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HomeMy WebLinkAbout11242-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No Z 1 2 6 3 3 Date ....... addition THIS CERTIFIES that the building ................................................ /~7260~ Herren Lane Southold Location of Property · Street Ham/et ........... Block ............... Lot ................. County Tax Map No. 1000 Section . 56 3 11 x Filed Map No x. Lot No x Subdivision ..................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated June 23 19.8.1 h Building P itN 11262Z ............ . . ...... .. . pnrsuanttowhic erin o ..................... . dated ............ 2 19.81 d d fo tl of the dt) ly .................. was issue , an con rms to a requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Additi. on, to. existing dwelling. JOHN & ANN TARTAGLIA The certificate is issued to ........................................................... (owner, ~=cc~r-tenent)~ of the aforesaid building. N/A Suffolk County Department of Health Approval .......................................... N,5.3 1.023 UNDERWRITERS CERTIFICATE NO ............................................... Building Inspector Rev. 1/81 permissiomis hereby granfed to: BU BUILDING (THIS PERMIT MUST BE KEPT ON COMPLETIOI~I O~ THE WORK AUTH&IZE6Y 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 subn~itted in duplicate to the Building Inspec- tor with the foilowlng; for new buildings 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 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 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 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 premisest or other pertinent informa- tion required to prepare a certificate. Fees: -- 1. Certificate of occupancy (,_$5,0-0"-.,,) 2. Certificate of occupancy on p~ng dwelling 3. Copy of certificate of occupancy $1.00 or land use $5.00 New Building ............. Old or Pre-existing Building(X); ........ ~ ZVacant Land Location of Property . ..~.. ~.~. ............................ : ......... .~:-~' ........ House No. Street Ham/et Owner or Owners of Property .... ~?. f~ ,-Z ~¢.~__./~ ~ County Tax Map No. I000 Section . ~-. ~.'. Block '?. Lot Subdivision ................................. Filed Map No...; ....... Lot No PermitNo ........... Oate of Permit ....... Applicant .,~.~....~,4/.'/-z/,...~. ,~,~,~..- Health Dept. Approval ........................ Labor Dept. Approval ...................... ,., Underwriters Approval ........................ Planning Board Approval .................. ~ ,. L Request for Temporary Certificate ..................... Final Certificate ........ - ......... - Fee Submitted $ ............................. Construction on above described, building and pern~it'm, eets all ~.c .~_ . able~codes and regulations. R.,. 10.10-78 APPlicant .... "~' ' "''~' '~' "" .......................... ~0~,046~ THE NEW YORK BOARD OF Fl!RE UNDERWRITERS I~ BUREAU OF ELECTRICITY ~- ,~J./~L~tT. il, '[~}. ' 85 JOHN STREET, NEW YORK, NE~7~ORK. 1OO3~[ THIS CERTIFIES THAT only the electrical equipment as described below and introduced by tim applicant na~ed on the able application number in the premises of ~k~. JoVan T~rC~gl~, 7~) Hort:~ l~ S~o%d, ~ ~.,.mod o~ ~:~u~t 6 / 1981 ..d yo..d ~o ~ m ~o.~ ~.~.~ .~ ~q.~o~.~ of V,~$ ~o~d, RXTURE OUTLETS ~ECEPTACLES SWITCHES 4 3 FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS FLUORESCENT DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS UNU~ HEALERS MULB~OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R V I C OTHER APPARATUS: 1,..G.~ NO OF CC COND A w.o. NO OF HFLEG A. WG. NO, OF NEUTRALS A, WG Co. N.Y'. ].1741 This certificate must not be a{tered in any manner; return to the office . co,, 50" Board if; may be identified by their credentials. IN ANY MANNER. FIELD INSPECt'ION ~ FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY FINAL DATE COMMENTS '.~..m~ ADDITIONAL COMMENTS: FORM NO, I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ' SOUTHOLD, N.Y. 11971 d .~,. ~. TEL.: 765-1802 Examine d ., 1 .~../. , ~ (BuildilSg Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No. ~/d .~..~. ...... DatJddd~L. .~.~... 