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Home My WebLink About13512-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No .................. Date ....................... One family dwelling THIS CERTIFIES that the building ............................................... Location of Property .. ....................................................... House/vo. Street Hamle~ County Tax Map No. 100OSection ..It.3 ..... Block . 7 p/o 4 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated February J.4 19 8.4..p gP itN 13.512. Z. .............. ' ....... ursuant to which Buildin erin o ................... dated .Oc.to.b.er .30, 19 8.4, wasissued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ONE FAMILY DWELLING WILLIAM & ANN ZOLDESSY The certificate is issued to .......................................................... (o wrier, of the aforesaid building. 13-80-206 Suffolk County Department of Health Approval .......................................... N742064 UNDERWRITERS CERTIFICATE NO .............................................. .. .. .----T... B~f',lding'I-s-ect-rnp o '" Rev. 1/81 lrOB~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 13512 Z Date ............................... , 19. Permission is hereby granted to: ......... .......... ~;..~...~..~ ........................ ./.~...~.~.. . ............... ~.....~ .//..~ ............ at premises I/ocated at ....~...r~.......~...(~. ......... ~.~F~...,,~... .................................................... ............................................................................................ ~.~...,:.~j~......~.../.. ........... Building Inspector. Fee $../..~_..~... ......... County Tax Map No. 1000 Section ..././~... ........... Block '"(~'7' .......... Lot No....~.C~.....~.... ..... pursuant to app cation dated g~..- . /~/ '"~c~'/ .... ......................................... , l y ........ , aha approvea ay the Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted m~ 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 p~operty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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 $5.00 2. Certificate of occupancy on pre-existing dwelling $15.0 0 3. Copy of certificate of occupancy $I .00 4.Vacant Land C.O. $5.00 5. Updated C.O. $15.00 Date .......................... NewConstruction ...... Old or Pre~existing Building ............ Vacant Land ............. Location of Property ~ f.~g-c:N , . .... House No, Street Hamlet Owner or Owners of Property ......................................................... County Tax Map No. 1000 Section ...l.l.~ ....... Block.. Z ........... Lot .... .~./.~)..~ ..... M N "- Subdivision ' Filed ap No..-, ........ Lot o ............. Permit No. [.~..~..I..'~.. Date of Permit {.0 .~.~..~.?Applicant ..~. ( .L-.L-!../~...~ f.~?../~..~f~..~.~?.~.~?.f Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $.. ~. ~''''~ ~ Construction on above described bu ilding aped permit meets all applicable codes and regu lations. Applicant, .~'/,/~~ .~~Z/, ......................... Rev. 10-10-78 Co-E THE NEW YORK BOARD OF FIRE UNDERWRITERS ~0~[].~ BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only the elec trlcal equipment as described below and i~troduced by the appllca~t named on the above application number in the premises of in the fotlowlng location; [] Basement [] 1st FI. [] 2nd Fl. Section Block Lot was examined on }~'0~1 ~() ~ ][ ~ and found to be in compliance with the requirements of this Board. FIXTURE I~ FIXTURES OUTLETS SWITCHES INCAN~DESCENT FLUORESCENT RANGES OVENS EXHAUST FANS DRYERS FEEDERS TIME CLOCKS MULTI-OUTLET SYSTEMS DIMMERS OTHER APPARATUS: NO OF CC, COND, A W G, NO OF HI-LEO A W 0, ina. OF NEUTRALS A. W, G, PER ,O' OF CC COND, OF HI-LEG OF NEUTRAL t 210 I R/O I~c~ 30~ E This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspecto, GENEI~AL MANAGER may be identified by their FIELD INSPECTION DATE COMMENTS FOUNDATION ( 1 st } FOUNDATION (End) 2. ROUGH FRAME & ...... FLUMBING INSULATION PER N. Y. STATE ENERGY ADDITIONAL COMMENTS: 765-XSOZ BUILDING DEPT. INSPECTION FOUNDATION XST [ ] ROUGH pLBG. [ ] FOUNDATION ZND [ ] INSULATION [ ] FRAMING [ ] FINAL 7GS-1802 BUILDING DEPT, INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PI. BG. FOUNDATION 2ND [ ] INSULA. TION FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL,: 765-1802 Approved ~/.. ~ .... , 1 .~:. Permit No../~...~..~./..~.. / a. This application must be completely filled in by Wpewriter or in ink and submitted to the Building 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 streets or areas, and giving a detailed description of layout of properW must be drawn on the diagram which is part of this appli- cation. 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 issued 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 ~vhatever 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 descr/bed. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulation_s, and to admit authorized inspectors on premises and in building for necessary jl3spections. ...7:* 1/: ............ (Signature of applicaflf, or name, if ~fcorporation) (Mailing address ~tCapplicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises.. ,/.F,"~ (.x:?~...D~.. .... .~:~.' .............................. (as on tlte~tax roll or lgtest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Electrician's License No ....................... Other Trade's License No ...................... Location ofland on which proposed work will be done. . ./:d<~f-; . .~A't4/. ~43e~ ' House Number Street Hamlet County Tax Map No. I000 Section .... ~l. ~ .......... Block ... ~.~ .......... Lot ......... ~.~.~... Subdivision ..................................... Filed Map No ............... Lot ............... (Nmne) State existing use and occupancy of premises and intended use and occupancy of proposed constrnction: a. Existing use and occupancy ...... ~.~. ~f~: ....................................... b. Intended use and occupancy .... ~... ~.g~ .~..~ (~ 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... 4. Estimated Cos ................... Fee ...... (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, specify nature and extent of each type of use ..................... 7. Dimensions of existing structur}s, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ................... ... Height ...................... Number of Stories ...................... 8. Dimensions of entire new condO;ruction: Front .......... . .... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 113. Date of Purchase ........... Name of Former Owner .................. 11. Zone or use d~stnct m which premises are situated ............................................ 12. Does proposed construction vi6Iate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ........ : .................... Will excess fill be removed from premises: Yes No ~ 14. Name of Owner of premises .................... Address ................... Phone Nog ./'~Z...':. ~.(~.. 7..eff.(.'*.~ Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, andAndicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interibr or corner lot. STATE OF NE/~ Y~j~.K? ~, $ $ --'' '%--' '~'('l~dn~ 'o~n~tivi~l'si~ii~'c'o~l't;a'c'ti .......... being duly sworn, deposes and says that he is the applicant above named He is the ..................... .................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is d~ly autgodzed to perform or have performed the said work and to m~e and file this application; that all statements con~tained ~ this application are true to the best of his ~owledge and belief; and that the work will be perfo~ed in the m~ner set forth in the application filed therewith. Sworn to before me this Nota~ Public, .~'.~ ~..., ...... County c~Ic