HomeMy WebLinkAbout11208-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Buildin§ Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
Z10647
Date August 28 ~.1.
THIS CERTIFIES that the building ................................................
Location of Property 6910 Soundvtew Avenue, Southold, New York
House No. Street Ham/et
County Tax Map No. 1000 Section 055 .Block 09 .Lot 026.8
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
June 3 81
...................... 19 . . . pm'suant to which Building Permit No..1.1.~.Q.8.Z ..............
June 25 81
dated ............................ 19..., was issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for which tkis certificate is issued is .........
Inground Pool and Fence
The certificate is issued to Arnold R. Golz
..................... .....................
of the aforesaid building.
Suffolk County Department of Health Approval N/R
UNDERWRITERS CERTIFICATE NO. N524931
Building Inspector
Rev. 1/81
'(THIS PERM;IT /~UST BE KEPT ON
Permission is hereby granted to:
F~LL
COMPLETION OF THE WORK AUTHOR ZED)
'and ~pprov~l by the
1.
FOUNDATION (1st)
FOUNDATION (2nd)
ROUGH FRAME &
PLUMBING
3.
INSULATION PER N. Y.
STATE ENERGY
qODE
FINAL
ADDITIONAL COMMENTS:
FORM NO. 6
TOWN OF SOUTHOLD
I3uiJding Department
Town Hall
$outhold, N.Y, 13971
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 buikJings 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 Flealth Dept. of water supp{y and sewerage d sposal-(S-9 form or equal).
· Approval of electrical installation from Board of Fire UnderWriters.
4.Commercial buildings, Industrial buildings, Multiple Residences aod similar buildings and installa-
tions, a certificate of Code cornpliance from the Architect or Engineer responsible for the building.
5.Submit Plann ng t3oard approval of completed site plan requirements where applicable,
B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and 'pre-ex'sting"
land uses:
1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or
topograph c features.
2.Sworn statemen[ of owner or previous owner as to use, occupancy and condition of buildings,
3.Date of any housing code or safety inspection of buildi?gs Or prerf~ises, or other pertinent informa-
tion required to prepare a certificate.
C. Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or I,'-md use $5.00
3. Copy of certificate of occupancy $1.00
New Building~.U.v'.' .... ; .... Old or P/~e~existing Buildings, ....... Vacar(i/t,~and ....
HolJ,~e No· / ~ 11 ~ Street ............... -' ~ i L ....
Owner or
OwnersofProperW., .,<~..~,~ .........................
County Tax Map No. 1000 Section , dt~,..~ ..... Block''~,~, ,~ ...... Lot..
· of Permit~ .... Applicant ..... ¢ ....
Hea th Dept Approva --- ~ Labor De t A ro '
Underwriters Approval .~ .......... Plannin~ Board Annrnwl ~ ~ \~'
Request [or Temporary Cer t_ificate ................... Fha Cert ,icate
.onstruction on above described building and per~i~~[~/~d i:~gu lations,
'* ' BO LD NG DEPT COPY OF APPLICATION FORM 46-EL, NEW YOR~ BOAR~ ~F F~ U~DERW~ITERS,
'~ ~ - F~LETHISCOPYWtTHBU LDNG~DEP~T:~NRE~ED~ :' : ~: ~ ~;
NAME
SUPPL ED ~;': "" {
8Y ~ ~ ' ', ' FROM ~EIR ' ~
qLD~ REMODELED ~ .m~
LIST BELOW ALL EOU RMENI , , ~
: NdMEEB OF OU!TLETS N°' °' FiXtur" ~ ~ ' i ~;.~'A
Lamp ~ept~c~ MOTORS ~ T~R~ tiff ITS
tibn~ ~em~ .'~11 R~pt~l~ awitch Pende~ Bracket NO. Y~ Each:. ~'' ;Each
Out*
RE~R~S:'~Li~0TH~R E~ECTRICAL DEVICES NOT S~T FORTH ABOVE ~.. ' ~ , ~. ~ : D~ NOT USE T~IS SPACE,
fi
~F'~R~" ]~ ' CONCEALEC TRANS~RMER~ OF'
*[AVOIb-, OEL~YJBY, GIVING FULL AND A~CUR~TE INFO~MXTION. ALL ~PAC~ ~Q~.BE FI~L~
1OOO663
THE NEW YORK BOARD OF FiRiE UNDERWRITERS
BUREAU OF ELECTRICITY
JI~E[ 24, ].9~! 85 JOHN STREET, NEW YORK, NEW ~'ORK 100:~8
Date Application No. on file ~'~5L81
THIS CERTIFIES THAT
only the electrical eq~.~ ~nt ~s ~s~rlbed ~ele~ a~ introd~ed by ~he ~pli~a~Lna~d o~ ~ above appljcatio~ number in tke premises of
in the/ollowing location; [] Basement [] 1st FI. [] 2nd FI. C~t~Jl(~ Section Block Lot
was examined on J1.~Lr~ 18, 1981. and fou~td to be in c~tnpliq~ce witk tke ~equirements of this Board.
