Loading...
HomeMy WebLinkAbout11118-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall 5outhold, N.Y. Certificate Of Occupancy No..Z.1 1.0..0.~ ...... Date ......... ~.ay..2.0 ................. 19 42. THIS CERTIFIES that the building ................................................ House No. Street Ham/et County Tax ~ap No. ~ 000 Section . ,Q ~J 8 ....... Block ...Q ~ .......... Lot ., .q~ ~ ........... Subd~vzsion..;~ea~.o.(~. A.c.~e~ ............. Filed Map No, ~5.~...Lot No. ~ ~ ~.,.a. ~, ~... conforms substantially to the Applicatmn for Building Pemit heretofore filed in this office dated ... ~.~ ~ ~. ~Sq ........ , 19 ~;.1. pursuant to w~ch Building Permit No..~ } 3 ) [3..} ............ dated .... [,J~r~ ~,..~q .............. 19 ~.1., was issued, and conforms to a~ of the requirements of the applicable promsions of the law. The occupancy for which this ce~ificate is issued is ......... ..... q. 1B~.~.q~rY..r99Ft .q,O ¢J-[:~ 9~..h'?. ~g.~q l;~.g~ .~.~4~)~;... .................... The certificate is issued to .... t$O~(~r~O. ~.~ $~-g~!~. g[t~..¥~. ~.. ~.~ .................. (o~nor,~~ of the aforesaid building. Suffolk County Department of Health Approval ...R~{~ .................................... UNDERWRITERS CERTIFICATE NO ...... ~. ~ g.~Q 97 ................................... Rev, 1/81 Building Inspector ~o~ ~o. ~ TOWN BUILDIHG ToWN ;!HALL SOUTH'OLD, N. BUILDING (THIS PERMIT MUST BE KEPT ON ~HE PP, EK41Si!S UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~ N9 11118 7 Oo,e ....~ ~.~x.~..,,..,~....g. 19.~'.?/. Permission is hereby granted to: , ...... ~a.~.~.~.~.,;:~.,:~ ................ ;. ~ ~ ~ ~ ~ ~:.....~.~..~ ~. ~ ~ ~.~:~ ~,.~.,.~....~.~;L~ ........... ~.~....~ ....... ~....~.~....~.~ ...................... ,.~...~ ................ .~. ........................................ at premises located at ...;~..~.....~~--.~.~, - l~ ~.~.~.~...~.~.....~..~ ........... ~.., ....... ~o~z.,...~......~....~.. c~,,~ ~ M~ No. ]~00 S,~o, ....a.Z.~,.,,.,. ~...:~ ........ ~o~ ~o...a.~.~ .......... ~/ ....:. ' . ' , 9 and approved by the pursuant to application;dated ........... ....~,...., ~ B~ildlng Inspector. ~ee ,./...~ ...... . R~¥. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southo~d, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A This apphcat~on must be filled m typewriter OR ink, and submitted in duplicate to the Building Inspec- tor w~th the follow,n§; for new buildings or flew use: 1. Final survey of property w~th accurate location of all buildings, property lines, streets, and unusual natural or Iopograpb~c 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 buddings, 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 Planmng Board approval of completed s~te plan requirements where applicable. For existing buddings (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 buddings or premises, or other pertinent informa- tion reqmred to prepare a certificate. Fees: 1. Certificate of occupancy 2. Cert~f,cat0 of occupancy on pre-existing dwelhng or land use 3. Copy of certificate of occupancy $1 $5.00 New Building ::.7(~.,/' ~.... Old or Pre-existing Building ~--~"'~-- Vacant Land I" Location of Property . .-~.>.~./~... F~.O.O. (~...O~.~ .......... ~.~ (¢ ............ House No. Street Hamlet Owner or Owners of Property . . ~. ( .......... ~.[~ . .'!. ~¢;¢~ ~ '. County Tax Map No. 1000Sectlon ..~.~ .......... Block ~ Lot ~ ......... ,o. ,o 5 ..... .............. ................... Underwriters Approval ........................ Planmng Board Approval ~ ................. Request for Tomporary Certificate. ~ ................. Final Certificate ... ~ ................. Construction on above described building and permit meets all applicable codes and regulations. ~.~0. ~lfO0/ :->'~ ~ ~.~-.,~., ~ r-~ ~, ~,,-,' ~ ~'~. ~.~.,.""~ ~,:~ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 86 JOHN STREET, NEW YORK, NEW YORK 10038 Application No. on file N 5 in the following location; [] Basement FIXTURE ]RECEPTACLE! OUTLETS DRYERS ~ 1st FI, ~ 2nd FI. Section Block and found ~o be in complmnce w~th the requirements of th~s Board. LoL FIXTURES RANGES OVENS EXHAUST FANS FLUORESCENT SYSTEMS OTHER APPARATUS. S E R I NO O E COND OF ~C COND NO OF HI-LEG AWG OF HI tEG NO OF NEUTRALS AWG ~e. f282-~ This certificate must not be altered ,n any manner, return to the office of the Board if ~nco'rrect. Inspectors may be idenhfled b their credenhals COP~ ~OR BUILDING DEPA ~MENT. THIS COPY OF E' '~ ~ c rmcs ot ..... FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: 0 N 6.