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HomeMy WebLinkAbout13584-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z'138'10 Date August 30 .................................................. 19~. THIS CERTIFIES that the building new dwelling. Location of Property .... 59.6.©. ............... North Rd. Greenport House No. Street Hamlet County Tax Map No. 1000 Section ..... ~ ..... Block ........ .3. .....Lot ..... 3. ....... Subdivision..~.q~.d..~g.~..~. 97.e.~. .............. Filed Map No.. ~.~./2t. 7..Lot No ....... 3. ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ... ~.o.v.~rg~.e.~.. 5 ...... ,19 ~.~. pursuant to which Building Permit No ....... ~.3.5. 0~.g. ....... dated .... ~.o.v. ~$b.e.z:. 27 ........... 19 .S.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 ......... .... ~ev:. On~-:f~,~-y. R~e~,~.~, ............................................... The certificate is issued to ........... ~T.O~..1~),17 .E.~..Q ............................... (owner, ~ of the aforesaid building. SuffolkCo tyD tm tofHealthAppr al fl~-S0-222 un epar en ov ................. . ......................... N6935~ 3 UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 I~OB,~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. ¥. BUILDING PERMIT (THIS PEP-d~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~- 13584 Z Permission is hereby granted to: ........ .___F.~.... ........ a~....,:~..x.~ ............ =....~zz~......v.....~./~...-..z,z.:.~......./../.?¢~ -- ,~/_, ~/..//~, .. ,o ..... .~.~.2-E~..~......~..~.......~..,~. ....... ~......~ ................ ~. .............. Co~n~ To~ Mop No. ~000 S*~.on .~.~ ...... ~o~k ..0...~ ........... Lot No..00..~.. ......... Building Inspector. ~e, ~./...ZZ.. .......... Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall ,~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted~pl[c;~; to ti 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 natura~ 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 br 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 peopertv showing all propertv 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 land use --?re-B×±st±ng C. 0. $15 · 00 3. Copy of certificate of occupancy $1.00 Vacant land C.0. $ 5.00 Date~. ~ ...... New Building .. ~ ...... Old or Pre-exi~ing Building ........... ~ Vacant Land ............. Location of Property ~ ............ ~~ ~~ Street Owner or Owners of Property ;' · .....~ ~ .~ ............... CountyTax Map No. 100~ S,c~ 0,~ ..... Block ~~ .... Lot:...~ .......... Subdivision~..( .~~. ~,..Filed Map No. 5~..Lot ,o..~.......... Perm it No. ~Z~. Z~ ate of Permit q/X~l~.~.Appl:cant ~,~ .~ ~~ ........ Health Dept Approval ~ ~' ~ ~ ~ff ~C~abor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Tempor~ Cer,tificate ..................... Final Certificate ...... ~ ......... Fee Submitted .~...~) 0 ~'~'-J Construction dn above described building and, j~ermit meets all a~pplicable codes and recitations. ........ THE NEW YORK BOARD OF FIRE UNDERWRITERS 1001071 BUREAU OF ELECTRICITY THIS CERTIFIES THAT Joe MazzeferrO, P~te 48 3/S E/ of [V~qnhasset i Blk,, G~eenport, N.Y. in ~he follotvlng location; [] Basemen~ [] 1st ~?. ~ 2~d FI. Section ~lock Lot ~ ~.,.~.od o. Hay 20, 1985 and found to be in compliance wlth the r~quirements of this Board. FIXTURE OUTLETE DRYBRS SWITCHES 34 FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS FLUORESCENT OTHER APPARATUS: l~GFCI 1-Smoke Detector. S E R NO. ~CC~.COND, OF CC, COND 2/0 C A W, G, NO OF NEUTRAt5 OF HI-LEG 1 G & S Electric Box 215 : Southold~ N.Y. 11971 Lie. 578 Per-- ~..~ This certificate must not be altered in any manner; return to the office of the Board if ~ncorrect. Inspectors may be identified by their credential COP~YfO. a~J LDIN(~ DEPARTME.T. TH S COPYO~CE.[ F[~5~T~TA~ ~E~D L" A.V ~A..~R TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Permit No.~ Owner~(p~lease~/?nt~) ~--/'~f '"'~/~ p~fl Plumber E~ ..~"C_A / //~/~ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this ~_~ O day of Notary Public, q~/~ County ~n ~/0 2/o Z FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N. STATE ENERGY ODE FINAL COMMENTS ADDITIONAL COMMENTS: 76S-1802 BUILDING DEPT, INSPECTION- [ ] FOUNDATION IST [ ] ROUGH PLBG. [,.,T/FOUNDATION :)ND [ ] INsuLATiON [ ] FRAMING REMARKS: DATE FINAL ' FORM NO. 1 ToWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c .... i . . . .