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HomeMy WebLinkAbout11068-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Ho. Z10762 Date ........ .~9Y.~.m..~9.r..~ ............. 19..8.1 THIS CERTIFIES that the building ................................................ Location of Property ..... .2.0.0..0. ?.e.e..p..I-l.o. 3: .e. ?.v.~..v.e., ....... ~.n..~.t:.:L.~u..c?.,..~ .e.~..~ .o.v.k .... House No. Street Hamlet County Tax Map No. 1000 Section . . . 1. .2.3 ...... Block .... 0..6 ......... Lot ...0..0.2 ........... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated · . .H.~.r'.qh...J..1. ......... , 19..8. ~ursuaut to which Building Permit No. 3.1068 g dated .. ~.a.v.qh...2.4 ................. 19..8. ~, 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 ......... ...&u.~.; .~.~.o.n.~...~.q~...&z3.e.~..~.~3.o.~.. ?..~..~.~?.~..~.~.~..~.¥?.~).t..~.~ ........................ The certificate is issued to .... g.a.'qh.e, v. .:i..n.e. . K. 9.n..n. 9 ~.l.7. ................... - .............. (owner, of the aforesaid building. Suffolk County Department of Health Approval ..... ~I./.B. ................................. N542377 UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 FOKM ~;0. ~ TOWN OF SOUTHOLD BUILDING D~:PARTMENT TOWN HALL SOUTHOLD, N~ Y. N°. BUILDING FEIU~IT (THIS PERMIT MUST BE KEPT ON THE PREMIS~:S COMPLETION OF THE WORK AUTHORIZED) 1'10 6 8 2[ Dote ...... UNTIL FULL Permission is hereby gronted to: ." Z/ ~' f" /,~/ . ...... ~d.~. .................. : ...... : ...... : ................ .......... ,,~'~2......~.~...~¢,,...,? ................ .............. ............ .... 1'7- ~ ~ ~ ;Lot No. .~.~z ....... county Tax Mop No. 1000 Section ...,~,.~ ............ . Block ...... ~ ............... pursuant to ~pplicotion d~t~d ..~.~....~. .............. ~....., 19.~., ~na ~pproved by the Buildlno Inspoctor. Rev. 6/30/~80 FOP,,M NO. 6 TOWN OF SOUTHOLD ~ Building Department Town Clerks Office 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 Inspector 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 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 installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed s~te plan requirements where applicable. B. For existing buildings (prior to April t957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property 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 in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2, Certificate of occupancy on pre-existing dwelling or land use $5.00 3 Copy of certificate of occupancy $1.00 t i Date .....!"~"'I' .b.~...]..~ ..................... New B~ilding ................ Addition ......~.... ..... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..,~[.~Jc4r,~.,.,.t,~,(~.t,~ ............... .x......~ .......................................................................... Owner Or Owners Of Property ~ O'tr\ v'.% 1/-~ ~, ~, ,~x.'~ ~ ~ ..~.. Subdivision ................................................................ Lot No ............. tBIock No ............. House No ............. Permit No ..................... Dote Of Permit .................... Applicant .... .JT~..~,~Z~O.~z;.~,_.!~.£2.~.~¢.;~,.:~.;'.~.~/..~r Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Find Certificate ......................................... Fee Submitted $ .-..'.z~'.:.~)*.-~J .................... Construction on above described building a~r~d,~rmit meets __ . ......... Sworn to before me this ................ day of ............................................ (stamp or seal) !~ \\~,\ Notary Public .................................... County -\ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN ~TREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only ~he electrical equipment as described belo~ a~d introduced by t~ applicant named on the able application number in the prem~es of in the foltowmg Ioca{~on; ~ B~em~to~ ~ 1st FI. ~ 2nd Fl. Section Block Lot was exa~ataed on l~%~r~er ~ ~& andfoundtobeincomphancew[ththerequlrementsofth~sBoard. FIXTURE FIXTURES 27 47 29 27 RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS DRYERS FURNACE MOTORS APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R OTHER APPARATUS AWG OF CC COND g C NO OF H~-LEG AWG OF HI-tEG E AWG OF NEUTRAL 2 P.O. Box ~2, ~v~e~ N,Y. 11901 ~643g 1l Th~s cerhf~cate must not be altered m any manner; return to the office of the Board if incorrect, nspectors may be ~denttfied THiS COPY OF NOT BE ALTERED [~ A~Y COPY BUILDING DZPARTMENT. ~ANNER. _~E~LI~SPECTION 1. FOUNDATION (lsd) COMMENTS FOUnDATiON (2nd) ® ROUGH FRAME& PLUMBING INSULATION PER N.Y. STATE ENERGY CODE FINAL ~DITIONAL CO~TS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 ppro ed ermit No. (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No ................. Date ............. ,19 .JT~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building nspector, 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 