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HomeMy WebLinkAbout13519-zPORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z.13521 .. Date June 14 85 THIS CERTIFIES that the building .... .N.e._w.,D..w.e.l. 1. ~.n~ ............................. 7925 No. ~ayview ~<ct. ' Location of Property 2565 Brigan%ine Dr. Southold h3dsb io: ....................... 's;/e i ....................... County Tax Map No. 1000 Section 079 . .Block 04 .Lot 065 Subdivision....H.a.r.b..o.r..L.i..g.h.~.s...E.s.t:.: ...... Filed Map No. 5147. .Lot No. 63 conforms substantially to the Application for Building Permit heretofore filed in this office dated Oct. 10 19 8..4pursuant to which Building Permit No. 13519Z dated ....... .N,o.v.: .... 8. ........... 19.8.4., 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 ......... ..... V 7.-.-~'777..N.e..w..P.r..i. ¥.a.t.e...O.n.e..F..a.m.i.l.y..D.w.e. 1..1.i.n. c3. ).n.c. 1..u.d.~.n..g..d,e.c..k77.-.C 7 .... The certificate isissued to CHELLEL, THOMAS & GAIL (owner , d~ee'o~-tet~m'O- of the aforesaid building. Suffolk County Department of Health Approval . 14-SO- 206 N691473 UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 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~ 13519 Z Permission is hereby granted to..~ ......... .'~,~./.~....~, ................................ ..... ...~~.:~....~..a... .......... ..L.~i~i~..-...~:.~ ............... : .... ,o ..=c,~,~.~._,,:z~: ....... ~.~....~,~....o....~......~..~o.~ .................. ...... z~.~ .................... ..--~0~..~...~..~i.c......~.~(.~'..M~ .................................... at premises located at ..... Z.~.. ................ ~.~.....t~, .......... ~. ...... ~.,:...~.~ ........................ ....... :. .......................... ~.....g~-.~.~....~?£~:.~.~....~2z~,...., ....... ~~..~o-~ .~'~..~.~..&.?.~..~..~:~. .................. ~.z..~ 7... ................................ ~.~.~.. ..... Building Inspector. ~. ,..~zo......~ Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD 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 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 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: I. Accurate survey of p;~operty 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 $§.00 2, Certificate of occupancy on pre-existing dwetling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 $15.00 Date New Building ............. Old or Pre~-existing B/~ilding ............ Vacant Land ............. Location of Property r~...~-.~. ~...~£.~q.c~p.~.f.q .~...~.~. ...................... JO. ~...~..©./.. ,~_~. .... House No, ~J Street Hamlet Owner or Owners of Property ... i'~. County Tax Map No. 1000 Section ....~.'~.~ ....... Block .... .0..~;. ...... Lot ..... ~,~'.~),~'~. .... )~ '~'.~..~.~ Labo gept Appro al Health Dept. Approval .............. r . v ........................ Underwriters Approval ..... v/'~) ~ ~..~..~ Planning Board Approval ................. Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $... Construction on above described building and p~rmit meets all applicable codes and ~egulations. ~(~ ~,,-,b,~\ Applicant. C.(~/~:.~,..~...'.. (,~.~-~, ...~.~, . ./~.'. ........ Rev, 10-10-7a HENRY J. SMITH & SON, PLUMBING, HEATING & FUEL OIL MAIN ROAD SOUTHOLD, N.Y, 11971 (516) 765--3690 March ~5~, 1985 ]tlc. John Bertani Builder, Inc. colonial Road Southold, N.Y. Dear Sir: This is to certify that low lead solder - 95.5% - was used on the domestic water system at the home of Gail & Thomas Chellel - Building Permit ~13519Z. Yours truly, HENRY J. SMITH & SON INC. HPS:ag iuolu'~i THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~.,~ ~ ~, ~u~ ~..~..o.~o.o,,m~ ~/~ N 691473 THIS CERTIFIES THAT only the elec trical equiptneng as described below and introduced by the applicant ~at~ed on the able appl~t~o~ ~ber i~ t~ premises of T. Chollol, C/O~yview ~ ~ig~t~ze, ~ug~ld~ ~ Y in ~he followl.g location; ~ B~ement ~ 1st FI. ~ 2nd FI. Section Block Lot was exatnined on ~ ~ ~ attd found to be in compliance ~ith the re~ulrements of this Board. FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS DRYERS SYSTEMS NO. OF FEET OTHER APPARATUS: R V I C A W G, NO OF HI-LEG A W G, NO. Of NEUTRALS OF CC. COND OF HLLEG i z/0 i G ~, S EleCtric /]ox ~ut~Jld, N. Y, Lic 578 E GENERAL This certificate must not be altered in any manner; return to the office of the Board if incorrect Inspectors may be identified by their' ~:redentials. . CO!~Y FOR B?ILDING OEP~RTMENT. THIS. copy O~CE~R~IF, C~T~E F~T ~,~ !