Loading...
HomeMy WebLinkAbout13578-zFORM NO. 4 TOWN OF 5OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ....SJ325Q ....... Date ...... ku~us~ 9 . ,19 85 THIS CERTIFIES that tile building ..... @ .~.d.%~. $.o.~... ................................ Location of Property .. ~5.q.5. ................ ?.e.q.~.%s.l?...Axe.: ........... 0. ,~.~.c~o..g.~?,... House No. Street Hamlet County Tax Map No. l 000 Section ....q 3.7, ..... Block ..... ./4 .........Lot .... .5 :.2. ......... Subdivision ............... ~. ............... Filed Map No. ~c .Lot No. ~c conforms substantially to the Application for Building Permit heretofore filed in this office dated November 3 84 ~ 357.8Z ..................... ,19... pursuant to which Building Permit No ..................... ~ovember 23 84 dated ............................ 19 .... 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 ......... .... Dormer. a&di~ion .'t;o..axis.tJJ~g. one. ~.m.i. 1. y..d.w.e..1.1.i.n.g: ................... The certificate is issued to ............. Jg-NE~ ,&. J. Qt~A. 0..J)~...QR.O. .................... fowne~~ of the aforesaid building. Suffolk County Department of Health Approval ................. ~f.-~ ..................... UNDERWRITERS CERTIFICATE NO. ' .... 317D.3%q. 7 ................... Building Inspector Rev. 1/81 TOWN OF Sou"rHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CC~PLETION OF THE WORK AUTHORIZED) N9 13578 Z Permission is hereby gr<~nted to: ...~...~..~.~.~..-......~.~ · ..~.~.~....~.~.....~_.....: ...... ., .i...~...~.~...~.:.~: ........ l.~.~.~ ....... ......................... , ......................... e~mlses ,~oted et ..~.~.'..~.~~...~..~......~~~..,~.. ...... pursuant ,o application doted ..... ~..~....~i~ ............ , 10..~..~., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 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 ia IIII1~1111~ 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 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 $15.00 3. Copy of certificate of occupancy $1 .O0 4.Vacant Land C.O. $5.00 Date .....Cb -' ~--. New Building .. ~.."..~.. .... Old or Pre-existing Building ............ Vacant Land ............. Location of PropertyHous~'~' '~' ~ '~' ' ' ~' ~'l'~ & s' '))' ' ' '~' ?' ?' ' 'No. Street'C .......... .~ ...... Owner or Owners of Property ] ~-~.~).~..~. ;J')-}-/.~..D ./).c~ ...... .C_~.~/~ .0.~ ............. County Tax Map No. 1000 Section I .~... ~- · Block ..g ....... Lot Subdivisio,n ................................. Filed Map No ........... Lot No .............. Permit NJ '~.. ~.~ .~..~..- Date of Permit i. ~.~-~.~.~.Applicant. ]./~ ~.¥) .~.~. .... .~..~...~..~.-. ~/~/,~. .... Health Dept, Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ................... Request for Temporary Certificate ..................... Final Gertificate ................ Fee Submitted $...~.P-~....g. ¢}....~..~.. l .~..(~. ..... Construction on above described building and p~mit meets all applicable codes and regulations. . . _,:9 © ,~ppdcant ~ ,-C ¥.~t'3~,~.-.~.. ~.......~-/~-...'~. ........................ R~, 10-10-?~ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~g 85 JOHN STREET, NEW YORK, NEW YORK 10038_ Bate a~,~. 05, ~9~.~ ~.~,,~..o.~o.o.~.~ 3~/~ N703417 THIS ~ERTIFJES THAT only the el~trical equipment as described below and introduc~ by the applicant named on the abo~e application number in the premlses of ~ Cancro, 4515 ~quash ~venue~ C~,~qh~e~ ~ in the following location; ~ Basement ~ 1st FI. ~ 2nd ~l. Section Block tot was examined on and found t~ be in compliance with the requirements of this Board. July 29, 1985 FIXTURE FIXTURES RANGES OVENS OUTLETS SWITCHER DRYERS FLUORESCENT FUTURE APPLIANCE FEEDERS LJNfr HEATERS DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R V I NO. OF HI-LEG .o. OF CC CONO AW, G OF HI-LEG NO OFNEUTRAI OF NEUTRAL 4515 Pequash Aven~e This certificate must not be altered in any manneo return to the office of the Board if !ncorrect. nspectoi:s COP~ FOR BUILDING DE may be identified by F1E~D I~FECTION FOUNDATION (1st) COMMENTS FOUNDATION (2nd) 2. ROUGH FRAME & FLUMBING INSULATION FERN. Y. