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HomeMy WebLinkAbout11249-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of' the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy PLUMBERS CERTIFICATION DATED: No. ZI5420 Date March 23, 1987 THIS CERTIFIES that the building P o o 1 Location of Property ... l. 9. .5..G.r.e. house No. ' ...... County Tax Map No. 11300 Section ...I. 0..7 ...... Block .... 0.2. ......... Lot 003. I l Subdivision Greton Estates .Filed Map No. 6.4..4.7 Lot No. 3 conforms substantially to the Application for Building Permit heretofore filed in ttfis office dated .J.u..n.c..1.9. ~..1.9.8. I ' pursuant to which Building Permit No, I 124 9z dated Ju 1 y 6, 198 I 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 ......... Inground pool with fence The certificate is issued to SUSAN S. & DENNIS A. HUBBARD (o wner, of the aforesaid building. Suffolk County Department of Health Approval N/A ..... N528555 UNDER~VRITERS CERTIFICATE NO .................................................. N/A Building Inspector Rev. 1/81 : BUILDING ~ BUILDING! PZRM~T ~ i' ~TH~S PE~VUT MUST .~ K~,T ON ~H,~ ~S~si'UN-nL ~U,L COMPLETION OF THE WORK AuTH~RIZE ~ ,,~ ~:~,~ ~z ~.~,.:,.J~......4. ......................... , P~r~issio~ is hereby granted to: / ~ ' ;; ~ ' atprem~ses oca a CO~ty Tak Map No. 1000 Section pUts(Jant ~ application doted B~[ld, ing I?pector. ~ee ~ ........ ?.~ ......... THE NEW YORK BOARD OF ,FIRE UNDERWRITERS 100U~73 T~S C~TmmST~aT in the yoHowlng location; ~ Basement ~ 1st FL ~ 2nd ~7. ~1 Section Block Lot ~,,~ .~.,.,i.oa o. J~:Y 20, 1981 .,,d yound to be in co,nplia~ce w/ti, the re~ire,nents of th~s Board. FIXTURE OUTLETS SWITCHES FIXTURES RANGES OVENS DISH WASHERS EXHAUST PANS 1 2 1 DRYERS SYSTEMS NO. OF FEET S E R V I C OF HI-LEG NO OF NEUTRALS OTHER APPARATUS: (S~a~i~ Pool) ~his certificate covera cca~,Li,a:m.e at the da~e of iuspect~ i~se oi ~ ~iro~Cs i~ ~ ~s~ ~o ~e~ fr~4~ ~ ay a q~liiied ~r~on. ~mr/~ glec. Co., 30 ~iltzh/re Dr,, CD~,ik, N.Y. 11725 GENEI~AL MANAGER 11 [~ T~s ce~ must not be altered in any manner return to the office of the Board if i~co~ect, tnspector~ may be identified by their credentials. 76S4802 BUILDING DEPT. INSPECTION~r [ ]FOUNDATION 1ST [ ] ROUGH ~iP~BG. [ ] FOUNDATION 2ND [ ] INSULA~IQN [ ] FRAMING [ ] FINAL · REMARKS: FIELD INSPECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY FINAL COMMENTS: TOWN of SOUTHOLD OFFICE OF BUILDING INSPECTOR Receipt :No. 3 t 5 2 '/ ro~n .a. Southold, New York 11971 ...... ................ ................................ /....~.....c .......... ~,..~ ................ , .............. ~ .................................. /~oo Oo,,ars Fee ~ Fee for ~ Yard Sale [] [] [~C~ck i / f -~ ........... Z~...:..~ ....................... Fee for [] H.I.C. Fee for ~..C.~r tif icate [] Building Permit ~ of Occupancy [] Misc, Building Inspector ¢~.~- cc- !la- rig, I. Accurate survey of p~operty showing all property lines. ~;~reets. 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 premises, or other pertinent informa~ tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy New Dwelllng~ $25.00, Accessory ..$10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $]0.00 4.vaoa=t ~.=~ C.O. ~ ~0.00 /Z.~. 5.Updated C.O. $' 50.00 Date2.~'. ............. New C on s t r u c % i o n ...... Old or Pre-existing Building ............ Vacant Land ............. ~ooation of Property ,.;;,,; ;~; ........................................... , .......... ~....~Z-.-.-.-.-~? Owner or Owners of Property ..~...~...~..~.)0 ~, '~ ~O~ J~., County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No /./, .'~.~. ~.'~Date of Perm ;t ~, ,~/~./ Applicant Permit No .......................................... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate .................... Final Certificate ~.~r..l~.(~.l~J~.~~-~/~. Fee Submitted $ ........................ Construction on above described bui}ding and permit meets all applicable codes and re_~ulations. Applicant . . . .............. Rev, 10-10-78 TOV/N OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. F ....................... ......... . ......... Disapproveda/cil. ................ 7.~. '~'"'"~""~'"'"'"'"'"'"" .......................................... - . ........................... ' ' APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sere of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of Jot and of buildings on premises, relationship to adjoining premises or public streets al areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this application. c. The work cogered 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 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) ...... ........ ........ .... (Address of applicant) State whether applicant i~'e~ lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of p em.ses ...... ~ .................................. .~.~....~....(~......l~.. ............ ~ ............................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ................ /...0....~.~. ....................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ........................................Lot No. Street ond Number ....... ~.....~.~..~...]./.-~...?..~..~, ........ ..~=....7.~. ......................... ~...~..~'.~../...,~..i ?..S:~ ........ Municipality 2. Store existing use ond occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .................. z ............................................................... .~ ............................ b. Intended use and occupancy ............... ./.~..~....~....(¢~ ............... .~....OT..}../..~;..~..../~....)....~.....~. ....... ...~....~......~.. ............... 3. Nature of work~l~eck'which applicable): New Building' ..'~..~...~....L~.... Addition .................. Alteration'. ............. Repair .............. :.., Removal .: ................. Demolition .................... Other Work ................................................ , 4. Estimated Cost ......L~I'..~..~......c~ .................................... Fee'~ ~/~ . . . (Des~iption)~- (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specif~nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear .......... ~r.~. ............. Depth .................... ...... ......... of ......... ................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ................. Z.& ........... Rear .......... Z~ ........... Depth ....... ~..~ ........ He ght .: ........ ' .......... Number :of Stories ................................................................................................ : .................... 9. Size of lot: Front ..................!...~:.~.~ .......................... Rear .......... ~..I ..................... Depth ...... 1.~.~ ................. 10.' Date of Purchase ........................................................ Name of Former Owner ........................................................ Zone or use district in which premises are situated .......... ~Z~. .......................................................................... Does[proposed construction vi91ate any zoning law, ordinance or regulation: Will lot be regraded . ........... ~.~ ........Will excess fill be removed from premises: ~ Yes ( ) No Name of Owner of premises ...~'.~..~,L~ ....... ['}.~.~Address ..~.~...~ Phone No....~.~.~ / Name of Architect ................ : .............................................. Addre~ ................................ Phone No ....................... Name of Contractor ....................................... ~ ............ Address ' ' rJ'Ct~ ~tlPU- ~0~% .,2.~.7.~.~.~.~hone No ........ ' PLOT DIAGRAM ~ ~/~o Locate clearly and distinctly ~H buildings, whether exisHng or proposed, and indicate all set-back dimensions from number or description according to deed, and show street names and indicate 11. 12. 13. 14, property lines. Give street and block whether interior or corner lot. STATE OF NEW Y©~(- ~- ~'c c COUNTY OF ...~.~O..,~,,/h,. ........ .......................................... ~ ................................................ g duly sworn, deposes and says that he is the applicam (Name of individu'al sigging contract) above named. He is the ....................................... r ............................................................ (Contractor, agent, corporate officer, etc.) of said OW'her or owners, and is du, ly authorized to perform or hove performed the said work and to make and file this application; that all statement,s contained in this application are true to the best of his knowledge and belief; and thor the w6rk will be performed in the manner set forth in the application filed therewith. Sworn to J~efore me this , ........ ........... ,19xz.,/t ff. (1.... Noto p Cou. .......................... I~ONALD F. A~t~A,,. '~TARY PUBLIC, Sta~e of New York Ne, 01AB47388,~9, Temt [xpires, ~a~ch i DATE: SKIMMER LINE 0 '-4 C m 0 0 < ~>0 ~',_~.°, fl'