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HomeMy WebLinkAbout13563-zFORM NO. 4 TOWN OF 5OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ....... Z. ? 35.9.3. .... Date ......... A..ug.u,s.~., .~ ............... 19 .8.5. THIS CERTIFIES that the building ...... a.d..d .5.t,.~,o..n ................................. Location of Property ...1. T~ ................ S..h.5~p.y.a. ?.d..L.a..n9 ......... E..a.s.l;..~.a.~.i. qn. .... House No. Street Hamlet County Tax Map No. 1000 Section ..... -~ .~ ..... Block ........ .1 ......Lot....2 ............. Subdivision ............ x. .................. Filed Map No...x ...... Lot No .... .x ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated · .~.o. ~z.e.rn.b.e. ?. ~ ........ ,19 ~ .~)pursuant to which Building Permit No ....... .1).5.6..33 ........ dated ...... .N.o.v.e..m.b.e?.. ,2 .1 ......... 198. .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 ......... ... $ .d.d.<~ .~ 9.n, ,~,9. ,e,x,~, s..~.~.n,¢. 9.n.e.~ f .a.m.~.l.y..d.~.e. 1..1.i.n.~: ............................ The certificate is issued to ............... VA..SILzos ?OI~FII~ZS (owner, ~'y4~q~aX, oX X~a~,zr~ of the aforesaid building. Suffolk County Department of Health Approval ............... ~./.A. ....................... UNDERWRITERS CERTIFICATE NO .................... N.. .6 9.3.6.1. .~ ...................... Rev. 1/81 Building Inspector I~,M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y, BUILDING PERMIT CrHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO- 13563 Z Permission is hereby granted to: .............. ~~ ........ ~ ...... ~. ........... .~ ...... ... ............ ............. ..... ~?i ........ U'~'"~ ........ ~ ................................................................................. County Tax Map No. 1000 Sectio~)........~...~..~.... Block ......... ) ............ Lot No ....... ~ ............... Building Inspector. Fee $...~...~..:..~... Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD I~uilding 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 im~l~ to the Building Inspec- tor with the fo~owing; 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. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pm-existing" land uses: 1, 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. C. Fees: 1, Certificate of occupancy $5.00 2, Certificate of occupancy on pre-existing dwelling $ ].5.00 3, Copy of certificate of occupancy $1.00 Date . New Building . .F~..../~ ..... Old or Pre-existing Building ............ '~ Vacant Land ............ Location of Property...~..'~ ~.... ~ f? .... ~..~..~..o~.,~. House No. J x[ St ~t Owner or Owners of Property . .t2.~.. [I..~~ ......................... County Tax Map No. 1000 Sectiod .... O. ,~.~. .... Block ...... ~ ........ Lot... ~ .......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. ~ ~ .~.-'.~ 3.~'Date of Permit~.. '..~.~/oC~,Applicant..~J~.~ ....... Health Dept. Approval -"' ...... Labor Dept Approval ~ ............. Underwriters Approval .......... .Ik~ ,;z;~,/~.. .... Planning Board Approval .................... Request for Temporary Certificate ..................... Final Certificate . ...~'~., .~ .......... Fee Submitted $...~.... ~..~.....V/..~..~.~. ~ .... Construction on above described building and per,mit meets all app[J, cable codes and regulations. ............. : ....... Rev. 10-10.7e ~ ~ THE NEW YORK BOARD OF FIRE UNDERWRITERS ~UREAU OF E'EC~R'C~T~ · =.'h,-,~..~,.~ May 24,, 1985 85 JOHN STREET, NEW YORK, NEW Date ~ppllcatlo. No, o~f~le N693418 THIS CERTIFIES THAT only the electrical equipment as described be~w and introduced by the ~ppl~t ~medpn the ab~e apptic~ion number in the pretnlses o] Vasiiio~ Por~iris, ~hipyard Lane, 2nd on Ae~, ~n the ~ollo~,~g Ioc.~io,H ~ B~sernen~ ~ ~s~ FI. ~ 2nd FI. Section BIoc~ was examlned on ~y ~O t ~ ~ and found to be in compliance wlth the requiremettts of this Board. FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS 7 7 7 DRYERS OTHER APPARATUS: 1-G.~.Ci[. 1-~mo~e ~[et~ctor E I C CONOI NO OF HI-LEG OF HI-LEG OF NEUTRAL S ~lectric 215 ~outh~ld, NY 11971 Lio#578 This ce¢fificate must not be altered in any manner; return to the office of the Board if [ncm'rect. Inspector may be ,identified ~ COPYiFOR 8~UILDI I'ANY MANNER. F1EL~ INS'PECTION 1. FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING COMMENTE INSULATION PER N. STATE ENERGY qODE 4. FINAL ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ,, ooOUTHOLD, N,Y. 11971 TEL.: 765-1803 :,xamined. ~.~% ?':1.., 19 '~pproved .~.~ ~J., 19 ~. Permit No. t .~..~..'~o.:.~.~.' Received ........... )isapproved a/c ........................ ' ............. (Building Inspector) APPLICATION FOR BUILDING PERMIT Date . .' ........ , 19 INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ets 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- ation. 