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HomeMy WebLinkAbout11279-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. g.I.Q 966 .......... Date ......... THIS CERTIFIES that the~b~i&d&~-...~.n~.~l. ~.~ ~. .............................. Location of Property .. 285 ............... $ ~.L~ lVa.l~.~?. Ry.~nue .......... ¢ ~.t.~ 9g~.~.. House No. $~re~t Hamt~ County Tax Map No. 1000 Section .. 10& ....... Block . .C~ 1 ......... . .Lot..C~Q 9, ~0.0.1 ....... Subdivision ..... X ......................... Filed M~ip No..X ...... Lot No.. ~ ......... ~.. conforms substantially to the Application for Building Permit heretofore fded in this office dated .. J~].y..15. .......... ,19.8l pursuant to which Building Permit No... ] .~.2.7.~. ~ ........... dated ... ~J.u].y..15. ................ 19 ~.1., 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 ......... ...... ~..~k~g r.o.q~ d...~?. &m..m.i.n.g. pp.o.~, ........................................... The certificate is issued to ..... ~..e.r~ .n;L,5..1~ ,..&..~9.d.a..R. ,..B.~a..:]..k~.e. ..................... (owner, ~ of the aforesaid building. Suffolk County Department of Health Approval ...... .n.q ~.. ?.~.qu. ~ ?.e.d. ..................... UNDERWRITERS CERTIFICATE NO ....... Il..5 ~ 9.0.8.5. ................................. Building Instructor Rev. 1/81 N~ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMIS~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~ ~,~ z ~,...~/..~ ~.~ ........... Permission is hereby granted pursuant to Bu ding Inspector. // Rev. 6/30/80 ~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 submitted in duplicate to the Building Inspec- tor with the following; 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 featu res. 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 P~anning 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 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 New Buird~ng X Old or Pre-existing Buiiding(:~) _ ~ . =/Vacant Land Loeat on of Property..2 Owner or Owners of Property ~ ~ / County Tax Map No. 1000 Section ...~ ~ Block .~.~. Lot Subdivision ................................ Filed Map No ........... Lot No .........., .... Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. Underwriters Approval/~ ,~.. ,~.2.~,~/~.~,~.~'~.~.<~. ........ Planning Board Approval .................. ~..~ Request for Temporary Certificate ..................... Final Certificate ........ - ......... * Fee Submitted $ ............................. Construction on above described building and perm,~all appl~C~fe~(:~s and regulations, ..... ....................... ~=ORM 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 foltowing; 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 featu res. 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 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, 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 New Building .... )(' Old or Pre-existing Building(X) -~- --= ZVacant Land - Location of Property . ,2; ...... .~7~/,~. f .~. .~. ~?.~. . . . ~f.~. , , C~ ~ ~'f~ ~ Owner or Owners of,roperW ~> ~ ~'''~'~ County Tax MapNo. 1000Section ...~.~ ....... Block ....~.~ ........ Lot ~' Subdivision ......................... , ....... Filed Map No ........... Lot No .............. Health Dept. Approval/ ........................ Labor Dept. Approval ...................... ,.. Underwriters Approvav~,. ~... ~....w ........... Planning Board Approval .................. ~ ·. ~ Request for Temporary Certificate Final Certificate - Fee Submitted $ ............................. Construction on above described building and perrn]t~all app~gable_.9o'~es and regulations. Applicant . - ~. .,. . Rev. 10-10-78 THE THIS CERTIFIES THAT NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTR CITY,~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of in tbefollowing location; ~ Basement ~ 1st FI. ~ 2,~d FI. d,xEsa,d6~ "i~X}g Sect,on Block Lot was examined on J k% ] ~'~, , ~' J ~O [ and found to be in comphance with the requirements of th~s Board. FIXTURE OUTLETS FIXTURES [ECEPTACLES SWITCHES NCANDE$CENT FLUORESCENT RANGES OVENS DISH WASHERS EXHAUST FANS DRYERS FURNACE MOTORS FEEDERS TIMECLOCKS LINIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R V I C NO OF CC COND A W G NO OF HI LEG A W O NO OF NEUTRALS A W G PER ,~ OF CC COND OF HI LEG OF NEUTRAL OTHER APPARATUS J GENEI~AL MANAGER t± This cerhflcate must not be altered ,n any manner, return to the office of the Board if. mcgrrect Inspectors may be idenhfled by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF cE~RTIFICA~T~ M~ST NOT B~ ALIERE? IN ANY MANNER. FIELD IMSi~CTION 1. FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION FER N. STATE ENERGY qODE FINAL COMMENTS ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 1197'1 TEL.: 765-1802 APPLICATION FOR BUILDING PERMIT Ap plication No?