premises, relationship to adjoining premises or public streets >r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- zation. c. The work 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 apphcant. Such permit ;hall 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 'J~all have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Bailding Permit pursuant to the Building Zone Ordinance of the Town of Southokl, 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. l'he applicant agrees t~. comply with all applicable laws, ordinances, bill,ding code, housin~code, and regulations, and to ldmit authorized inspectors on premises and ill buildings for necessa~ectix~. ~ ~//~. ~ qtate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................... Xlmne of owner of premises ... (as on the tax roll or latest dded) ff applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..... .-~....~....C?.~ .......... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work wilt be done ......... ~ ....................... House Number Street County Tax Map No, 1000 Section .................. Block .................. Lot ................... .......... Lot Subdivision ..................................... Filed Map No. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended use and occupancy ...~_~.d~.~...~....~q ./.~...~/.~'~.~. ?.~,~.~. ........................... .3. Nature of work (cheek which applicable): New Building .......... Addition. .. Alteration Repair .............. Removal ..... Estimated Cost.. ,~,. ,Sr. ~ .~5~.. ..... / / ).' If dwelling, number of dwelling units ...... ...... Demolition .............. Other Work ............... (Description) .............. rec../,~."' ................. ~ ........... (to be paid on filing this application) ........ Number of dwelling units on each floor ................ ). l. L If garage, number of cars ............................................... ~ ....................... If business, commercial or mixed occupancy, specify nature~d extent of each type of t se ..................... Dimensions of existing structures, if any: Front..~..~..~/,~X:/~q. Rear .............. Depth ............... Height ............... Number of Stories ..... ~. ................................................. Dimensions of same structure with. alterations or additions: Front ................. Rear ................. Depth ...................... Height ...................... Number of Stories ..................... Dimensions of entire new construction: Front ............... Rear ............... Depth .............. Height ............... Number oY Stories ............... ::~< .................................... Size of lot: Front ...................... Rear ................ :~. .... Depth ..................... Date of Purchase ............................. Name of Former Owner ............................. Zone or use district in which premises are situated ..................................................... Does proposed construction violate any zoning law, ordinance or regulation: ............................... · ' ' is' Ye Will lot be regraded ............................ Wdl excess fill be removed from prem se , s No _. Name of Owner of l;zr~mis rag~. . Address ................... Phone No ............. Nmne of Architeck_d~/Y, .~f~e~Y~./.~, .............. Address ................... Phone No ........ Name ofContractor//3~...O.~.~.~. ~ ...... Address ................... Phone ~o...' i ..... PLOT DIAGRAM Locate clearly and distinctly all buildh~gs, whether existing or proposed, and, indicate all set-back dimensions from :operty lines. Give street and block number or description according to deed, and show street names and indicate whether terior or corner lot. TATE OF NEW'~ORI~, ~e ~ ~ being duly sworn, deposes and says that he is the applicant bore named. e~sthe ....................... · ..~'~...,.--..,,,..~ ................................................ ' · //~ (Contractor, a~nt, corporate officer, etc.) f said owner or owners, and is d(dy ai~thofi~d_koA~orm or have performed the said work and to make and file thi~ pplication; that all statements conhined in this application are true to the 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 ........ /ZZ~ ......... day of ..... ~c,~oG..., 19 .o~/ Term ExoIrea March 30, 19 ~ ] AP?~O'TD AS NOTED DATE: FEB: ~'~."'~ BY: NOTIFY BUILDING DEPAR 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: ]. FOUNDATION - TWO REQUIRED FOR POURFD CONCRETE 2, ROUG'-I - FRAMff~G ~, PLUMBING 3. INSULATIOXl 4. FINAL -COf, ST~]JC¥1?,N MUST DE COMPLETE F©,~ C O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR I~I~IGN OR CONSTRUCTION ERRORS. Ir- r kiAfnrlJc, K ~ I-J,~, DONALD A. OENIE ARCHITECT A.IIA.! I:l.C. c_.×'z-4. DONALD A. DENIS A.I.A. FI.C. ~ ~:~ ARCHITECT~.~ ~:~ F \ i DONALD A. DENIS A.I.A., P.C. ARCHITECT Il DONALD ARCHITEcTA' DENIS A.I.A.~ .I, coJ~Fr~ r~l~-Vf'~-I-