Loading...
HomeMy WebLinkAbout11178-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No .................. Date ................................. 19... THIS CERTIFIES that the building . .~,d,d,~.~,oT~ .................................... Location of Property .~.~.QO...~?.~.~g.e..~.~..~.e ..... -...~. ~.~c.1~og~ ....................... House No Street Ham/et County Tax Map No. 1000 Section , .0.~_5. ....... Block .... .0.~, ........Lot .... .Q©3 ......... Subdivision ............................... Flied Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated ..... .F/.~ .!9 ......... , 198'1. pursuant to which Building Permit No..'I.'I.'I.~.$Z .............. dated ..... lv[~. 7..2.~. ............... 19~.q., 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 ......... ~or increased roof & attic space The certificate is issued to . .RIC~I,~RD. ~... &..['~RGg2~. K,. ~'O~q~ER .................... (owner, lessee or tenant) of the aforesmd building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE NO. Ixi52qc:)~G Building Inspector Rev 1/81 N©. 11178 Z Permission is hereby gron~ed to: FO~ ~0. TOWN O~ BuILD'lNG TOWN HALL SOUTH'O~D, N,. Y. BUILDING PERMIT ~ (THIS PERM1T MUST BE KEPT ON'~HE PRE'ISiS UNTIL F JLL cOMPLETIO~I OF THE WORK AUTHORIZED) . Dote ....... ..,.~ ..... gI~ at premises located at .........r~...~...~, ................. t..~"~..~.,..m~.:~.'~ ..... i ~' .................................. ....................................................................................... · ....... __ , ~.~,~ .¢.~. -~. County Tax Map No. 1000 Section .......... Block ~.. , , ....... Lot No. ,..~.~.~ .......... C/ /~ ' ~ 19 and approved by the pursuant to application ~doted ........................... 'r' ~ ................... P'"" ; ' Building Inspector. Fee $ ...... .~ ................. ~g ~jnSPector 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 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 premises, or other pertinent informa- tion required to prepare a certificate. Fees: 1. Cerbflcate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling ~r 3. Copy of certificate of occupancy $1.00 f / land use .~/~/$5.00 Date .. New Building ............. Old or Pr~,existing Building(Z) . _.~. _ ~ ZVacant Land i..; ........ Location of Property/~o'~'~ Owner or Owners of Property ..~-.~ dl_~ .~...~.~._..~.. d~.~..~..~..q~..~...~..~ ..... County Tax Map No. 1000 Section ... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. /. ( ! .Tx~. ~ Date of Permit-~.~. ).~..(..Applicant .~.c~. ~..~...~.~ .-~.~.. Health Dept. Approval ~ [ ~ .Labor Dept. Approval ~/ ~ Unde~riters Approval ~. ~.~. [~. G ~ ........ Planning Board Approval. ~/~ .......... ~,.~ Request for Temporary Certificate ..................... Final Certificate .... ~ .......... * flee Submitted $ ..... , ........................ Constructioa on above described buHdin~ and p~[rmee~s all a~cabl~ and regulations. FORM NO. 6 TOWN OF SOUTHOLD Buiiding Depar[men[ Town Hall Southoid, N,Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and subr~itted 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 topograohm 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 instaHa- 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 topograph[c 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- don required to prepare a certificate. / Co Fees: 1. Cert[ficate 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 ............. Otd or Pre-existing Building(X) ...... =/Vacant Land ............ Location of Property ~?,© .~ ¢,~C-~ '~' Hou~ No. Srree~ Ham/et Owner or Owners o[ Property .......... -.- ~ ' CountvTax Map No 1000Section .... ~ .... Block ..... ~ ...... Lot .... ~¢.~ ...... Subd[wsion ............... Filed Map No ........... Lot No .............. Health Dept, Approval ........................ Labor Dept. Approval ...................... ,.. Request for Temporary Certificate ..................... Final Certificate . Fee Submitted $ ............................. Construction on above described building and/13~rmit~meets all apP~cable~odes and regulations· Apphcant .: .. ........................ Rev. 10-10-78 n~ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~' ~J"L%""K2 [ ~ ]-9~]~ 85 JOHN STREET, NEW YORK, ~'~C~R1~1~038 THIS CERTIFIES THAT o~ly theelectr~a[~l~e ' e~as~de~ri{~ed~b~l~w~l~nt`~d~ed~p~iaa~t~d~heab~ve~pplic~ti~un~mberinthepre~ises~f~ ~ ....... '~'e:~' ' ~" ~ ..... ~;,~'~ ~ ..... [] l~t FI, FIXTURE FIXTURES OUTLETS FLUORESCENT VAPO~ [] 2nd FI. Section Block Lot and found to be in comphance with the requirements of th~s Board. RANGES OVENS DISH WASHERS EXHAUST FANS DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS MULTI-OUTLET SYSTEMS NO OF FEET DIMMERS SERVICE DISCONNECT S E R V I C E AWG NO OF HI LEG OF HI LEG AWG ~THER APPARATUS rh~s cerhficate must not be altered ~n any manner, return to the office of the Board if , COPY FOR BUILDING [~EPARTMENT. THIS COPY .