohn
Borv
on Q_~_8]~or ~wo a~r ~r~e -is completed and
a f£nal inspectio~ ha~ h~s' not/-~ been done.
In order to complete this file, it is necessary that
a Certificate of Occupancy be issued. Please fill out the
enclosed form(s), return same to the above office with a
check for $5.00 payable to the Town of Southold. Please
indicate to whom the Certificate of Occupancy is to be mailed,
and arrange with this office for an inspection date.
Thank you for your prompt attention.
Very truly yours
Victor Lessard
Administrator
VL:ec
Enclosures
r
I
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N.Y.
NOTICE OF DISAPPROVAL
File No ................................
Date
!
PLEASE TAKE NOTICE that your application dated . .L~<&'~./.../. ............ , 19
for permit to construct. ~..~<~:;-~.~. ~(..~.. . :.Z,. / ..................... at
h[gt3s'e ~io~ ............ 7' ' Street / Ham/eft
Connty Xa,~ Map No. 1000 Seotio,~ , ./;¢~.7 ....... Blook ... ~ ...... Lot ...O. (.~
Subdivision ................. Filed Map No ................. Lot No ..................
is returned herewith and disapproved on the following grounds ~'~,~rf~....~.~'~.RT~'~.
. ~?~ ~. ~? .... ~2 ~ z~ z~ ........ ~.~... ~...z~
....~. ~: .~... ~...~.:~ ..........................
/ / Buildin~ Inspecto/~~~
RV 1/80
FIELD INSpECTiON COMMENTS ~ '4 '
FOUNDATION (1st)
FOUNDATION (2nd)
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
G~DE
FINAL
ADDITIONAL COMMENTS:
HOTEl
II IMONUMENT
0 \
SURVEY FOR
CONSTANTINE VLOUTELY
MATTITUCK
TOWN OF SOUTHOLD GUARANTEED TO:
SUFF. CO. N.Y. SOUTNOLD. SAVIN6S DANK
CONSTANT{NE VLOUT EL'Y
SCALE ' I" = 50' GUARANTEED TITLE DIVISION
OF AMERICAN TITLE
MAY 29, i968 ~.INSURANCE CO. '
JULY 16, 1970 PROFESS ER AND
LAND DURVEYORt..N.Y.S, LIC,NO. ~845
, RIVERHEAD~ N, Y. ,
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1802
Approved . .:. . ...... l¢/. Permit
Disapproved a/c ...... 7;...-'-'~. · ........................ .,/ '
, L (Buildm= inspector)
APPLICATION FOR BUILDING PERMIT
Application No./.I/.~.'~/.~ .......
Date ~'~ P"'
INSTRUCTIONS
a. This application must be completely filled in 'by typewriter or in ink and submitted in triplicate to the Buildi
Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according te schedule.
b. Plot plan showing location of lot and of buildings on premises, relationsbip to adjoini~g premises or public stre~
or areas, and giving a detailed description of layout of property must be drawn on the diagam which is part of this apt:
cation.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon apprcval of this application, the Building Inspector will issue a Building Permit to the applicant. Such pern
sEall be kept on the premises available for inspection tI'.roughout the work.
e. No building shalI be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupan
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 t
Building Zone Ordinance o£ the Town of Soutbold, Suffolk County, New York, and other applicable Laws, Ordinances
Rcg,_dations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe
The applicant agrees to comply with ail applicable laws, ordinances, building code, housing code, and regulations, and
admit authorized inspectors on premises and in buildings for necessary inspections.
........... .................
~~pplicant, or~;a corporation)
(Mail ng address of applicant) ,//~/o ~
State whether applicant is oxvner, lessee, agent, arctfitect, engineer, general contractor, electrician, plumber or build,
Nane of owner of premises .~-3!:7..d~. ~../T'-,~t, tl/ZT..d, dt!Y7 .............................................
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
. ...... L?...z.4 ,, e_)
Builder's
License
No.
Plmnber's License No .........................
Electrician's License No. /~... ~.~/~'~¢-?r'~/
Other Trade's License No ......................
1. Location of land on which proposed work will be done ..... .t~'/.O., ./ff./.. ~.../7-..~, .~--.. ~7~.,0....,'5~..~..
House Number Street Hamlet
County Tax Map No. 10O0Section ... / 0.7. Block ' .~ Lot.. /.~..
Subdivision ..................................... Filed Map No ............... Lot ..............
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed constrtlction:
a. Existing use and occupancy .... ~..4Z'.~,~./.d~ .~.../'-~./~ .~.
b. Intended use and occupancy....,~... ~7.,4~...~,.~27~-../~..~0~'7~.. ,,~.D!J~'~ .~,, ~. ,--.~.~,~,~, ..........
Nature of xvork (clieck which applicable
Repair .............. Removal .,.
o
Estimated Cost ......... r.O,,O. .....
;. If'dwelling, number of dwelling units .,
If' garage, number of cars .... ~ .....
i. If' business, commercial or mixed occupa
I. Dimensions of existing structures, if any:
l-leigt~t , . ./.~..~ .........Num bet of St
Dimensions of same structure with altera
Depth .................... ... Iteigll
:L Dimensions of entire new construction: I
Height . .~.,~../ ......... Number of
~. Size oflot: Front . ./.~.q~.r. .......
). Date df Purchase ................
l. Zone or use distr/ct in wbicli premises,
.>. Does proposed construction violate any:
L Will lot be regraded . .~..
L Name of Owner of
Name of Architect
Name of Contractor
New Building .......... Addition .......... Alteration ..........
.... Demolition .............. Other Work ...............
8~k . _ / 'iD (Description)
(to be paid on filing this application)
............ Number of dwelling units on each floor ...............
Front.. k~'74~.' iT ./.~. .... Rear .............. Depth
3ries ... ~ .................................................
ions or additions: Front ................. Rear ................
~ . ................ Number of Stories ....................
/.
... Rear ../. O.,.~ .~. ?....' ....... Depth ....... ..~..7 ......
......... Name of Former Owner .......... ~ ...... ~ .........
situated ................................... ". ...............
ordinance or regulation/5 . ..,ft,t'~... ~ ................... ../.
· Will excess fill beiemoved from premises: ' Yest.,/No
Address ................... Phone No ................
....... Address ................... Phone No ................
PLOT DIAG RAM
Locate clearly and distinctly MI buildinl whether existing or proposed, an&indicate all set-back dimensions from
roperty lilies. Giv? street and block number )r description according to de sliow street names and indicate whether
.terior or corner lot.
1'ATE OF NE~~ S S /
OUNTY OF ..... F-ff' ''_ ...... '
..... ~/~./3:/... ,e~.-...~O~ ................. being duly sworn, deposes and says that he is the applicant
(Name ofindMdual sigfi~g co~t ~ct)
)eve nalned.
e is tli .. ...................................................................
f sakl owner or owners, and is duly authol
)plication; that all statements contained in
'ork will be performed in the manner set for~
worn to before me this
' / of.
....................... day
Nota~ Public, State of Ne~ Yo~
NO. 52-0344963 Suffolk Coun~
~mmiss}o9 Expires March 3~,
Contractor, agent, corporate officer, etc.)
ized to perform ,or have performed the said work and to m~e and file this
this application are true to the best of his knowledge and belief; and that the
hi tlie application filed therewitli.