~°2 ['00' LOT 4 FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 119,71 TEL.: 765-180;~ ~.pproved ................ , 19... Permit No.. (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No, .l l,/./. ........ Date ...... F-./. ........~.., 19 . 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 Dr areas, and g~ving a detailed descriptiou of layout of property must be drawn on the diagram which is part of this appli- 'alien. 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 applicant. 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 ;hall 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 3uilding Zone Ordinance of the Town of Sonthold, Suffolk County, New York, and other applicable Laws, Ordinances or l~egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. Fhe applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to tdmxt authorized inspectors on premises and in buildings for necessary inspections. · ............ (Signature of applicant, or name, if a corporation) (Mailing address of applicant) ~essee, agent, architect, eugineer, general contractor, electrician, plumber or builder. gtate whether applicant (as on the tax roll or latest deed) tf applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ..... ~ ............... Electrician's License No....oq...~...~.. ?. .......... ~o~ Other Trade's License No....~..~. ?. ............. ....... ' e .... 1. ~cation of land on whic~ proposed work will be done, .~/~. ~99.~ .~/).~.~..~ . ........ ..................... House Number Street Hamlet County Tax Map No. 1000 Section .... ~.T ~.. ~ ~. Block ~*~.. ~q.c~.{ Lot ..... -~ ~ ...... Subdivision...~ff~.~.Q~ ~...~. ~ [-.~ ~ ........... Filed Map No. ~.~7~ ...... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..................................................................... b. Intended use and occupancy..........'-~ ~......v~..~ ..... ~ . .~. . ~~./At~7..~x2 applicable): New Building Addition Alteration ' Nature of work (check which .............................. Repair Removal ' Demolition Other Work (Description) Estimated Cost -.~. ,~,45. 0,~, .0..o Fee (to be paid on filing this application) If dwelling, ~umber of dwelling units ...... /. ....... Number of dwelling units on each floor ................ If garage, nuinber of cars ' If business, com~ey?al or mixer occupancy, specify ~ature and extent of each type of use ........ : ........... Dimenslonsofexistmgstmcturqs, ifany: Fron~ .... ~ ....... Rear .~ .......... Depth .~ .......... He ight .... ~.~(... Number of Stories ~: ...... d. ~ ........................................... Di~nensions of same structure with alteration~or additions: Front ...~.~ ........... Rear. ~ ............. Dep~ .... .~.~ ............ '.. Height .~ ................. Number of Stories ..................... Dimensions of e~t~re new construction: Front..;. ~. ~ ~.. Rear .. ~. .......... Depth . ~. ~ ........ Height ..... ~ ......... Numoer oI ~tones ........ x~ ............................. ..~ .............. ~ ~ ' / q ~.2 . Name of Fom~er Owner ~ ~ ~ ~ Date o~ Purchase .... ~ ............... , ............................ Zone or use dist~ct in which premises are situated ~ ~a ~ ~ ~, [ Does proposed constructiop~o!at~ any zoning law, ordinance or regulation: ...................... W~ lot be regraded .... ~..: ................... Will excess fill be removed from premises: Y~ .... N~e of Owner of premises . .~d .W/~(/[~ ...... Address /~P. ff~..OC .... Phone No.. 7 b.~- f.~ PP~... N~e of Architect . ~ ~ ~ ........................ Address ....... h ........... Phone No ................ N~e of Contractor ,( ~ .... Address . Phone 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, and show street names and indicate whether terior or corner lot. : rATE OF NEW ~,0~1I.//~b'~P--~// , ~ ~--, / ~--' ....... '¢-~r~.......',-~r..~ ........ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) .e is the ................................................. (Contractor, agent, corporate officer, etc.) f s~d owner or owne~, ~d is daly authored to perfom or have performed the said work and to m~e ~d file ~is pplication; that all statements contained in this application are true to the best of his ~owledge and belief; and that the ~ork will be performed in the manner set forth in the application filed therewith. worn to before me this ......... ~Z .~7; ..... day°f ..... ~ot~Public? ......... ,,,,,,, . .. . . Ter~ Expires March 30, 19 .....