~-----.. .... '.~ ........... ./ff. ...... (13~ilding Inspector) APPLICATION FOR BUILDING PERMIT BLDG. DEPT. TOW ,pF SOUmO,LO Received ........... ,19... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, ~ith 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/'Fegulations, and to admit authorized inspectors on premises and in building for neces~.~. ~.~ --/~'SienatuYe o f ~ppli~~~;ia't;~) .... .... ~' "" .~'~ .... t ...... xv.p .? ..,-~:~- ......t (Mailing address of applicant) State wh~her applicant is owner, lessee, agent, architect, engineer, general, contractor, electrician, plumber or builder. ... .......... : ....... ........................................ Name of owner of premises ~...<~..~P~.~~ .................................... .~/ .... I/(~ or~e tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... PlumbersLicenseNo.~ ./~..~...~... Electrician's License No. Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................... .... . . ............. . . , ' , . .............. House Number Street Hamlet County Tax Map No. 1000 Section ....... 3 ~.-~. · .... Block ..... 3 ........... Lot... ~ .~. .......... 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 ............. .".. ? ~ ~. :.., ...................................... h, Intended use and occupancy ....... / .... ~.~JA(./~/~.. ~o ........ 3. Nature. of work (check which apiplicable): New Building ...... Addition .......... Alteration .......... Repair"~"'~':8~ltlC '~ .... RemOval .............. Demohti' '"'on ............ Other Work ............... 4. ,Est~a~tod Cost ............... , ........... Fee ....................... ,. : , ' ' ~- (to be paid on filing this application) 5. ¥~ d~elling, number of dwelling Bnits ............... Number o f dwelling units on each floor ................ If garage, number of ca~ ..... ~ ................................................................ .... 6. If business, commercial or mixefl occupancy, specify nature and extent of each type of use ..................... 7. D~ensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............ :.. Number of Sto~es ........................................................ D~ensions of same structure w~th alterations or additions: Front ................. Rear .................. Depth .................... ~.. HeiSt ...................... Number of Stohes ...................... 8. D~ensions of entire new construction: Front ............... Rear ............... Depth ............... HeiSt ............... Number of Sto~es ........................................ ................ ........ ........ ....... ............. ..... ............ ........................ :. . ... ... .. .......... ~0. o~ eu~ ~.~¢.~ ~,mo of Fo~, Ow,~ 11. Zone ~r use district in whick p~mises--/are situated .............................. ~ .................... 12; Does proposed construction violate any zoning law, ordinance or regulation: ........ ~ .................... 13. Wffi lot be regraded ...... ~ ~ .... ~ ......... .~... Will excess fill be r~o~d.from premises: Yes No 14. Nmne of Owner of pre¢ise~~~ddross . ~3.~.~ 2~x.~:. Phone No..~g~.~ [XO .~ ...... ,., ....... PLOT DIAGRAM Locate :cle~ly ~d dist~ctlg ~! bufld~gs, whe~er exist~g or proposed, and, indicate ~1 set-back d~ansions from prope~y fines. Give street ~d block~number or descdpfion accord~g to deed, ~d show stmet nmos and indicate whether interior or Corner lot. STATE OF NEW YORK, S.S COUNTY OF ................. j ~ being duly sworn deposes and says that he is the applicant (Name of individual sigoing contract) above named. He is the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performe~l'the said work and to make and file this application"~ ;' that all statements conlained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........ ;....3'7.'..C~. ....... day o.f .... .~ .s~tnMZ'7... .........19 ~.~ N0tary Public,. ' NOTARY PUBLIC, State ol New York ~' ..... ~<". ] .(~.3~,~ .~...~.,~'~'..~~..~ ..... No. 47Q7878, Suffolk Cbunt~.,,~,.,~ ' / ] "~/ ~ ~,~t/Sigt{ature of applicant) i[~m,~xD(es March 30J l~t ~ // / -