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: 7GS-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING ~ FINAL REMARKS: INSPECTOR BUILDIN~ DEPT. INSPECTION FOUNDATION XST [ ],ROUGH PLBG. FOUNDATION ZND [-/J/INSULATION FRAMING [ ] FINAL REMARKS: DATE, //2~Z/~-// INSPECTOR Examined )0. · .~¢0:2~. · · · ·~.. ~ ..t .~ 19~.. Approved ./Q.~..L~...¥3. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT TOWN OF SOUTHOLD Received ........... ,19.. · INSTRUCTIONS a. Ttds 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 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 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 i~/~c~~.~ (l~ig~ature of applilt~t, 6~-name, if a corporation) ..... v ..... ;C.";,; '~'; ;" ....... · ....../' ' ' (Madtng address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · ............................ .............................. Name of owner of premises. J~.. ~,..~ ..... /d0.d..~..~..~?~-~....~....C-~. ,~'~. -~J~' '0' (as on the tax rd11 or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Humber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location ofl_~and on which proposed work will be done .t~.~..' ~.~ ~~ ~ ............... ......... g ..................... Street ................... [ _ 'fl;~;1;; ~ -"}5 ," ~ ..... I' ..... ~ff:2~;~; ;~p No. 1000 Section....} ~. ~..~:~. Block .~:~. ~ ~. Lot. ~D.~ ~:& ....... 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 ~. ~.:~C.~.~'/;J . ./~.~4~... ~¢.*.q~4~. .......... '-..;g~ h~,x .~,: ' ............ b. Intended use and occupancy . .~. ~. ~ ';~ '''~:~ :~' ~ ........ ' ~ .................. ~:..-; .~,,~g .i~C~ C..~ ................. / : ~" ~ , i (Description) 4. Estimated, Cost ~..~.,.O..O.L~. ....................... Fee ............................. 5. If dwel!ing, number of dwelling ,units ..... ~'. ........ Number of dwelling units on each floor .'~'/~. ~ ./-'~?" ......... Ii' garage, number of cars ..... : ................. ~ .............................................. 6. If business, commercial or mixe~ occupancy, specify nature ~d ~xtent of each type of use . .~ .............. .... t '~~r~pt. ~ ~, ~.. Rear pth ,7. D~ensmns of ex~stmg s ..... ~~ .............. De .............. Height .............. ~Nfi~eYof~.. ~. ........................... D~ensions of same structure with alterations or additions: Front ................. Rear ............ ' ...... Depth .................... L. HeiSt ...................... Number of Stories ...................... ,8. Dimensions of entire new constmctmn: Front ....... Rear ............... De ............... Height ............... N~mber of Stories ............ t ........................................... 9. Size ofllot: Front . ~ ~ .O .... [ ........... Re~.. ~.~ ................ D~pth 10. Date of Purchase .... ~O/. ~ ...... 7.f ............... ........ Name of Fomer Owner/ ~ ~ ~ ~O~ ....... ~1 1. Zone or use district in which pr~mises are situated ........................ 12.~ Does proposed construction vi¢~t~ any zoning law, ordinance or re~lation: ../M~ ......................... 13. Will lot be regraded ...... /~n~,~ ............. Will excess fill be removed from premises: ~Yes No 14. Nme of Owner of premises .~.~["]..~.~.~.O~dd~,~ .... N~e of Architect .......... [ ................. Address ........ ~ .... '~... Phone No. ~. · .~. ¢~. Nme of Contractor .. ~ ~. ~ ~ ............. Address ................... Phone No ............ ~.. PLOT DIAGRAM Locate 61early and distinctly alll buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block humber or description according to deed, and show street names and indicate whether interior or corner lot. COUNTY OF.. ual sign'ing contract) above named. He is the .. ........... of said ow0er or owners, and is du application~ that all statements conl Lo't" I ...,S ~ ~" O ....... being duly sworn, deposes and says that he is the applicant (Contractor, agent, corporate officer, etc.) y authorized to perform or have performed the said work and to make and file this ained in this application are true to the best of his knowledge and belief; and that the work will be performed in the mannSr set forth in the application filed therewith. Sworn to before me this .... : ....... ..... ,, ...... ....... .... ,,-r ,,NV ~'. L.~T _J_A__./~ ~5. ~. ~©[7l/_..k. NN_A_ ..C_ ,.~ N.._.C. '* I NC~TL ~,.__~_.~, ~,. ~'..~ ¥ 5~ ~._ !¢¢? ..........................,