FIXTURE
OUTLETS
RECEPTACLES SWITCHES
1 2
FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS
FLUORESCENT VAPOR
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME'CLOCKS UNIT HEATERS MULTI-OUTLET
SYSTEMS
NO. OF FEET
DIMMERS
SERVICE DISCONNECT S E R ~ V I ' C
OTHER APPARATUS:
NO, OF CC CO~D, A.W.G. J NO OF HILEG A W.G. NO.OF NEUTRALS A.W.G
PER ~ OF CC COND OF HI.LEG OF NEUTRAL
($~ Pool) This certificate covers c~mpliance at ~e date OE ~mpec~i~n c~ly.
Becauae of unusual env2ror~ents i~ is advisable to have frequen~ tes~ ~d/or
repairs ~r~ds
This
Glenn It. Bradloy
RFD 169 Hot,on A%~.
¥mttit3~k~ N. Y. ].1952
L~e: ~!227
e must not be altered in any manner; return to the office of th Board ifi rrpct, ma), be identified
lheir ~edentlals.
IN ANY MANNER.
FORM NO, 1
TOWN OF SOUTHO~D
BIIILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N,Y, 11971
TEL.: 765-1803
ExaminedxJ~g-~..2.5.7 ...... 19 q~.( ,~ Application No././, ,~.d. ~.. .......
^pprov / . r. ..... 19 .PermitSo. /
Disappr~ed a/c ........ -~... · .~"~-,'~' ..................... /
(Building Inspector)
Date .................. , 1
IN STRUCTIONS
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 to schedule.
b. Plot plan showing location of lot and of buildings on premiseg, relationship to adjoining premises or public stre~
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this apl:
cation·
c. The work covered by this application may not be comnrenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector wilt isSUe a Building Permit to the applicant· Such penn
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 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 of the Town of Southold, Suffolk County, New York, an~, other applicable Laws, Ordinances
Regulations, for the construction .o.f buildings, additions or atteratiofis, or for rJ~fig~al or dem~olitio$ras herein describe
The applicant ,agrees ~o comply with all applicable laws, ordinances, buildin~_.~,~housing~eode,,~d regulations, and
admitautb, orized inspectors on premises and in buildings for necessary insp~. . ....... ~,. '"- .............. ~.~ {~'"
(Signature of applicant/or'name, if6 corporati n)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, eng~nee~electncmn,
plumber
or
build:
;22/'m;;, · ...................................
If ap~rized officer.
.... ~ ~ (Name and itle of corporate officer) ......
Builder's License No ..........................
Plumber's License No .........................
Other Trade's License No .....................
I. Location of land on which proposed work will be done ..............
.......... ¥7/.0. ..................................................................
House Number Street ttamlet
· ~':'-'-~7-: .. Block.. ~ .... Lot .....
Subdivisioa...~)/.ff~/~).x~.(~.a;~; Lt : Filed Map No. . .~ a,.¢.. Lot. ..] .......
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
b. Intended use and occupancy .................... .. · .. · .. · · ...'.-
3. Nature of work (check which applicable): New Building .......... Addition.. ! ....... Alteration .. ~ .......
Repair .............. Removal ............ Demolition ........... ~.. Other Work ...............
(to be paid on filing this application)
' " each floor
5 If dwelling number of dwelling units Number of dwelhng units on
If garage, number of cars ........................................... , ............................
5. If business, commercial or mixed occupancy, specify nature and extent of each type of use ...................
7. Dimensions of existing structures, if any: Front ............... Rear ....... ; ....... Depth ..............
Height ............... Number of Stories ............................ ' ...........................
Dimensions of same structure with alterations or additions: Front ........... i ..... Rear .................
Depth ...................... Height ...................... Number o~ Stories ............. _. .......
3. Dimensions of. entire new construction: Front ............... Rear ....... i ....... Depth ..............
3. Size of lot: Front ............... ar ............. epth ...........
I. Date of Purchase ............................. Name of Former Owner ! ............................
1. Zone or use district in which premises are situated ..... ; .................. i ............................
!. Does proposed construction violate any zoning law, ordinance or regulation: ...; ............................
t. Will lot be regraded ............................ Will ex.~ess fill be removed from premises: Yes ~ No
*. Nmne of Owner of premises ~.g/I/lJ./~.. ffr~g2,... Address ~.'l~.~.q~& .... J ..... Phone Iqo.-~.. ~.q~. Y./. 7~.q...
Name of Architect . .. Address J . Phone No ..............
Nmne of Contractor . w~---~. ...........Address .. ~ ........ Phone No. oS~.~,ff, f. ~ .~..d.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from
:operty lines. Give street and block number or description according to deed, m~d show street names and indicate whether
~terior or corner lot.
t5-o
says that he is the applicant
e is the
(Contractor, agent, corporate officeri etc.)
f said owner or owners, and is duly authorized to perform or have perfonnedlthe said work and to make and file this
cplication; that all statements contained in this application are true to th~ best,'of his lmowledge and belief; and that the
,ork will be performed in the manner set forth in the application filed therewith.
worn to betilre me this . '
........ ........