HomeMy WebLinkAbout13612-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. Z~357~ Date July ~ ., 19~.5.
THIS CERTIFIES that the building one-family dwelling.
Location of Property . .2.9.5 ............ .O.e.d...~?.m...R.o.8. d. ........... O..~.~.e.n.~. ............
House/Vo. Street Ham/et
County Tax Map No. 1000 Section 25 ..... Block 5 .Lot 6
Subdivision x ...Filed Map No. x .Lot No. ~z
conforms substantially to the Application for Building Permit heretofore ~ed in this office dated
November 30 19¢.~. . pursuant to which Building Permit No. 'q 36~ 2Z
dated ....D?.q~.m..b.e.~..~. ............. 19 .~.g., 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 .........
...... 4..o.n.~.~..<m~.:r..~*..~¢5~.- ................................................
The certificate is issued to .... ROLLIE ~ LAURA KENNEDY
................. ?o;,;.'o;,'~ .....................
of the aforesaid building.
Suffolk County Department of Health Approval ......... ~/4..-.S.Q'r2. ~./4. ......................
UNDERWRITERS CERTIFICATE NO .................. ~.. .6 9.6.'1.'J. .6 ........................
Building Inspector
Rev. 1/81
TO~VFI OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOI-D, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
NB 13612 Z
Permission is hereby granted to: ,, , , ~ t ,
.........................
.....................................
at premises located at ....~.....O...~.........~...-,c~),.........~...~.........~......, ....... .~~ ....................
County Tax Map No. 1000 Section .....(~....'~.....~.. ...... Block ....... ~ ........ Lot No ..... ~ ...............
pursuant to application dated .... ...~..~~....~r...~.. ........... , 19.?..~.., and approved by the
Building Inspector.
Fee $..~.,?....~...~..~,, ?.....
Rev. 6/30/80
FORM NO. 6
TOWN OF SOUTHOLD
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
naturat 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.
§.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'f_
land uses:
1. Accurate survey of peoperty showing ali property lines, streets, buildings and unusum 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/ landuse--[~t*e-]~×±st,±n~; C.O. $15.00
3. Copy of certificate of occupancy $1.00 '¢acanf, la,ct C.O. $ 5.00
Date .~ .~.~..r.~..~.~../S.~.~..- ....
New Building ..~; Old or Pre-existing BuiMing Vacant Land
Location of Property ............
House No. Street Hem/et
County Tax Map No 1000Section O~.~.. Block .,~.~ .... Lot...(~° ....
/3~/& ~--~ mitlgJ~ ]?.~! Applicant
Pe mit N- D of Pe
Health Dept. Approval .~..%~(~). ~ .~..-~..z-] App
............ Labor Dept. reval ........................
Underwriters Approval .~.. ~.°~..~0.\~. ·~. ........... Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .......................
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southoid, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
This application must be filled in typewriter OR ink, and submitted i9 duplicate to the Building Inspec-
tor with the following; for new buitdings or new use: '.~'~
1, Final survey of propertv with accurate location of all building~ p~operty Jines, streets, and unusual
natural or topograph ic featu res. ,,
2. F nal approval of Health Dept. of water supply and sewerage disC)ca,I--(S-9 form or equal).
3. Approval of e{ectrical installation from Board of Fire Underwr ters.
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 peoperty 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 )remises, or other pertinent informa-
tion required to prepare a certificate.
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or land use
3. Copy of certificate of occupancy $1 .-00
$5.00
New Building ...... ~5-~ Old or Pre-existing Bui[d[n,,~ Vacant Land
Location of Proparty Orchard Street and Old Farm Road~ Or±ent
House No. Street Hamlet
Owner or Owners of Property .Pe.~er Blank, ,Jr. and Mary Louise.l~.lAr~ ....
County Ta× Map No. I000 Section 025 81ock 05 lot. 006
Subdivision..Map ,o.f B .ayy. i.e.~..F.a.~.m. ......... F .ed Map No..7..0..4.5 ..... Lot No...~.(~ ...... :..
Permit No ........... Date of Permit .......... Applicant ..................................
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ....................... Planning Board Approval ....................
Request for Temporary Certificate ..................... Final Certificate .... .~.~ ............
Fee Submitted $....~.5...0.0. ....................
Construction on above described building and permitjs~eet.~J~p_ ii~od~e~g.!at, ions.
Applicant . ..~~~ -~. ;~.~.' ........ -~. ;~ .............
R~. lo-10-7s Wilt iam H ' , r., t~orney/agent
~ ~y~7~ ~¢~ Peter Blank, Jr. and Mary Louise Blank
L .o. Z
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL. 765-1802
CERTIFICATION
(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 signa
Sworn to before me this
~__day of ~d~ ,
19 f~f ·
Notary Public,~~ County
'Nota
zooo12i THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
~-Tr~ 85 JOHN STREET, NEW YORK, NEW yORK 10038
~ate J~ i~ i9~ ~,~,,licationNo..,,fi,e 3~3~7~/~ N 696116
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of
Rollle & Lavx,a Kennedy, 205 Old Fmrm Road, O~lent, N,Y.
was examined on 'JC~.e l0 ~' ~985 aad found to be in compliance with the r~qulrements of this Board.