~E/~.TEREO ~ ANY MANNER 76S-1802 BUILDING DEPT~ iNS:PECTION [] FOUNDATION 'tST [ ] ROUGH pLBG. [] FOUNDATION 2ND~ INsu~'rlON [ ] FRAMING REMARKS: DATK [ ] FINAL INSPECTOR FIELD Ii~FE~T I 0 N "DATE COMMENTS 1. . FOU__N D A~T I O~_N ~ (1st) FOUNDATION , (2nd) __ = '' STATE ENERGY ~ODE ADDITIONAL COMMENTS: "FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved Z~.of~,~...~.. ...... 1~.. Permit No./~.~..t/.~.: Disapproved a/c ..... . .~.... ~ ........ :. ......... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter 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 property 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 whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance 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 described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary ins~12ections. · :.co ........... (Signature of applicant, or name, if a corporation) . . . ..... JJe : ,tn. . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder, ......... ~.~. ,. ~/~?...,% ............................................................................ Name of owner of premises . .'~,~ S.../.....~'.'?.*..~. ..... ~ .~..~.. '.g~. *.~..~ .............................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer· (Name and title of co,orate officer) Builder's License No ..... f~ ................. Plumber's License No. ,~ ............... Electrician's License No..~f~g~ ........... Other Trade's License No .... ~/~ ............. 1. Location of land on which proposed work will be done...~~ ................................... 7 z: ........... ........ House Number Stre~ Hamlet County Tax Map No. 1000 Section ....... ~. '~.~ .... Block . . ~[~ .~ ........ Lot .... .~. fi)7 ........ .~~..(k/~t~.,,.....~, .~x~... Filed Map No... ~7~.'~... Lot... ~.~ ....... Subdivision.. 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ... -~.~d. ........................................................ b. Intended use and occupancy ...... ~.* '. .... , ~.r, .,~ ~~ ........................ 3. Nature of work (check which applicable): New Building ..... 'Addit on .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............. '.. , i ~..0~, _/~.,_~_. ~. (Description, ~ ' /~G ~ ................... Fee ;n~'t tio 4. Lst~ated Cost.. . ~ ....................... ' ; ~. [to be pa{dbn fil ~is applicl ~ 5. If dwelling, number of dwelling.]units ............... Number of dwelling units on each floor ................ If garage number of cars ~ 6. ]f business, commercial or mixe~ occupancy, specffy nature and extent of each type of use ..................... 7. D~ensions of existing stmctur6s, if any: Front ............... Rear .............. Depth ............... Height ............... NuOber of Sto~es.. ....................................................... D~ensions of same structure with alterations or additions: Front ................. Rear .... Depth ...... ' ............. ~.. HeiSt ...................... Number of Sto~es ...................... 8. Dimensions of entire new const~ction: Front . ~ Rear . ~.~ . . Denth . .~ . , ...................... . .......... ttelght ........... Nu~bar of Sto~es ...... ~ ............................................... Size of lot: Front ...... /'Zq~ ~ .......... Rear ..... ~.~ ......... Depth ...... {. 20 .......... Date of Purchase ...... ~. · · ;'·. · .. · .. . .... . .... Name of Fomer Owner . ............................ Zone or use district in which pr~mises are situated ..................................................... Does proposed construction violate any zoning law, ordinance or regulation: ... ~-~ ........................ Will lot be regraded ..... ~O~ ....... ~.,. ~ ~. ~ .... Will exce~ fill be removed from premises: Yes fo Name 0f Owner of premises ~. ~.. Address .~~ ...... Phone No ................ Nme of Architect . .~. a... ~.. ~ ..... ~.. u .... Address . ._~ ~ .... Phone No .................. Nme 0f Contractor .~. ~.. t~. Address . ~ ~~hone No. '~~.. 10. 11. 12. 13. 14. PLOT DIAGRAM Locate clearly and distinctly allI buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block!number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YOI~, ~ ..,~j).~.y.~f/~_~ iSS ,,,x~/~./~/ ~,,4~r'CY/~c~) ,"~ COUNTY OF ........... ! · .......... · ~ · ¢~..~f ................ being duly sworn, deposes and says that he is the applicant (Name of individual sighting contract) above named. He is the .............................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the mannelr set forth in the application filed therewith. Swgrn to b~fore me this N o t.t.t.t.t.t.t.t.t.C~r y Public, ...... ~ ........ ounty ,,-~/' ¥/~.~g1~84~ " '" .................. ~' ~:~I~8~ 1~ (Signature Of applicant) SINGLE FAMILY DWELLING ONLY FOR APPROVAL OF COl~ T~I~?,~N ONLy TH~ WA~I~R SUPPLY AND SEWAGE DElE WILL C~F~M · TA~D~DS OF SUFFOLK CO. DEPT. ~ OF ~LTH. $ERVI~S.