~./?:'..7 ./~. ...... INSTRUCTIONS a. This application nmst be completely filled iu by typewriter or in ink and submitted in triplicate to the Buildi Inspector, w~th 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan ~howing location of lot and of buildings on premises, relationship to adjoining premises or public stre: or areas, and giving a detailed descrq>tion o£ Iayout of property must be drawn ou the diagram which is part of this ap[ cat~on. c. The work covered by this .apphcation may not be commenced before issuance of Building Permit. d. Upon apprc.'al of tlus apphcation, the Building Inspector will issue a Building Permit to the applicant. Such peru shall be kept on the premises avadablc for inspection throughout the work. e. No budding shall be occnpmd or used in whole or in part for any purpose whatever until a CertiQcate of Occupan shall have been granted by the Budding Inspector. APPLICATION 1S ttEREBY MADE to the Building Department for the issuance ora Building Permit pursuant to t Budding Zone Ordinance of the Town of Soutbold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the constrnction of buildmgs, additions or alterations, or for removal or demolition, as hereiu describe Tt:c applicant agrees to comply with all apphcable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary i~tions. ~ . ~ "Z~ ...... ...... (Signature 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 prcnfises ..... ~_.....~~. ,~~ .............. , ............. (as on the tax roll or latest deed) If applicant is a corporation, s~gnature of duly authorized officer. (Name and title of corporate officer) Builder's License No .... .~...~e~,..~.~... Plumber's Licens2 No ........................ Electrician's License No. o...-~...~...~.. Other Trade's License No ..................... 1. Location of land on wlucb proposed work will be done ....... ...'?~.-?~. ....... : .................... ltouse Number Street County Tax Map No. 1000 Section .................. Block .................. Lot ................. Subdivts~on ..................................... Filed Map No ............... Lot .............. (Name) State existing use and occupancy of premis~ and intended use .and occ~apancy of proposed co..'n;rrnction: a. Existing use and occupancy ....... . .~..~'/'-'~ ~' b. Intended use and occupancy .......... ff .0~..~/~')°~t-~// ................................................ Nature ofw©rk (check which applicable): New Budding .......... Addition .......... Alteration .... , ...... Repair .............. Removal .............. Demolition .............. Other Work Estimated Cost C10 Fee ................. < ..... (to be paid on filing this application) If dxvelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars ........................................................................ If business, commercial or :nixed occupancy, specify nature and extent of each type of use ..................... Dimensions of existing 5m~ctures, if any: Front ............... Rear .............. Depth ............... Height ............ '... Number of Stories ............... ' ......................................... Dimensions cf same structure with alterations or additions: Front ................. Rear .................. Depth ...................... It,a~t ...................... Number et Stories ........... ;'c*' ........ Dimensioas of ..'ntirc n'.'w construction: Front ..... ~..~. ...... Rear . . . .~..~ ......... Depth . . . ?..~.~ ........ Height ............... Number of Stories ........................................................ ~,. _I lot. Front ...................... _,-- Rea ...................... Dept..~.h ...................... Date of Purchase ..... ~./~. ~.2 .................. Nan. ko of Former Owner ...%..f.,p./~..~.5....r~:~..,rf~..~.~ ...... Zone or use district in which premises are situated ...... ~/<'~.5. <~t.,>.~ ~ .F' ................................... Does proposed construction violate any zoning law, ordinance or regnlation: ..... .'~..°..'5<a ................... Will lot be regraded ....E~.? ............. , .... ~ Wil! excess fill be removed from premises: ~ - No Name of Owner of pre:ui,~zs . ,~P..--54~'d4,'.~.../~(-~'4~47/(. Address .. J.7..'~4¥x4..ir?.r..~.g.< .. Phone No..7.-?.~..~'.~..g'.¢.... Name of Architect ........................... Address ...... '...: ......... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctl'.,' :dl buildings, whether existing or proposed, and. indicate all set-back dlm-'ns!ons from :o;~ert'..' lines. Give sir:ct and block number or description according to deed, and show street names and indicate whether te~ior or corner lot. (Name of indMdual signing contract) ~ove named. e is the ....................... ~.~<Oet .iT'... ....................................................... (Contractor. agent, corporate officer, etc.) 5 said o~ner or owners, amd is duly authorized to perform or ha~e pe~:formcd thc said work and to mak~ and file this >plication; that nil statelncnts contained iu this applicatiou are true to tl~e best of bis knowledge and belief; and that thc ork will be performed in thc manner sot forth hi the application filed t:,ercwith. ,yom to before me this ..... ....... ...... .... No 52 81958~0, Sutf0[k C0u~ ~ {bl~2[Ul'e el 2Dp]IC~II~)