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 accordi~lg ~o schedule· b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stree or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this apF cation. c. The worh 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 peru 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 sh~ll 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, and other applicable Laws, Ordinances Regulations, for tile construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with alt applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. . ...... (Siguature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build~ Name of owner of premises .~..~/~.~. (as on the tax roll or latest deed) If applica 's a corporation, signa re?f duly authorized officer. (Name and title of corporate officer) Builder's License No. ,. c< ~. · .,.,~.~. ,/..~..-: .~. ..... ~ '~'~ Plumber's License No..$r'/t ~..~J~co ~ .[ .... Electrician's License No. '.T~.'t. 7..~p,c~../p.?..~...~.~--.~C . Other Trade's License No ............. ' ......... 1. Location of.land on which proposed work will be done ........... ................................ · .7 ........... ................ ......................... House Number Street Hamlet County Tax,Map No 1000 Section ..... ock .............. Lot ........... Subdivision Filed Map No Lot (Name) 2. State existing use and ~ccupanc~ ~f premises and intended use and ~ccupancy ~f pr~p~sed c~nstructi~n: a. Existing use and occupancy .......... ~ ./?.~'. ......... b. Intended;use,and occupancy .................................................................. L Nature of work (check which applicable): New Building .......... Addition .... Alteration .......... Repair .............. Removal ........ Demolition .............. Other Work ............... (Description) ' Estimated Cost /,4~,~ CLX. ~> Fee ~" ~ (to be paid on filing this application) ;. If dwelling, nmnber of dwelling ?nits ............... Number of dwelling units on each floor ............... If garage number of cars ~ .......... i. If business, commercial or mixed occupancy, specify nature and extent of each type of use ................... I. Dimensions of existing structure~, if any: Front ............... Rear .............. Depth ............. Height ' Number of Stories ' Dimensions of same structure wi~h alterations or additions: Front ................. Rear ................ Depth ' Height Number of Stories construction: Front Rear Depth L Dimensions of entire new ........................................... Height Number of Stories L Size of lot: Front ...... :......' ........... Rear ...................... Depth ..................... · ' Name o1~ Forme~qOwner ). Date of Purchase ........... i ............................................... .... . . , , , / ?. , .. ',. 1. Zone or use &strict ~n whxch prennses are situated ......................................... 2. Does proposed construction violhte any zonix~g law, ordinance or regnlation: ................................ 1. Will lot be regraded ......... ; .......... '! ........ Will excess fill be removed from premises: Yes No ~. Name of Owner of premises ...: ................. Address ................... Phone No ................ Name of Architect .......... ' .... Address Phone No Name of Contractor Address Phone No PLOT DIAGRAM Locate clearly and distinctly all. buildings, whether existing or proposed, and, indicate all set-back dimensions from roperty lines. Give street and block mnber or description according to deed, and show street names and indicate whether ,terior or corner lot. rATE OF NEWt~RI<z~- /~z OUNTY zh. .... , ............ ."~t~./xde:t.~... :i..'57~..~..~./.'~2~' ...... being duly sworn, deposes and says that he is the applicant (Name of individual sig¢ing contract) >ove named. e is the ..................... i ................... ) agent, corporate officer, etc.) ' fi said owner or owners, and is du~y authorized to perform or have performed the said work and to make and file this 3plication; that all statements contained in this application are true to tl~e best of his knowledge and belief; and that the 'ork will be performed in the manner set forth in the application filed therewith. worn to before me this ........... .~.~ .day o;f ........... .~..~ .~. ~.., ] I NO. 52-8125850, Suffolk County (Signature of applicant) ] Term Ex~ires March 30, 19~Q~ OvE'~'rok t4,98 TO 50UN9 VIEW&YE, NOTIFY g0~STNG ~R~ ~ 755-]802 9 AM TO 4 P~ FOR THE FOLLOWING INSPECTIONS: ]. FOUNPATION _ TWO REQUIRED FOR POURED CONCRETE 2. R( FRAMING ' & PLUMBING " ~ ..... ,~ ..... um MUST E FOR C. O. ALL ON SHALL MEET RE~RF,~,ENTS OF THE N, Y. NO~ RESPONSIBLE FOR ~IGN OR CONSTRUCTION ERRORS.