~ ]~GENERAL MANAGER ' Per ~ ' ..... InspeOors may be identified by their credenhals. REED IN ANY MANNER. FOUNDATION ( FOUNDATION ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE FINAL FORh/I NO, 1 TOWN OF SOUTHOLD BUILD}NG DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined ./~.~..?/. ~-<~...., 19d~.~.. Approved .t¥ rf . ., . Permit No. , ? Disapproved a/c .......................... ,)~ .... ~.-. (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No..././.4.'.'~-~.. ..... Date 5' ~ 19 INSTRUCTIONS a: This application nmst 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 according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stre~ or areas, and gwing a detailed description of layout of property must be drawn on the diagram which is part of this ap[ cation. c. The work covered by this application may not be commenced before issuance of Building Pen'nit. d. Upon approval of this apphcation, the Building Inspector will issue a Building Permit to the applicant. Such peru. shall oe kept on the premises avadable for inspection throug!~out the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupan 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 t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or ,for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and itl buildings for neces~ion, s~ . ~ '(Signature of applicant~ or name, if a corporation) ? lo - / ho ,,, . t D.' ST ...... .......... t. [. 9~'V.r~.; .C~ ~ (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 applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Plumber's License No ....................... Electrician's License No. Other Trade's License No ...................... 1. Location of land on which proposed work will be done...~%~..<~'~c[~,....~,.. ~'t.~.S¢...~..14~''. .......[;~J~'~t~.. ~.~...~. ~;usl N~]~Jr' ¢~- ~ Stree~ .................... l)~'l;~ ...................... County Tax Map No. 1000 Section ~.~ Block ~ ........ Lot(~ ~ ..... Subdivision .................................... '. Filed Map No ............... Lot .............. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed const~ction: a. Existing use and occupancy ......................... b. Intended use and occupancy ...t g~ l ~.~ g~ 1 .'.~ ..... ~ ....... .I.Nature of work (check which applicable): New Building .......... Addition .......... Alteration ...... Repair .............. Removal .............. De,nolition .............. Other Work ............... ' (Description) 1 Estimated Cost .. .. " (to be paid on filing this application) L If dwelling, number of dwelling ~nits .... .-~. ........ Number of dwelling units on each floor ............... If garage, number of cars .................................................................... . . 5. If business, conlmercial or mixed' occupancy, specify nat.ure and extent of each tyRe. of use ........ '-... .... ^'~" 7. Dimensmns of ex~stmg, structurei, if any: Front... ~.O. lYZ..,1~.. Rear ...}t,q..'(f~t ..... Depth . .-;$.[ &..~¢}.. ~. Height .... ]~....'~.~... Number of Stories ..... ~. [/~ .......... ~,..l'?' '/¥ ............. by.' z',~ ....... Dimensions of same structure wi!h alterations or additions,Front ....Ag./Z...~ ....... Rear ...,/.p.'["~. I ...... Depth ...... ~ [..~.~..~., ....:.. Height.. J.~.'~..'~. ......... Number of Stories ..... Jif.P- ........... L Dimensions of. entire new constntction: Front ............... Rear ............... Depth ............. Height ............... Number of Stories ...................................................... Size of lot: Front i ' Rear Depth Lq .-/.ia Name of Former Owner ....... ). Date of Purchase ...... hp ' ............... sesare's ''' ?...~v.I .%J.,~. J ""'' 1. Zone or use district in whic rend ituated ...... ~ .~ . ,~ .......................... ! Does proposed construction viol~t'e any zoning law ordinance or regulation: .~. ' Will fill b d f p i Y I. Will lot, be regraded ......... .~.(~ ................ excess e remove rom rem scs: es ~. None of Owner of premises ...I ................. Address ................... Phone No ................ Name of Architect Address Phone No Nmne of Contractor Address Phone No ~terior or corner lot. 'T°~ ~,~,~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from :operty lines. Give street mid block humber or description according to deed, and show street names and indicate whether -roe TATE OF NEW_YORK .... ou:,rr¥ OF . ~./~ ~ ~ 7-/-'z"/'~ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) hove named. ' e is the ..................... : ................................................................... I (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duly authorized to perform or have performed the staid work and to make and file this pplication; that all statements conthined in this application are true to the best of his knowledge and belief; and that the ,orb will be performed in the manndr set forth in the application filed therewith. worn to before me. t~is : .......... ......... dayoi ..... ........ ota. PnU,c, ~0! LINDA F. KOW,~LSK[ ' · TARY PUBLIC, State of New Yor~ , . . .. ........~ ' ........... I ~to. 52.4524771 (Signature of applicant) ; iQuahfied In Sutfolk Count Co ~ Y remission [xp~res March