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HomeMy WebLinkAbout13600-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building .... .0.r~e...f.a.m.~..~y..d.w.e. ~.l.~.n.g.. .................... Location of Property 200 Fine Bal. & 305 Maple Rd. Southold House No. Street Hamlet County Tax Map No. 1000 Section .... 0.5. 6. .....Block ...... 9. ........ Lot ...1.8... 2. .......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... ~ 9Y....kY ......... , 19~..4. pursuant to which Building Permit No. 13600Z dated ...i~ q¥,ern, b.e..v..3.0. ............ 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 ......... .... On.e.. f ~n.i.],~, ~.~.e. ~ ~. j_.r~g ..................................................... The certificate is issued to CARLISLE E COCHRAN JR. & JOAN E. COCHRAN ................... ?o¥,;o;, ...................... of the aforesaid building. Suffolk County Department of Health Approval .... 1fi.-..S.0.-.1. 5. .5...1./..2.8.(8. 6. ................. UNDERWRITERS CERTIFICATE NO ........... .~.7.3. .09.9.5. ..... 1. / .~ .4/.8..6 ................. Flumbers certificate 8/5/85 Building Inspector Rev. 1/81 1~t~'~' NO. e~ 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) NO 13600 Z Date ~ ;30 .. Permission is hereby granted to: ....~..~...~.~.~ .................................................. .~.~~.....~.....'/.,.....LL.t...7..I ................ ~. ' Z~ ~ ~.,' . at premises located at County Tax Map No, lO00 Section .... .(~...~,,',,~, ........ Block ........ ~ .......... Lot No ..... /,..~;..~... pu.uant tO application dated ..~.~......~t...-~ ................ , 19.~..~.., and approved by the Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1~02 APPLICATION FOR CERTIFI'CATE OF OCCUPANCY / Instructions A, This application must be filled in typewriter OR ink, and submitted ~lmmm~ 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. B, 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 $ :[ 5.0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 / Date...~ ./~? .~¥.~, .............. New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property . .~..~.fl~,. ~./..~./.~,. House No. Street Hem/et Owner or Owners of Property .~.~.~.//.~....~... ,~..~.~.~..~.~...~-...~..~.-~.~.~./.~..~....~.~. ¢..4(.~f~...~T ...... County Tax Map No. 1000 Section ....'~..~. ........ Block ...M .......... Lot..../?.; ,.~. ...... Subdivision ....,~..L/~. ?. ........................ Filed Map No ........... Lot No .............. Permit No./.~, .~..¢~..~... Date of Permit .~.//.~.z2/~.?.Applicant...~.~5'. ~/~.~ ..................... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $....~.t ~ ................... Construction on above described building and permit me,,~ll appticable~odes and regulations. Applicant .... ~~~ ....................... Rev. 10-10,78 THE NEW YORK BOARD OF FIRE UNDERWRITERS 1001071 BUREAU OF ELECTRICITY ~ 8S JOHN STREET, NEW YORK, NEW YORK 10038 Date ~ .L~ ~ ~ ~ ,'~-'"~ ~,,~,,o.~o.o.~,,~ ~o~/~ N 730995 THIS CERTIFIES THAT only the electdcal equipment as described below ar~ introduced by the applicant named on the able application number in the premises of .... ' . ~/~ Pine ~d,~ was examined on ~]';~)'~,t;~).~ ~ ~ ,[ ¢~ ~ ~j and found to be in compliance with tile requirements of this Board, OUTLETSFIXTURE SWITCHES FIXTURES RANGES OVENS DISH WASHERS EXHAUST FLUORESCENT DRYERS FURNACE FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATER DIMMERS SYSTEMS NO. OF SERVICE DISCONNECT OTHER APPARATUS: S E NO. OF CC COND, A. W O PER ,e' OF CC, COND :l R V I ~ C NO. OF HI-LEG OF HbLEG E NO. OFNEUTRAL$ 0E NEUTRAL J. L971. GENEI~AL MANAGER This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credefitibls. COPY )F BUILDING DEPA lENT. THi~ OF, ) IN ANY MANNER. TOWN OF $OUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Permit No. /3~O~ (please print) - (pleaSe print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber' s signature) Sworn to before me this ~_~ day of \~J~-~ · Notary Public, NOTARY PUBLIC, State of New York N(~. 4~,95~50 Qualified ir) Suffo~ Co~,nty Commission Exp~rc~ ~1¢4oh 30, 19~.~' County Notary Pubic FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS: '%, -T t... I,., , C),c ,,7 .v LLI ': , '!. · LiJ 'FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL,: 765-1803 Approved ?...t?n~...~l..[~...'..