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 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 tuilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or [egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. '.'lie applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to .dmit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of prcialses ............................ , a 1 t If applicant is a corpo}ation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. ~ (~ ~ Plumber's License No...$'. 3.~...r?. ............. Electrician's License No..~..~ ~..~ ............. Otl T adc' Li N lcr r s cense o ...................... 1. Location of land on which proposed work will be done.. 't ~ ......... 0" .................. ' ~/ ............. House Number Itamlet County Tax Map No. 1000 Section -.. [..o'~..O. ....... Block .... O..~..~t' ......... Lot..~. 7'. ~ ...... : ..... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy....b~: Od'M'., ~:'1~...~w*~,.¢~ ...................................... b. Intended use and occupancy . 'G~..~ ~..~. ft~PO~r....C~/,~zt,~.,..: ............................ ' Addition iX Alteration Nature of work (check which applicable): New Building ............. : ....... Repair .............. Removal ..... Estimated Cost ......"/...~d..,~...o'.~... 5. If dwelling, number of dwelling units. .. ' Other Work Demolition i (Description) Fee 9- ~".wl ......................... ~'. (to be paid on filing this application) ......... Number of dwelling unit~ on each floor ..... ~ ........... If ffarage number o~f cars ........................................ ~ ........................... If ~usiness xi'~i ' .~.g.' ....... ~.6 i 6 comm ciai or mixed occupancy, specify nature and extent of each tyge of use ..................... 7. Dimensions of e ng structures, if any: Front .... Rear .......... Depth ............. Height. /..~ t. ...~ ...... Number of Stories ...~5,~e~. ................... ! ............................ Dimensions of same structure with alterations or additions: Front ...~. 6 ....... I .....Rear . b':. 2~. ............. 9/ '9,,' Height / 6 ! Number of Stories ~ Depth ..................................... i ................ 8 Dimensions of entire new construction: Front ............... Rear ........ : .......Depth .............. Height ............... Number of Stories ............... , ............. , ........................... Size of lot: Front ....g.~. '. ............ Rear ..... /..ay. .............. Dep~th . ,/.,~:Of. 'A ..... ....... Date of Purchase . ~x~,~..o.l.~..q. .......... Na .me of Former Owner .)c~d~,~-../Z.~ ......... Zone or use &strict m wlhch premises are s~tuated..~?,~..*. ~ 'I ........................... Does proposed construction violate any zoning law, ordinance or regulation: ... b-ar...- ................... Will lot be regraded ...}'3.~. ;:..;.., .... ~. .....: ....Will excess fill be remover from premises: Yes ' ~ Name of Owner of premises q).°-ff4;cq.-s~...[.~..~... Address . ~..c..*:%~...h.:~./q..~.'Phone No ........ ........ Name of Architect ................. ; ......... Address ............... 1 .... Phone No ........... Name of Contractor ~ .~'~,' ....... Address ,O_~..~ ~ b.'¥'. Phone No. 9..~ .q .-. 6 .~. ~ i i. 1. 2. 3. 4. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from >roperty lines. Give street and block number or description according to deed, and show street names and indicate whether nterior or corner lot. STATE OF NEW YORK, S.S COUNTY OF (Name of individual signing con~ract) above named. being duly sworn,~de~oses and says that lie is the applicant He is the ' , ,,z~,~ , (Contractor agent; qorporate office etc.) of said owner or owners, and is duly authorized to perform or have performed thel said work and to make and file this application; tha~t all?fitements contained ~n this 'applica'ti.oti are true to the best of his knowledge and belief; and that the work will be pe.rforn)~, in the manner sO{ forth in the apphcation filed therewith. Sworn to before me this clay of . ., 19 NOTARY~ , PL) I C, ,~: ~ e i', , % k NOTARY PUBLIC, State,el Ne'er '(tlrl~ , · .,4.x.z,a~,, "'~J, ...... , (Signature of applicant) HO 410'187g, ;, '~ ~"Junly No, 4707818, Sullblk C0unt~.r,-~ ' l[~rfiq £xllres ~,[ , 3',' Il ', ~em [×HrcsMa c 30 9~->. '~ i U, NOTI?.,~ BUtLD[NG DEPARTMENT AT '765-1802 9 AM TO ~ PM FOR THE FOLLOWING I~SPECT!ONS: I. FOUND,AT[ON - TWO ~OLJIRED FOR' POURED CONCRET~ 9. RO~H - FRAMING & PL~J~NG ~ ~N%¢LAmJON ~. Frh,'r'~ _ CONSTRL~CTiON f' ~ Bc ~ .... ~E FO~ C.O ~ ~ L C~F':~ TM 'CTION SHALL ? ~ S~AT~ C~,~tJCT!ON & ~NERC" CODES. N~T RESPONSiBLc FnR DESIGN OR CONSTRUCTION ER2OqS. ,/ copper tubing is used for ,water distributing system; piping shall be of types K or L only EXCE U A7" B AS NOTED 765-1802 9 AM TO 4 PM FOR THE CHECKED BY C .I !: tA / ~u~ '/Mo _1 .i ,¸% ~ ~Mo d If copper tubing is used for water distributing system~ piping shall be of types K er L only -v, I , IFICATIO~ C~RT B~FOR~ A~- B /43 NOTED NotIFY ~TII~NG DEPARTM~ ~ 765-1802 9 &M TO 4 PM FOR THE 2. ROUGH - ~RAMING & pLUMBING CODES. NOT RESPONSIBLE FOR DATE NO.