F,X?UEE FIXTURES RANGES OVENS EXHAUST FANS
41.
50 39 41
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS
TIME CLOCK~, UNIT HEATERS MULTI-OUTLET DIMMERS
SYSTEMS
NO. OF FEET
SERVICE DISCONNECT
OTHER APPARATUS:
1~.5 Ton A/C Unit
3 .G.F.C.I. 1-Smoke Detecto~
S E R V I '
NO OF CC COND, A W.O. NO OF HI-LEG
C E
OF HI-tEG
NO OF NEUTRAl
1
OF NEUTRAL
2/0
Town Hazt~or Lane
SOuthold~ N.Y. 11971 Lic. 282
This certificate must not be altered in ~ny manner; return to the office of the Board if incorrect. Inspectors may be identified by their ~als.
COPY FOR B~[LD NG DEPARTMENT. THIS'COPY OF IN ANY MANNER.
FIELD INSI~ECTION
COMMENTS
FOUNDATION ( 1 st)
FOUNDATION (2nd)
ROUGH
FRAME &
FLUMBING
oA~
INSULATION PER N.
STATE ENERGY
q?DE
Ye
FINAL
ADDITIONAL COMMENTS:
¢4'
' · ~n ., . '~
FOEM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Exa rain ed .. J~...~...~..~...~. ........... , 19.~..~...
hpproved~.~...~...q....~.~.. .......... , 19.~.,,L]... Permit No....,}...~..~...]..G.......~.. ........
Disapproved a/c ............................................................................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Application No .................................
OLDG. DEPT.
TOWN OF SOUTHOLD
Dote November 28, 19...~..~. ......
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted in triplicate 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 o,
areas, and giving a detailed description of layout ofproperty mast be drawn on the diagram which is part of this application.
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 issue 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 i~ buildings for necesso~ inspections.
.................
(Signature of applicant, or name, if a cor~n)
....................
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engin..eer general contractor, electrician, plumber or builder.
Owner
Name of owner of nrem ses Hr. amd Mrs. ~e~ned~
If applicant is a corporate, 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 ............................................... S u b d i v i s ia n
1. Location of land.on .which proposed work will be done. Map No.: ........................................ Lot No 16
.........................
Street and Nu .... .0..Z.~...P.~..m..~..o..~..cl.. .....................................................................................................................
Municipality
2. State existing use and occupancy of premises and intended use end occupancy of proposed construction:
a. Exisiting use and occupancy ...................................................................... ~ .........................................................
b. Intended use and occupancy ~.e...~...c$...w.e..~.~...:)...~, .(~D.g ,¢'.~.~-~ house
oou , ooo o z5 5- ,q 6.
3. Nature of work (check wh ch applicable): New Building.....~. ........... Addition .................. Alteration .................
Repair .................. Removal .................. Demolition .................... Other Work ................................................ .
~ (Description)
4. Estimated Cost $ 95,000
[ (to be paid on filing this application)
5. If dwelling, number of dwel,ling units ............................ Number of dwelling units on each floor ............................
If garage, number of cars .........................
6. If business, commercial ori mixed occupancy, specify nature and extent of each type of use ............................
?;~: !' {D'i~/~i~iqns of ~e~ist~ihg. stFuctbres, if any: Front ............................ Rear ................................ D~pth ....................
! "Height ........................ t Number of Stories
Dirr~ise~ll~e structuCe with alterations or additions: Front .................................... Rear ............................
Depth ................................ iHeight ............................ Number of Stories ................................
8. Dimensions of entire new c~nstruchon: Front .................................... Rear ............................ Depth ........................
Height .................... Number of Stories ......................................................................................................................
9. Size of lot: Front ...............; ......................................... Rear .......................................... Depth ................................
10. Date of Purchase ............... I ........................................ Name of Former Owner ........................................................
11. Zone or use district in which premises are situated .....................................................................................................
12. Does proposed construction ~iolate any zoning law, ordinance or regulation: ........................................................
13. Will lot be regraded . ........... I ............... Will excess fill be removed from premises: ( ) Yes ( ) No
Name of Architect ............ , ............................................. Address ................................ Phone No .......................
PLOT DIAGRAM
Locate clearly and distinctly ~ll buildings, whether existing or proposed, and indicate oil set-beak dimensions from
property lines. Give street and b.lock number or description according to deed, and show street names and indicate
whether interior or corner lot.
.~t:~~~ ~..-..being duly sworn, deposes and says that he is the opplicam
/ (Nomo of individuol
obovo homed.
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 m~ke and file
this application; that all st~temefits contained in this application are true to the best of his knowledge and belief; and
thor the work will be performed injthe manner set fodh in the application filed therewith.
Sworn to befone me this ~ j -- ~ . '
Not~w Pu~~~~ .............. Coun~ ~~....~.... ~...~..~.~..~ .....................