~q. 19. Disapproved a/c ..................................... Received ........... ~ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .....///.'.~.? .......... 19 .~.!( INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation· c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such per~.it shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary in ....../~ ~~© ~ .~. ~.~e: .................. (Signature of applicant, or name, if a corporation) · ~9.x....~$....~.o...~.¥e~., x ~.7.../. ~. 7.7. / ..... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· ...... ................................................................................ Name of owner of premises . .~?..~/('.-5~...E......~.o. ~.~.F.~ ./2...-~...~...... ~ .ri.4..' . .~..o?..~....~.:.. (as on the 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 ...... .~./-~ ............... Plumber's License No.. ~..~..~..~..~...~.~'...~.../~. Electrician's License No.../..~. ~..'~.'.. ~ ....... Other Trade's License No .......... :~. .......... 1. Location of land on which proposed work will be done .................................................. · .... ................. ./.d. ............ :. House Number Street Hamlet County Tax Map No. I000 Section .~. fi// .............. Block . .~..' .............. 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 ..................................................................... b. Intended use and occupancy .......... ............ . ......... 10. 11. 12. 13. 14. Locate clearly and distinctly ali property lines. Give street and block interior or corner lot,. Nature of work (check which ap lieable): New Building ...... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition ............ Other Work ............... ; -~ ~ (Description) Esti~/iCed!Cos~;*.t~.. ?./ ...o?~., ..... i ......................... Fee ..................................... I *" (to be paid on filing this application) Ifd elli fdwelli g~ / N fd lli hr w ng, numbero n nits ............... umbero we ngunitsoneac oor ................ If garage number of cars - , If business, commercial or m~xed occupancy, specify natt~re and extent of each'type of use . ~ .............. Dimensions of existing structures if any: Front - Rear w.-7' Depth ' -- Height-,-- ............. Number of Stories..': .-'TT. ................................................... r)imensions of same structure wlth alterations or additions: Front ...--tx ............ Rear --" . . . Depth .... --.'2' .............. !.. Height ., .~.-. ................. Number of Stones..-.'-:. ...... } .......... Dimensions of entire new construction: Front .~.8. t.... Rear ..~Z[ '. .......... Depth .~.~. ........... Height .............. ., Number of Stories ii i//~ .... iiI ii ....... ii ................... y ............ Size of lot: Front ...~..~,} .~., ./..,. ........ Rear....~..o~. ............... Depth . ./.~.O.: .cZ. ............. Date of Purchase .... zf,/.,-~/.F.~. ............... Name of Former Owner . ./~..t2.~.OC-Z',~ .... ~'~..~. .......... or use district in which pr~mises-- are situated.., fi}.../,](tel~-q.Z-.T'.O.le.~..C...~. ~...~../.~.~..x(C/.4f.~. .............. Zone Does proposed construction violate-- any zoning law, ordinance or regulation: ..~..~ ........................... Will lot be regraded ., ./~/,0., ~,.~¢~,., g' },, '~'~tt/~,~ '-.~' · · Will excess fill be removed from premises: Yes Name of Owner of remises ;x~g~ ~- ~..c/(4~.~.Address /5~ o~/ jo~rh'~_i~ Ph No ? ~' //~ P · · , .................... t .......... one ................ Name of Architect .......... i ................. Address ................... Phone No ................ Name of Contractor" Address Phone No PLOT DIAGRAM buildings, whether existing or proposed, and, indicate all set-back dimensions from number or description according to deed, and show street names and indicate whether STATE OF NEW YORK, COUNTY OF ......... ........ ,IS'S i .................................................. being duly sworn, deposes and says that he is the applicant ' (Name of individual sign!ns 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 ail statements conthined 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 Nor^RY PUBLIC, State of Ne[v fork .................. No. 4707878, 8t*ff0[k-O0ml~[ ~ (Signature of applicant) i ] Term Expires March 30, 192~,~ :J Z.-r 0 : " v(r~ESl O. ~-'-IC~)- O~ Z 0 8 (; '7 c n c~ m, u < > r~ ~